• Johanna E Vriezekolk, Agnes M M Eijsbouts, Wim G J M van Lankveld, Hanneke Beenackers, Rinie Geenen, and Cornelia H M van den Ende.
• Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands. j.vriezekolk@maartenskliniek.nl
• Patient Educ Couns. 2013 Jun 1; 91 (3): 357-63.

ObjectiveTo examine the potential effectiveness of a multimodal rehabilitation program including an acceptance-oriented cognitive-behavioral therapy for highly distressed patients with rheumatic diseases.MethodsAn observational study employing a one-group pre-post test design (N=25). The primary outcome was psychological distress. Secondary outcomes were quality of life, illness acceptance, and coping flexibility. Group pre-to-post and pre-to-12 months follow-up treatment changes were evaluated by paired-samples t-tests and Cohen's effect sizes (d). Individual changes were evaluated by the reliable change index (RCI) and clinically significant change (CSC) parameters.ResultsSignificant effects were found post-treatment and maintained at 12 months in psychological distress (d>0.80), illness acceptance (d=1.48) and the SF-36 subscales role physical, vitality, and mental health (d ≥ 0.65). No significant effects were found for coping flexibility and the SF-36 subscales physical functioning, bodily pain, social functioning, and role emotional. Both a reliable (RCI) and clinically significant (CSC) improvement was observed for almost half of the highly distressed patients.ConclusionThe patients enrolled in the multimodal rehabilitation program showed improved psychological health status from pre to post-treatment.Practice ImplicationsA randomized clinical trial is needed to confirm or refute the added value of an acceptance-oriented cognitive-behavioral therapy for highly distressed patients in rehabilitation.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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