Effectiveness in the Long-Term Follow-Up of Brief Group Psychoanalytic Psychotherapy in Quality of Life, Symptoms, Coping, Anxiety, and Depression in Systemic Lupus Erythematosus Patients
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Abstract
Objective: To evaluate the effectiveness in the long-term follow-up of brief group psychoanalytic psychotherapy in improving quality of life, symptoms, coping strategies, anxiety, and depression levels in systemic lupus erythematosus (SLE) patients.
Methods: Prospective, randomized clinical trial including 80 SLE patients divided into two groups: therapy (n=37) and control (n=43), with standard clinical care. Therapy group received weekly therapy for 20 weeks. The assessments were at baseline, after 20 weeks and after 24 months from the end of intervention. Damage and disease activity were assessed by rheumatologists. Self-administered questionnaires were supervised by blind evaluators: quality of life, symptoms, coping strategies, anxiety, and depression. Intent to treat statistical analysis. Comparisons of variance between groups over time (ANOVA repeated measures). P <0.05 significant.
Results: At baseline, both groups were homogeneous. After intervention, therapy group showed significant improvement in most domains of quality of life, symptoms, all domains of anxiety, and depression and several domains of coping strategies. Benefits in quality of life and coping remained at 24 months follow-up. However, the improvement in anxiety, and depression was not maintained. Medications and clinical variables did not change.
Conclusion: This study showed the effectiveness of brief group psychoanalytic psychotherapy in improving quality of life, symptoms and coping strategies in SLE patients even in the long-term follow-up. Depression and anxiety levels reduced at the end of therapy, although, the improvement did not last 24 months.
Keywords:
clinical trial, coping strategies, long-term follow-up, psychoanalytic psychotherapy, quality of life, systemic lupus erythematosus
Article Details
How to Cite
CONCEIÇÃO, Céu Tristão Martins et al.
Effectiveness in the Long-Term Follow-Up of Brief Group Psychoanalytic Psychotherapy in Quality of Life, Symptoms, Coping, Anxiety, and Depression in Systemic Lupus Erythematosus Patients.
Medical Research Archives, [S.l.], v. 12, n. 2, feb. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5003>. Date accessed: 21 nov. 2024.
doi: https://doi.org/10.18103/mra.v12i2.5003.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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doi: 10.1007/s10067-010-1509-0
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doi: 10.1177/0961203313477227
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23. Liang H, Tian X, Cao LY, Chen YY, Wang CM. Effect of psychological intervention on health-related quality of life in people with systemic lupus erythematosus: A systemic review. Int J Nurs Sciences. 2014;1:298-305.
doi: 10.1016/j.ijnss.2014.07.008
24. Zhang J, Wei W, Wang CM. Effects of psychological interventions for patients with systemic lupus erythematosus: a systematic review and meta-analysis. Lupus. 2012;21:1077-1087. doi: 10.1177/0961203312447667
25. Dobkin PL, Da Costa D, Joseph L, et al. Counterbalancing patient demands with evidence: results from a pan-Canadian randomized clinical trial of brief supportive-expressive group psychotherapy for women with systemic lupus erythematosus. Ann Behav Med. 2002:24:88-99. doi: 10.1207/S15324796ABM2402_05
26. Edworthy SM, Dobkin PL, Clarke AE, et al. Group psychotherapy reduces illness intrusiveness in systemic lupus erythematosus. J Rheumatol. 2003;30:1011-1016.
27. Greco CM, Rudy TE, Manzi S. Effects of a stress-reduction program on psychological function, pain, and physical function of systemic lupus erythematosus patients: a randomized controlled trial. Arthritis Rheum. 2004;51:625-634. doi: 10.1002/art.20533
28. Karlson EW, Liang MH, Eaton H, Huang J, Fitzgerald L. A randomized clinical trial of a psychoeducational intervention to improve outcomes in systemic lupus erythematosus. Arthritis Rheum. 2004;50:1832-1841.
doi: 10.1002/art.20279
29. Haupt M, Millen S, Jänner M, Falagan D, Fischer-Betz R, Schneider M. Improvement of coping abilities in patients with systemic lupus erythematosus: a prospective study. Ann Rheum Dis. 2005;64:1618-1623.
doi: 10.1136/ard.2004.029926
30. Navarrete-Navarrete N, Peralta-Ramírez MI, Sabio-Sánchez JM, et al. Efficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erithematosus: a randomized controlled trial. Psychother Psychosom. 2010;79:107-115.
doi: 10.1159/000276370
31. Conceição CTM, Meinão IM, Bombana JA, Sato EI. Psychoanalytic psychotherapy improves the quality of life, depression, anxiety and coping in patients with systemic lupus erythematosus: a controlled randomized clinical trial. Advances Rheumatol. 2019;59:1-10.
doi: 10.1186/s42358-019-0047-y
32. Marty P. La psychosomatique de l’adulte. 7th ed. Paris: Puf; 2011.
33. Bombana JA, Abud CC, Prado RA. Assistance and teaching of psychotherapy at the program of treatment and studies of somatization (PAES, UNIFESP). Rev Bras Psicot. 2012:14:34-48.
