Psychoanalytic psychotherapy improves quality of life, depression, anxiety and coping in patients with systemic lupus erythematosus: a controlled randomized clinical trial

Abstract

Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease which impairs the quality of life. The objective of study was to evaluate the effectiveness of Brief Group Psychoanalytic Psychotherapy to improve quality of life, depression, anxiety and coping strategies in SLE patients. Methods: In a randomized clinical trial, 80 female SLE patients were allocated into two groups: therapy group (n = 37) and control group (n = 43). Therapy group (TG) attended weekly psychotherapy sessions for 20 weeks; control group (CG) remained on a waiting list. Both groups received standard medical care. Questionnaires and scales were applied by blinded evaluators at baseline (T1) and after 20 weeks (T2): Socioeconomic Status, SLE International Collaborating Clinic/American College of Rheumatology-Damage Index, SLE International Disease Activity, SLE Specific Symptom Checklist, SLE Quality of life, Hospital Anxiety Depression Scale, Coping Strategies Inventory. Intent to treat intra-and inter-group analysis was performed for all variables in T1 and T2 using Qui-square, t-Student, Mann-Whitney and Wilcoxon tests. Analysis of Variance was used to compare categorical variables over time. P < 0.05 was considered significant.Results: The mean age of patients was 42 years; 54% were white, with mean disease duration of years 12. At baseline, both groups were homogeneous in all variables, including medications. After 20 weeks of psychotherapy TG was significantly different from CG, with lower frequency of symptoms (p = 0.001), lower level of anxiety (p = 0.019) and depression (p = 0.022), better index in five of six domains of quality of life scale (p ≤ 0.005), including total SLEQOL (p < 0.001) and with higher positive planful problem solving strategy (p = 0.017). No change in disease activity score was observed in both groups. Conclusions: Psychoanalytic psychotherapy was effective to improve many domains of quality of life and one positive coping skill and to reduce SLE symptoms, anxiety and depression levels. Brief group psychotherapy can be a useful tool to complement medical care in SLE patients. Trial registration: Number NCT01840709.

Using Clinical Characteristics and Patient‐Reported Outcome Measures to Categorize Systemic Lupus Erythematosus Subtypes

“…Irrespective of the origin of the symptoms, current treatment recommendations for fibromyalgia in SLE are similar to those of primary fibromyalgia and include graded exercise, improvement in restorative sleep, cognitive and behavioral therapy for underlying mood disorders, and pharmacologic therapies directed at depression and neuropathic pain (43–46). Aerobic exercise has demonstrated safety and efficacy for alleviating fatigue and depression in patients with SLE (47–49).…”

Towards a practical management of fatigue in systemic lupus erythematosus

“…48 Physical activity has been shown to improve fatigue in patients with SLE, 44 49 with more time spent in moderate or high physical activity associated with less fatigue. 50 Patients with SLE with otherwise unexplained fatigue should undergo dedicated psychological assessment, and behavioural issues should be specifically taken care of using appropriate psychological counselling [51][52][53][54][55] and pharmacological intervention, when needed. The exact benefit of antidepressants on fatigue is difficult to assess in SLE because there is no specific trial, but there is no reason to believe that those treatments would not be appropriate, keeping in mind the potential interaction with hydroxychloroquine, which may lead to QT prolongation.…”

Lúpus Eritematoso Sistêmico: relação entre os diferentes tratamentos e evolução clínica

“…Psychoanalytic psychotherapy was effective in improving many aspects of quality of life and a positive coping ability, in addition to reducing SLE symptoms, anxiety and depression levels 24 .…”

“…The author also highlights a lower frequency of symptoms, lower level of anxiety and depression, and increased access to medical treatment. As much as the study has been shown to be beneficial, more research time is needed to understand how much the psychological factor can change the immune responses 24 .…”