Abstract
Stress resilience factors, and interventions to ease stress and enhance resilience, are gaining increasing attention for the treatment of rheumatic conditions. This Review presents a digest of empirical work on the factors that determine the risk of adapting poorly to a rheumatic condition, and on the resilience factors that counteract such risks. We consider the types of stress-management and resilience treatments that are most effective in promoting the physical and psychological functioning of patients at risk of long-term adjustment problems. Prospective research shows that cognitive–behavioral and social risk and resilience factors predict the long-term physical and psychological functioning of patients with rheumatic conditions. Furthermore, validated screening instruments are becoming increasingly useful in clinical practice to identify and select patients at risk. Stress-management and resilience interventions offer promising ways to improve the long-term functioning of patients. These treatment methods might be especially useful when they are tailored to the specific risk and resilience factors of patients, and when they incorporate innovative approaches to the delivery of services, including internet applications such as eHealth, to increase efficiency and availability of treatments, and to optimize patient empowerment in rheumatic conditions.
Key Points
-
Cognitive–behavioral risk (for example, pain-avoidance and worrying) and resilience factors (such as social support) are predictive for the long-term physical and psychological functioning of patients with rheumatic conditions
-
Validated screening instruments can be used to identify patients at risk for long-term impairment in physical and psychological functioning
-
Stress-management and other resilience interventions can improve patients' long-term functioning, and seem to be especially useful when tailored to the specific risk and resilience factors of individual patients
-
Innovative approaches to service delivery, including internet applications such as eHealth, promise to increase the efficiency and availability of treatments, and to optimize patient empowerment in rheumatic conditions
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Stanton, A. L., Revenson, T. A. & Tennen, H. Health psychology: psychological adjustment to chronic disease. Annu. Rev. Psychol. 58, 565–592 (2007).
Keefe, F. J. et al. Recent advances and future directions in the biopsychosocial assessment and treatment of arthritis. J. Consult. Clin. Psychol. 70, 640–655 (2002).
Vriezekolk, J. E., van Lankveld, W. G., Geenen, R. & van den Ende, C. H. Longitudinal association between coping and psychological distress in rheumatoid arthritis: a systematic review. Ann. Rheum. Dis. doi: 10.1136/ard.2010.143271.
Edwards, R. R., Bingham, C. O., Bathon, J. & Haythornthwaite, J. A. Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum. 55, 325–332 (2006).
Dixon, K. E., Keefe, F. J., Scipio, C. D., Perri, L. M. & Abernethy, A. P. Psychological interventions for arthritis pain management in adults: a meta-analysis. Health Psychol. 26, 241–250 (2007).
Koulil, S. van. et al. Cognitive-behavioural therapies and exercise programmes for patients with fibromyalgia: state of the art and future directions. Ann. Rheum. Dis. 66, 571–581 (2007).
Newman, S., Steed, L. & Mulligan, K. Self-management interventions for chronic illness. Lancet 364, 1523–1537 (2004).
Riemsma, R. P., Kirwan, J. R., Taal, E. & Rasker, J. J. Patient education for adults with rheumatoid arthritis. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD003688. doi: 10.1002/14651858.CD003688 (2003).
Evers, A. W., Kraaimaat, F. W., Geenen, R., Jacobs, J. W. & Bijlsma, J. W. Longterm predictors of anxiety and depressed mood in early rheumatoid arthritis: a 3 and 5 year followup. J. Rheumatol. 2, 2327–2336 (2002).
Evers, A. W., Kraaimaat, F. W., van Riel, P. L. & de Jong, A. J. Tailored cognitive–behavioral therapy in early rheumatoid arthritis for patients at risk: a randomized controlled trial. Pain 100, 141–153 (2002).
Hawley, D. J. & Wolfe, F. Depression is not more common in rheumatoid arthritis: a 10-year longitudinal study of 6,153 patients with rheumatic disease. J. Rheumatol. 20, 2025–2031 (1993).
Thieme, K., Turk, D. C. & Flor, H. Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables. Psychosom. Med. 66, 837–844 (2004).
Wolfe, F. & Hawley, D. J. Measurement of the quality of life in rheumatic disorders using the EuroQol. Br. J. Rheumatol. 36, 786–793 (1997).
Wolfe, F. & Skevington, S. M. Measuring the epidemiology of distress: the rheumatology distress index. J. Rheumatol. 27, 2000–2009 (2000).
van Koulil, S. et al. Tailored cognitive-behavioral therapy and exercise training for high-risk fibromyalgia patients. Arthritis Care Res. (Hoboken) 10, 1377–1385 (2010).
Thieme, K., Gromnica-Ihle, E. & Flor, H. Operant behavioral treatment of fibromyalgia: a controlled study. Arthritis Rheum. 49, 314–320 (2003).
