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Disclosing your feelings may help the course of rheumatoid arthritis: results from a randomized clinical trial.

16 June 2009 Journal of Psychotherapy and Psychosomatics

The health and physiological effects of an intervention which facilitates the opening of feelings are described in a paper published in the current issue of Psychotherapy and Psychosomatics.

The efficacy of emotional disclosure in alleviating psychological and physical stress has been well documented in controlled laboratory studies. A next step is to evaluate its clinical utility in 'real world' settings. A group of Dutch investigators adapted the emotional disclosure intervention for use in home-based settings by stimulating the suggested effective ingredients of cognitive-emotional processing, and evaluated its psychological and clinical effectiveness.

Reviews indicated the need to examine the physiological changes brought about by emotional disclosure, which may be particularly relevant in immune-mediated diseases. This study was the first to examine neuroendocrine and immune changes after emotional disclosure in patients with rheumatoid arthritis. Sixty-eight patients were randomly assigned to four weekly oral emotional disclosure or time management sessions.

At baseline and 1 week and 3 months after the sessions, depressed and cheerful mood, joint scores, erythrocyte sedimentation rate, cortisol, noradrenaline, interleukin-6 (IL-6), interferon- (IFN- ), and IL-10 were evaluated. Repeated measures analyses of variance were performed. At the end of the investigation, no effect on psychological well-being and clinical outcome was found (p 0.10). Cortisol (p = 0.01) and the serum level of the pro-inflammatory cytokine IFN- (p = 0.05) were differentially affected by the two conditions.

The change of IL-6 nearly reached significance (p = 0.07). The physiological changes are in agreement with theories on the mechanisms underlying emotional disclosure benefits and are suggestive of better disease control after emotional disclosure. General and study-specific reasons for the absence of psychological and clinical effects are discussed. The findings warn against widespread implementation of this home-based emotional disclosure intervention in unselected rheumatoid arthritis samples.

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