To date, there have been no published intervention programs designed to enhance psychosocial adjustment and quality of life in children and adolescents with lupus. In one clinical trial that was sponsored by the National Institute of Arthritis and Muscu-loskeletal Disorders (Brown et al. 2008), participants included adolescent females with SLE with a mean age of 15 years. Participants were randomly assigned to one of three arms: cognitive-behavioral intervention, educational intervention, or a delayed/no contact control condition.
Given the more developed cognitive schemata of adolescents as compared with those of younger children and the success of cognitive-behavioral approaches in enhancing behavioral and emotional adjustment, the cognitive-behavioral intervention was deemed to be an appropriate match for adoles cents with SLE and the specific physical and psychological sequelae that are unique to this disease. Although cognitive therapy was employed previously, primarily for pain management (Gil et al. 1996), the intervention was extended to other domains of functioning (e.g., negative affectivity, body image, social competence). The specific ingredients of the treatment package included coping skills training and cognitive restructuring techniques (Jensen et al. 1994). Efforts to teach active coping skills included training in relaxation, distraction, and problem-solving skills. Goals of the treatment included 1) developing skills for managing SLE, 2) reducing disability and perceptions of pain, 3) improving mood, 4) increasing self-efficacy expectations and perceptions of locus of control, and 5) delineating distortions associated with perceptions of physical appearance and social competence.
The cognitive-behavioral arm was administered over the course of 6 weeks. The first session focused on establishing rapport with the adolescents, explaining the rationale for the intervention, and teaching self-monitoring of mood and activity level. The second session focused on coping skills, including training in relaxation (e.g., progressive muscle relaxation, diaphragmatic breathing) and distraction (e.g., focus on things in the physical environment, mental counting technique). In addition, an important component addressed problem-solving skills (e.g., appropriate pacing of daily activities). These coping skills were discussed during the session, and the adolescents were asked to practice and apply skills as homework between sessions. Obstacles to practicing skills at home were discussed as a means of relapse prevention.
Finally, the third session focused on calming self-statements and cognitive restructuring, which are designed to diminish negative affectivity and alter perceptions of pain. Cognitive restructuring also was employed for the purpose of altering distorted perceptions of physical appearance and social competence. In this session, additional training was provided in the area of relapse prevention. Self-monitoring was employed as a means of ensuring compliance. The therapists also conducted two 10- to 15-minute telephone contacts in the week between sessions as well as other follow-up sessions. Finally, booster session were held with the adolescents at 2 months and 5 months after they began the study that focused on continued cognitive skill development, application, refinement, and relapse prevention.
Findings of the investigation revealed no significant differences in outcomes for the intervention or education group and the control group following testing or at any secondary follow-up time points. That the cognitive therapy group exhibited significantly greater change in some of the coping strategies than the other groups suggests that although the intervention may have had the desired effect of training the adolescents with SLE how to cope more effectively with their disease, this did not generalize to overall adjustment and disease adaptation or health-related quality of life.
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