Thieme, K., Flor, H. & Turk, D. C. Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments. Arthritis Res. Ther. 8, R121 (2006).
Turk, D. C., Okifuji, A., Sinclair, J. D. & Starz, T. W. Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Care Res. 11, 397–404 (1998).
Turk, D. C., Okifuji, A., Sinclair, J. D. & Starz, T. W. Interdisciplinary treatment for fibromyalgia syndrome: clinical and statistical significance. Arthritis Care Res. 11, 186–195 (1998).
Zautra, A. J. et al. Comparison of cognitive behavioral and mindfulness meditation interventions on adaptation to rheumatoid arthritis for patients with and without history of recurrent depression. J. Consult. Clin. Psychol. 76, 408–421 (2008).
Smith, B. W. & Zautra, A. J. The role of personality in exposure and reactivity to interpersonal stress in relation to arthritis disease activity and negative affect in women. Health Psychol. 21, 81–88 (2002).
Smith, B. W. & Zautra, A. J. Vulnerability and resilience in women with arthritis: test of a two factor model. J. Consult. Clin. Psychol. 76, 799–810 (2008).
Zautra, A. J., Hall, J. S. & Murray, K. E. In Handbook of Adult Resilience Vol. 1 Ch. 1. Resilience: A New Definition of Health for People and Communities. (eds Reich, J. W., Zautra, A. J. & Hall, J. S.) 3–29 (Guilford Press, 2010).
Dekker, J., Boot, B., van der Woude, L. H. & Bijlsma, J. W. Pain and disability in osteoarthritis: a review of biobehavioral mechanisms. J. Behav. Med. 15, 189–214 (1992).
Evers, A. W., Kraaimaat, F. W., Geenen, R., Jacobs, J. W. & Bijlsma, J. W. Pain coping and social support as predictors of long-term functional disability and pain in early rheumatoid arthritis. Behav. Res. Ther. 41, 1295–1310 (2003).
Evers, A. W., Kraaimaat, F. W., Geenen, R., Jacobs, J. W. & Bijlsma, J. W. Stress-vulnerability factors as long-term predictors of disease activity in early rheumatoid arthritis. J. Psychosom. Res. 55, 293–302 (2003).
Steultjens, M. P., Dekker, J. & Bijlsma, J. W. Coping, pain, and disability in osteoarthritis: a longitudinal study. J. Rheumatol. 28, 1068–1072 (2001).
Vlaeyen, J. W. & Linton, S. J. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85, 317–332 (2000).
Evers, A. W. et al. Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases. J. Consult. Clin. Psychol. 69, 1026–1036 (2001).
de Brouwer, S. J. et al. Experimental stress in chronic inflammatory rheumatic diseases: a review on psychophysiological stress responses. Arthritis Res. Ther. 12, R89 (2010).
Finan, P. H. et al. Interplay of concurrent positive and negative interpersonal events in the prediction of daily negative affect and fatigue for rheumatoid arthritis patients. Health Psychol. 29, 429–437 (2010).
Geenen, R., Van Middendorp, H. & Bijlsma, J. W. The impact of stressors on health status and hypothalamic-pituitary-adrenal axis and autonomic nervous system responsiveness in rheumatoid arthritis. Ann. NY Acad. Sci. 1069, 77–97 (2006).
Parrish, B. P., Zautra, A. J. & Davies, M. C. The role of positive and negative interpersonal events on daily fatigue in women with fibromyalgia, rheumatoid arthritis, and osteoarthritis. Health Psychol. 27, 694–702 (2008).
Zautra, A. J. et al. Examination of changes in interpersonal stress as a factor in disease exacerbations among women with rheumatoid arthritis. Ann. Behav. Med. 19, 279–286 (1997).
van Koulil, S., van Lankveld, W, Kraaimaat, F. W., van Riel, P. L. & Evers, A. W. Risk factors for longer term psychological distress in well-functioning fibromyalgia patients: a prospective study into prognostic factors. Patient Educ. Couns. 80, 126–129 (2009).
Zautra, A. J., Davis, M. C., Affleck, G., Tennen, H. & Reich, J. W. Dynamic approaches to emotions and stress in everyday life: Bolger and Zuckerman reloaded with positive as well as negative affects. J. Pers. 73, 1511–1538 (2005).
Zautra, A. J., Fasman, R., Parrish, B. P. & Davis, M. C. Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Pain 128, 128–135 (2007).
Johannes, B., Salnitski, V. P., Thieme, K. & Kirsch, K. A. Differences in the autonomic reactivity pattern to psychological load in patients with hypertension and rheumatic diseases. Aviakosm. Ekolog. Med. 37, 28–42 (2003).