34. Luborsky L. Principles of psychoanalytic psychotherapy: a manual for supportive-expressive treatment. 1st ed. New York: Basic Books; 1984.
35. Sifneos PE. Short term dynamic psychotherapy. Evaluation and technique. 2nd ed. New York: Plenum; 1987.
36. Blay SL, Fucks JSV, Barruzi M, et al. Effectiveness of time-limited psychotherapy for minor psychiatric disorders. Br J Psychiatry. 2002;180:416-422. doi: 10.1192/bjp.180.5.416
37. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.
doi: 10.1002/art.1780400928
38. Jannuzzi PM, Baeninger R. Qualificação socioeconômica e demográfica das classes da escala Abipeme. Rev Administ. 1996;31:82-90.
39. Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/ American College of Rheumatology damage index for Systemic Lupus Erythematosus. Arthritis Rheum. 1996;39:363-369. doi: 10.1002/art. 1780390303
40. Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI – A disease activity index for lupus patients. Arthritis Rheum. 1992;35:630-640. doi: 10.1002/art. 1780350606
41. Freire EAM, Bruscato A, Ciconelli RM, Leite DRC, Sousa TTS. Translation into Brazilian Portuguese, cultural adaptation and validation of the systemic lupus erythematosus quality of life questionnaire (SLEQOL). Acta Rheumatol Port. 2010;35:334-339.
42. Leong KP, Kong KO, Thong BYH, et al. Development and preliminary validation of systemic lupus erythematosus-specific quality-of-life instrument (SLEQOL). Rheumatology. 2005;44:1267-1276.
doi: 10.1093/rheumatology/keh605
43. Grootscholten C, Ligtenberg G, Derksen RH, et al. Health-related quality of life in patients with systemic lupus erythematosus: development and validation of a lupus specific symptom checklist. Qual Life Res. 2003;12:635-644. doi: 10.1023/ a:1025176407776
44. Savoia MG, Santana PR, Mejias NP. The adaptation of coping strategies inventory by Folkman and Lazarus in Portuguese. Rev Psicol USP. 1996;7:183-201.
45. Folkman S, Lazarus RS. If it changes it must be a process: a study of emotion and coping during three stages of a college examination. J Pers Soc Psychol. 1985;48:150-170. doi: 10.1037//0022-3514.48.1.150
46. Botega NJ, Bio MR, Zomignani MA, Garcia Jr C, Pereira WAB. Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD. Rev Saude Public. 1995;29:355-363. doi: 10.1590/s0034-89101 995000500004
47. Zigmond AS, Sanaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-370. doi: 10.1111/j.1600-0447.1983.tb09716.x
2. Hinojosa-Azaola A, Sánchez-Guerrero J. Overview and clinical presentation. In: Wallace DJ, B.H. Hahn BH, editors. Dubois’ Lupus Erythematosus and Related Syndromes. Philadelphia: Elsevier Saunders; 2013.p.304-309. doi: 10.1016/B978-0-323-47927-1.00032-3
3. Hanly JG, Omisade A, Fisk JD. Psychopathology, neurodiagnostic testing, and imaging. In: Wallace DJ, Hahn BH, editors. Dubois’ Lupus Erythematosus and Related Syndromes. Philadelphia: Elsevier Saunders; 2013.p.382-392. doi: 10.1016/B978-1-4377-1893-5.00030-3
4. McEwen BS. Neurobiological and systemic effects of chronic stress. Chronic Stress. 2017;1:1-11. doi: 10.1177/2470547017692328
5. Stojanovich L, Marisavljevich D. Stress as a trigger of autoimmune disease. Autoimmun Rev. 2008;7:209-213.
doi: 10.1016/j.autrev.2007.11.007
6. Pawlak CR, Witte T, Heiken H, et al. Flares in patients with systemic lupus erythematosus are associated with daily psychological stress. Psychother Psychosom. 2003;72:159-165. doi: 10.1159/000069735
7. Roussou E, Iacovou C, Weerakoon A, Ahmed K. Stress as a trigger of disease flares in SLE. Rheumatol Int. 2013;33:1367-1370.
doi: 10.1007/s00296-011-2292-1
8. Cohen WS, Roberts WN, Levenson JL. Psychiatric aspects of systemic lupus erythematosus. In: Lahita RG, editor. Systemic Lupus Erythematosus. New York: Elsevier Saunders; 2004.p.785-825. doi: 10.1007/978-3-319-56782-2_578-2
9. Robinson DJ, Aguilar D, Schoenwetter M, et al. Impact of systemic lupus erythematosus on health, family, and work: The patient perspective. Arthritis Care Res. 2010;62:266-273.
