Pain and depression in women with rheumatoid arthritis: The effect of cognitive behavioral therapy

Nastaran Mansouriyeh

DOI: 10.22122/cdj.v0i0.524


BACKGROUND: Pain is the main symptom of the disease in patients with rheumatoid arthritis (RA). This disease is the most common arthritis identified in women. Many studies have stated that there is a relationship between chronic pain and depression. The aim of this study was to examine the efficacy of the cognitive behavioral therapy (CBT) on reducing pain and depression in women with RA.

METHODS: Four patients with RA were included in a single-subject study with multiple baseline design conducted in Tabriz, Iran, in 2017. Scores were measured with Beck Depression Inventory (BDI) and McGill Pain Questionnaire (MPQ) before and during treatment periods.

RESULTS: The effect sizes according to the results of the BDI for the first, second, third, and fourth subject were 5.00, 0.66, 5.00, and 6.00, respectively. The effect sizes of the MPQ for the first, second, third, and fourth subject were 2.24, 3.44, 5.74, and 2.79, respectively.

CONCLUSION: The symptoms of depression are high among patients with RA due to chronic pain. CBT significantly reduced pain and depression in patients with RA. CBT is a great help in reducing the physical and mental problems of patients with RA.


Cognitive Behavioral Therapy; Pain; Depression; Rheumatoid Arthritis

Full Text:



Rezaei F, Neshat Doost HT, Molavi H, Abedi MR, Karimifar M. Depression and pain in patients with rheumatoid arthritis: Mediating role of illness perception. The Egyptian Rheumatologist 2014; 36(2): 57-64.

Ribeiro N, Schier A, Marinho T, Machado S, Nardi A, Silva A. Cognitive behavioral therapy for patient with rheumatoid arthritis and obesity. J Med Cases 2013; 4(7): 443-6.

Cunha M, Ribeiro A, Andre S. Anxiety, Depression and Stress in Patients with Rheumatoid Arthritis. Procedia Soc Behav Sci 2016; 217: 337-43.

Merskey H, Bogduk N. Classification of chronic pain. Seattle, WA: International Association for the Study of Pain; 1994.

Walsh DA, McWilliams DF. Mechanisms, impact and management of pain in rheumatoid arthritis. Nat Rev Rheumatol 2014; 10(10): 581-92.

Parker JC, Smarr KL, Slaughter JR, Johnston SK, Priesmeyer ML, Hanson KD, et al. Management of depression in rheumatoid arthritis: A combined pharmacologic and cognitive-behavioral approach. Arthritis Rheum 2003; 49(6): 766-77.

Margaretten M, Julian L, Katz P, Yelin E. Depression in patients with rheumatoid arthritis: Description, causes and mechanisms. Int J Clin Rheumtol 2011; 6(6): 617-23.

Akhlaghi M, Faezi S, Paragomi P, Ashofteh F, Alinejad P, Hatami N, et al. Investigating the short-term impact of cognitive-behavioral therapy (CBT) on quality of life in Persian patients with rheumatoid arthritis: The heterogeneous impact on Arthritis Impact Measurement Scales (AIMS-2). Rheumatol Res 2018; 3(1): 29-34.

Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol 2007; 26(1): 1-9.

Eccleston C, Williams AC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2009; (2): CD007407.

Lee EH, Lee SJ, Hwang ST, Hong SH, Kim JH. Reliability and validity of the beck depression inventory-ii among Korean adolescents. Psychiatry Investig 2017; 14(1): 30-6.

Lewis SA. Chronic pain. Curr Opin Psychiatry 1993; 6: 121.

Holroyd KA, Holm JE, Keefe FJ, Turner JA, Bradley LA, Murphy WD, et al. A multi-center evaluation of the McGill Pain Questionnaire: Results from more than 1700 chronic pain patients. Pain 1992; 48(3): 301-11.

Cohen J. A power primer. Psychol Bull 1992; 112(1): 155-9.

Dickens C, McGowan L, Clark-Carter D, Creed F. Depression in rheumatoid arthritis: A systematic review of the literature with meta-analysis. Psychosom Med 2002; 64(1): 52-60.

Fifield J, Tennen H, Reisine S, McQuillan J. Depression and the long-term risk of pain, fatigue, and disability in patients with rheumatoid arthritis. Arthritis Rheum 1998; 41(10): 1851-7.

Wolfe F, Michaud K. Predicting depression in rheumatoid arthritis: The signal importance of pain extent and fatigue, and comorbidity. Arthritis Rheum 2009; 61(5): 667-73.

Nash VR, Ponto J, Townsend C, Nelson P, Bretz MN. Cognitive behavioral therapy, self-efficacy, and depression in persons with chronic pain. Pain Manag Nurs 2013; 14(4): e236-e243.

Knoerl R, Lavoie Smith EM, Weisberg J. Chronic pain and cognitive behavioral therapy: An integrative review. West J Nurs Res 2016; 38(5): 596-628.

Tan EP, Tan ES, Ng BY. Efficacy of cognitive behavioural therapy for patients with chronic pain in Singapore. Ann Acad Med Singapore 2009; 38(11): 952-9.

Turner JA, Clancy S, McQuade KJ, Cardenas DD. Effectiveness of behavioral therapy for chronic low back pain: A component analysis. J Consult Clin Psychol 1990; 58(5): 573-9.

Eccleston C, Crombez G. Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychol Bull 1999; 125(3): 356-66.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 4.0

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.