Thieme, K. et al. Psychophysiological responses in patients with fibromyalgia syndrome. J. Psychosom. Res. 61, 671–679 (2006).
Bruehl, S. & Chung, O. Y. Interactions between the cardiovascular and pain regulatory systems: an updated review of mechanisms and possible alterations in chronic pain. Neurosci. Biobehav. Rev. 28, 395–414 (2004).
Maixner, W., Fillingim, R., Booker, D. & Sigurdsson, A. Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain. Pain 63, 341–351 (1995).
Bruehl, S., Chung, O. Y., Ward, P., Johnson, B. & McCubbin, J. A. The relationship between resting blood pressure and acute pain sensitivity in healthy normotensives and chronic back pain sufferers: the effects of opioid blockade. Pain 100, 191–201 (2002).
Bragdon, E. E. et al. Group differences in pain modulation: pain-free women compared to pain-free men and to women with TMD. Pain 96, 227–237 (2002).
Maixner, W., Fillingim, R. B., Kincaid, S., Sigurdsson, A. & Harris, M. B. Relationship between pain sensitivity and resting arterial blood pressure in patients with painful temporomandibular disorders. Psychosom. Med. 59, 503–511 (1997).
Julien, N., Goffaux, P., Arsenault, P. & Marchand, S. Widespread pain in fibromyalgia is related to a deficit of endogenous pain inhibition. Pain 114, 295–302 (2005).
Kosek, E. & Orderberg, G. Lack of pressure pain modulation by heterotopic noxious conditioning stimulation in patients with painful osteoarthritis before, but not following, surgical pain relief. Pain 88. 69–78 (2000).
Lautenbacher, S. & Rollman, G. B. Possible deficiencies of pain modulation in fibromyalgia. Clin. J. Pain 13, 189–196 (1997).
Elbert, T. et al. Sensory effects of baroreceptor activation and perceived stress together predict long-term blood pressure elevations. Int. J. Behav. Med. 1, 215–228 (1994).
Boersma, K. & Linton, S. J. Screening to identify patients at risk: profiles of psychological risk factors for early intervention. Clin. J. Pain 21, 38–43 (2005).
van Koulil, S. et al. Screening for pain-persistence and pain-avoidance patterns in fibromyalgia. Int. J. Behav. Med. 15, 211–220 (2008).
Zautra, A. J. et al. Fibromyalgia: Evidence for deficits in positive affect regulation. Psychosom. Med. 67, 147–155 (2005).
van Baar, M. E., Assendelft, W. J., Dekker, J., Oostendorp, R. A. & Bijlsma, J. W. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum. 42, 1361–1369 (1999).
Van Den Ende, C. H., Vliet Vlieland, T. P., Munneke, M. & Hazes, J. M. Dynamic exercise therapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD000322. doi: 10.1002/14651858.CD000322 (2000).
Fransen, M., McConnell, S. & Bell, M. Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review. J. Rheumatol. 29, 1737–1745 (2002).
Mannerkorpi, K. Exercise in fibromyalgia. Curr. Opin. Rheumatol. 17, 190–194 (2005).
de Jong, Z. & Vliet Vlieland, T. P. Safety of exercise in patients with rheumatoid arthritis. Curr. Opin. Rheumatol. 17, 177–182 (2005).
Häkkinen, A., Sokka, T., Lietsalmi, A. M., Kautiainen, H. & Hannonen, P. Effects of dynamic strength training on physical function, Valpar 9 work sample test, and working capacity in patients with recent-onset rheumatoid arthritis. Arthritis Rheum. 49, 71–77 (2003).
Häkkinen, A., Sokka, T., Kautiainen, H., Kotaniemi, A. & Hannonen, P. Sustained maintenance of exercise induced muscle strength gains and normal bone mineral density in patients with early rheumatoid arthritis: a 5 year follow up. Ann. Rheum. Dis. 63, 910–916 (2004).
Veenhof, C. et al. Effectiveness of behavioral graded activity in patients with osteoarthritis of the hip and/or knee: a randomized clinical trial. Arthritis Rheum. 55, 925–934 (2006).
Leeuw, M. et al. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain. 138, 192–207 (2008).
Hawley, D. J. Psycho-educational interventions in the treatment of arthritis. Baillieres Clin. Rheumatol. 9, 803–823 (1995).
Sim, J. & Adams, N. Systematic review of randomized controlled trials of nonpharmacological interventions for fibromyalgia. Clin. J. Pain. 18, 324–336 (2002).
Hadhazy, V. A., Ezzo, J., Creamer, P. & Berman, B. M. Mind-body therapies for the treatment of fibromyalgia. A systematic review. J. Rheumatol. 27, 2911–2918 (2000).