Doi: 10.1002/acr.20077
10. Archenholtz B, Burckhardt CS, Segesten K. Quality of life of women with systemic lupus erythematosus or rheumatoid arthritis: domains of importance and dissatisfaction. Qual Life Res. 1999;8:411-416. doi: 10.1023/A:1008915115370
11. Kulczycka L, Sysa-Jedrzejowska A, Robak E. Quality of life and satisfaction with life in SLE patients-the importance of clinical manifestations. Clin Rheumatol. 2010;29:991-997.
doi: 10.1007/s10067-010-1509-0
12. Thumboo J, Strand V. Health-related quality of life in patients with systemic lupus erythematosus: an update. Ann Acad Med Singap. 2007;36:115-122.
13. Cavicchia R, Borba Neto E, Guedes LKN, Vianna DL. Quality of life in patients with systemic lupus erythematosus. J Health Sci Inst. 2013;31:88-92.
14. Chaigne B, Finckh A, Alpizar-Rodriguez D, Courvoisier C, Ribi C, Chizzolini C. Differential impact of systemic lupus erythematosus and rheumatoid arthritis on health-related quality of life. Qual Life Res. 2017;26:1767-1775. doi: 10.1007/s11136-017-1534-4
15. Correa JD, Branco LGA, Calderaro DC, et al. Impact of systemic lupus erythematosus on oral health-related quality of life. Lupus. 2017;0:1-7. doi: 10.1177/0961203317719147
16. Lazarus RS, Folkman S. Stress, appraisal and coping. 1st ed. New York: Springer Publishing Company; 1984.
17. Rinaldi S, Ghisi M, Iaccarino L, et al. Influence of coping skills on health-related quality of life in patients with systemic lupus erythematosus. Arthritis Care Res. 2006;55:427-433.
doi: 10.1002/art.21993
18. Córdoba-Sanchez V, Limonero-Garcia JT. Coping and quality of life in patients with systemic lupus erythematosus: a review. Pens Psicol. 2015;11:129-139.
doi: 10.16925/pe.v11i18.1223
19. Hanly JG, Su L, Urowitz MB, et al. Mood disorders in systemic lupus erythematosus. Arthritis Rheum. 2015;67:1837-1847. doi: 10.1002/art.39111
20. Palagini L, Mosca M, Tani C, Gemignani A, Mauri M, Bombardieri S. Depression and systemic lupus erythematosus: a systematic review. Lupus. 2013;22:409-416.
doi: 10.1177/0961203313477227
21. Huang X, Magder LS, Petri M. Predictors of incident depression in systemic lupus erythematosus. J Rheumatol. 2014;41:1823-1833. doi: 10.3899/jrheum.140111
22. Martinez M, Sánchez AI, Martinez MP, Miró E. Psychological treatment in patients with systemic lupus erythematosus. A systematic review. Ter Psicol. 2016;34:167-181. doi: 10.4067/S0718-48082016000300001
23. Liang H, Tian X, Cao LY, Chen YY, Wang CM. Effect of psychological intervention on health-related quality of life in people with systemic lupus erythematosus: A systemic review. Int J Nurs Sciences. 2014;1:298-305.
doi: 10.1016/j.ijnss.2014.07.008
24. Zhang J, Wei W, Wang CM. Effects of psychological interventions for patients with systemic lupus erythematosus: a systematic review and meta-analysis. Lupus. 2012;21:1077-1087. doi: 10.1177/0961203312447667
25. Dobkin PL, Da Costa D, Joseph L, et al. Counterbalancing patient demands with evidence: results from a pan-Canadian randomized clinical trial of brief supportive-expressive group psychotherapy for women with systemic lupus erythematosus. Ann Behav Med. 2002:24:88-99. doi: 10.1207/S15324796ABM2402_05
26. Edworthy SM, Dobkin PL, Clarke AE, et al. Group psychotherapy reduces illness intrusiveness in systemic lupus erythematosus. J Rheumatol. 2003;30:1011-1016.
