Purpose. The purpose of this study was to examine the effects of self‐efficacy on self‐report pain and physical activities among subjects with fibromyalgia (FM). In addition, descriptive statistics of the Arthritis Impact Measurement Scale (AIMS), a measure developed for use with arthritis patients, were reported. Methods. Seventy‐nine subjects with FM, as classified by the American College of Rheumatology (ACR) criteria, completed the Visual Analogue Scale for Pain, the AIMS, and the Arthritis Self‐Efficacy Scale. A myalgic score was obtained during a tender point evaluation. Hierarchical multiple regression analyses were used to assess the effect of self‐efficacy on self‐report pain and physical activities measures after controlling for demographic variables (age, education, and symptom duration), disease severity (myalgic scores), and psychological distress (negative affect from the AIMS). Results. Higher self‐efficacy was associated with less pain and less impairment on the physical activities measure after controlling for demographic and disease severity measures. Conclusions. This study underscores the unique importance of self‐efficacy in understanding pain and physical activities impairment.

Objectives. This study examined whether pretreatment self‐efficacy and pre‐ to post‐treatment changes in self‐efficacy predict post‐treatment tender point index, disease severity, pain, and physical activity. Methods. One hundred nine subjects with fibromyalgia were assessed before and after a 6‐week training intervention. Measures included tender point index, physician ratings of disease severity, the visual analog scale for pain, the Physical Activities subscale of the Arthritis Impact Measurement Scales, and the Arthritis Self‐Efficacy Scale. Results. Pretreatment self‐efficacy significantly predicted post‐treatment physical activity, with higher selfefficacy associated with better physical activity outcome. Changes in self‐efficacy significantly predicted post‐treatment tender point index, disease severity, and pain; improvements in self‐efficacy were associated with better outcomes on each measure. Conclusions. Higher levels of self‐efficacy are associated with better outcome, and may mediate the effectiveness of rehabilitation‐based treatment programs for fibromyalgia.

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RA-related fatigue appears to be strongly associated with psychosocial variables, apart from disease activity per se. Correspondingly, treatment of fatigue may be enhanced by interventions that address relevant cognitive and behavioral dimensions.

Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that often causes considerable pain and disability (1). Although the etiology and pathogenesis of RA are not well understood (2), various lines of research suggest a relationship between stress and RA. However, the literature on stress and RA is not well integrated. The present review considers biologic, environmental, and psychologic factors that are relevant to the relations between stress and RA. This integrative review will be organized as follows. First, a tripartite model of stress will be outlined. Next, the ways in which each branch of the tripartite stress model are related to RA will be reviewed, as will recent studies that illustrate an integrative approach to the study of stress and RA. The final section of the article will address conceptual and methodologic issues relevant to continued integrative research. Stress and RA: general considerationsStress research often has been plagued by ambiguous definitions of stress. To help clarify this confusion, Cohen et al (3) identify 3 primary approaches to stress research: The physiologic approach focuses on stressrelated physiologic systems that are activated in demanding situations. The envin>nmental approach focuses on situational factors (e.g., financial problems or divorce) that function as stressful stimuli. The psychologic approach focuses on individual characteris-