Rossy, L. A. et al. A meta-analysis of fibromyalgia treatment interventions. Ann. Behav. Med. 21, 180–191 (1999).
Häuser, W., Bernardy, K., Arnold, B., Offenbächer, M. & Schiltenwolf, M. Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Rheum. 61, 216–224 (2009).
Brouwer de, S. J. M. et al. Can. psychological interventions alter the physiological stress response of patients with rheumatoid arthritis? Rheumatology 50 (Suppl. 2), ii28 (2011).
Pradhan, E. K. et al. Effect of mindfulness-based stress reduction in rheumatoid arthritis patients. Arthritis Rheum. 57, 1134–1142 (2007).
Keefe, F. J., Rumble, M. E., Scipio, C. D., Giordano, L. A. & Perri, L. M. Psychological aspects of persistent pain: current state of the science. J. Pain 5, 195–211 (2004).
Turk, D. C. Customizing treatment for chronic pain patients: who, what, and why. Clin. J. Pain. 6, 255–270 (1990).
Vlaeyen, J. W. & Morley, S. Cognitive-behavioral treatments for chronic pain: what works for whom? Clin. J. Pain. 21, 1–8 (2005).
Thieme, K., Turk, D. C. & Flor, H. Responder criteria for operant and cognitive-behavioral treatment of fibromyalgia syndrome. Arthritis Rheum. 57, 830–836 (2007).
Sharpe, L. et al. A blind, randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity. Pain. 89, 275–283 (2001).
Keel, P. J., Bodoky, C., Gerhard, U. & Muller, W. Comparison of integrated group therapy and group relaxation training for fibromyalgia. Clin. J. Pain. 14, 232–238 (1998).
Sinclair, V. G. & Wallston, K. A. Predictors of improvement in a cognitive-behavioral intervention for women with rheumatoid arthritis. Ann. Behav. Med. 23, 291–297 (2001).
Thieme, K. & Gracely, R. H. Is psychotherapy effective for fibromyalgia pain? Curr. Rheumatol. Rep. 11, 443–450 (2009).
Andersson, G. Using the internet to provide cognitive behaviour therapy. Behav. Res. Ther. 47, 175–180 (2009).
Cuijpers, P., van Straten, A. & Andersson, G. Internet-administered cognitive behavior therapy for health problems: a systematic review. J. Behav. Med. 31, 169–177 (2008).
Griffiths, F., Lindenmeyer, A., Powell, J., Lowe, P. & Thorogood, M. Why are health care interventions delivered over the internet? A systematic review of the published literature. J. Med. Internet Res. 8, e10 (2006).
Nicol, A.-M., Bush, C. G. & Balka, E. Internet devices and desires: a review of randomized controlled trials of interactive, internet-mediated, in-home, chronic disease monitoring programs. J. Res. Interprof. Pract. Edu. 1, 67–84 (2009).
Lorig, K. R., Ritter, P. L., Laurent, D. D. & Plant, K. The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or fibromyalgia. Arthritis Rheum. 59, 1009–1017 (2008).
van Lankveld, W. G., Derks, A. M. & van den Hoogen, F. H. Disease related use of the internet in chronically ill adults: current and expected use. Ann. Rheum. Dis. 65, 121–123 (2006).
Evers, A. W. M. et al. E-health treatments for chronic somatic conditions: The patient perspective [Dutch]. Nederlands Tijdschrift voor Dermatologie & Venereologie, 19, 427–430 (2010).
Author information
Authors and Affiliations
Contributions
All authors contributed equally to researching data, discussing content and writing the article, and reviewing/editing of the manuscript before submission.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Evers, A., Zautra, A. & Thieme, K. Stress and resilience in rheumatic diseases: a review and glimpse into the future. Nat Rev Rheumatol 7, 409–415 (2011). https://doi.org/10.1038/nrrheum.2011.80
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrrheum.2011.80
This article is cited by
-
Impact of resilience on disease severity and psychiatric comorbidities in patients with fibromyalgia
Egyptian Rheumatology and Rehabilitation (2022)
-
Age-related mechanisms in the context of rheumatic disease
Nature Reviews Rheumatology (2022)
-
Mental health and quality of life for people with rheumatoid arthritis or ankylosing spondylitis in Aotearoa New Zealand following the COVID-19 national lockdown
Rheumatology International (2021)
-
Psychosocial and clinical effects of the COVID-19 pandemic in patients with childhood rheumatic diseases and their parents
Rheumatology International (2021)
-
Living with arthritis: a “training camp” for coping with stressful events? A survey on resilience of arthritis patients following the COVID-19 pandemic
Clinical Rheumatology (2020)