27. Greco CM, Rudy TE, Manzi S. Effects of a stress-reduction program on psychological function, pain, and physical function of systemic lupus erythematosus patients: a randomized controlled trial. Arthritis Rheum. 2004;51:625-634. doi: 10.1002/art.20533
28. Karlson EW, Liang MH, Eaton H, Huang J, Fitzgerald L. A randomized clinical trial of a psychoeducational intervention to improve outcomes in systemic lupus erythematosus. Arthritis Rheum. 2004;50:1832-1841.
doi: 10.1002/art.20279
29. Haupt M, Millen S, Jänner M, Falagan D, Fischer-Betz R, Schneider M. Improvement of coping abilities in patients with systemic lupus erythematosus: a prospective study. Ann Rheum Dis. 2005;64:1618-1623.
doi: 10.1136/ard.2004.029926
30. Navarrete-Navarrete N, Peralta-Ramírez MI, Sabio-Sánchez JM, et al. Efficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erithematosus: a randomized controlled trial. Psychother Psychosom. 2010;79:107-115.
doi: 10.1159/000276370
31. Conceição CTM, Meinão IM, Bombana JA, Sato EI. Psychoanalytic psychotherapy improves the quality of life, depression, anxiety and coping in patients with systemic lupus erythematosus: a controlled randomized clinical trial. Advances Rheumatol. 2019;59:1-10.
doi: 10.1186/s42358-019-0047-y
32. Marty P. La psychosomatique de l’adulte. 7th ed. Paris: Puf; 2011.
33. Bombana JA, Abud CC, Prado RA. Assistance and teaching of psychotherapy at the program of treatment and studies of somatization (PAES, UNIFESP). Rev Bras Psicot. 2012:14:34-48.
34. Luborsky L. Principles of psychoanalytic psychotherapy: a manual for supportive-expressive treatment. 1st ed. New York: Basic Books; 1984.
35. Sifneos PE. Short term dynamic psychotherapy. Evaluation and technique. 2nd ed. New York: Plenum; 1987.
36. Blay SL, Fucks JSV, Barruzi M, et al. Effectiveness of time-limited psychotherapy for minor psychiatric disorders. Br J Psychiatry. 2002;180:416-422. doi: 10.1192/bjp.180.5.416
37. Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.
doi: 10.1002/art.1780400928
38. Jannuzzi PM, Baeninger R. Qualificação socioeconômica e demográfica das classes da escala Abipeme. Rev Administ. 1996;31:82-90.
39. Gladman D, Ginzler E, Goldsmith C, et al. The development and initial validation of the Systemic Lupus International Collaborating Clinics/ American College of Rheumatology damage index for Systemic Lupus Erythematosus. Arthritis Rheum. 1996;39:363-369. doi: 10.1002/art. 1780390303
40. Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI – A disease activity index for lupus patients. Arthritis Rheum. 1992;35:630-640. doi: 10.1002/art. 1780350606
41. Freire EAM, Bruscato A, Ciconelli RM, Leite DRC, Sousa TTS. Translation into Brazilian Portuguese, cultural adaptation and validation of the systemic lupus erythematosus quality of life questionnaire (SLEQOL). Acta Rheumatol Port. 2010;35:334-339.
42. Leong KP, Kong KO, Thong BYH, et al. Development and preliminary validation of systemic lupus erythematosus-specific quality-of-life instrument (SLEQOL). Rheumatology. 2005;44:1267-1276.
doi: 10.1093/rheumatology/keh605
43. Grootscholten C, Ligtenberg G, Derksen RH, et al. Health-related quality of life in patients with systemic lupus erythematosus: development and validation of a lupus specific symptom checklist. Qual Life Res. 2003;12:635-644. doi: 10.1023/ a:1025176407776
44. Savoia MG, Santana PR, Mejias NP. The adaptation of coping strategies inventory by Folkman and Lazarus in Portuguese. Rev Psicol USP. 1996;7:183-201.
45. Folkman S, Lazarus RS. If it changes it must be a process: a study of emotion and coping during three stages of a college examination. J Pers Soc Psychol. 1985;48:150-170. doi: 10.1037//0022-3514.48.1.150
46. Botega NJ, Bio MR, Zomignani MA, Garcia Jr C, Pereira WAB. Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD. Rev Saude Public. 1995;29:355-363. doi: 10.1590/s0034-89101 995000500004
47. Zigmond AS, Sanaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-370. doi: 10.1111/j.1600-0447.1983.tb09716.x