Supplementary Material for: A Tale of two Treatments: A randomized controlled trial of mindfulness or cognitive-behaviour therapy delivered online for people with rheumatoid arthritis

Introduction: This study aims to determine the relative efficacy of mindfulness-based stress reduction (MBSR) or cognitive-behaviour therapy (CBT) in comparison to a wait-list control (WLC) for people with rheumatoid arthritis (RA). Participants completed assessments before and after treatment and at 6-month follow-up.
Methods: Two-hundred and sixty-nine participants with RA were recruited and randomized in a 2:2:1 ratio to MBSR: CBT: WLC. Participants completed a semi-structured clinical interview for depression and were stratified for history of recurrent depression. We measured the primary outcome of pain interference, and pain severity, depression, anxiety, functional ability, and fear of progression. We predicted that MBSR and CBT would result in improvements compared to WLC . We also predicted that those with a history of recurrent depression would benefit more from MBSR than CBT for depression.
Results: MBSR and CBT were equally efficacious in reducing pain interference compared to WLC. Similar results were found for depression. MBSR demonstrated superior outcomes to CBT for fear of progression at post-treatment and functional ability at 6-month follow-up. CBT only was better than WLC for pain severity at 6-month follow-up. Depressive status did not moderate the efficacy of treatment.
Conclusions: MBSR and CBT resulted in statistically and clinically significant changes in pain interference compared to WLC. MBSR was more efficacious than CBT for functional ability and fear of progression, while CBT showed superiority for pain severity. The effect sizes were comparable to those achieved with face-to-face interventions, confirming both online treatments are effective for people with RA.

引言：本研究旨在明确正念减压疗法（mindfulness-based stress reduction, MBSR）与认知行为疗法（cognitive-behaviour therapy, CBT）相较于等待列表对照组（wait-list control, WLC）对类风湿关节炎（rheumatoid arthritis, RA）患者的相对疗效。所有受试者均在治疗前、治疗后及6个月随访时完成评估。
方法：本研究共招募269名RA患者，按照2:2:1的比例随机分配至MBSR组、CBT组与WLC组。受试者接受半结构化抑郁临床访谈，并根据复发性抑郁病史进行分层。本研究的主要结局指标为疼痛干扰，同时评估疼痛严重程度、抑郁、焦虑、功能能力及疾病进展恐惧。我们假设相较于WLC组，MBSR与CBT均可改善上述结局指标；此外我们还预测，合并复发性抑郁病史的受试者接受MBSR治疗后的抑郁改善效果优于CBT治疗。
结果：相较于WLC组，MBSR与CBT在减轻疼痛干扰方面疗效相当，在抑郁症状改善方面亦得到相似结果。治疗后评估显示，MBSR在疾病进展恐惧维度上的改善效果优于CBT；6个月随访时，MBSR在功能能力方面的表现更优。仅CBT组在6个月随访时的疼痛严重程度改善效果优于WLC组。抑郁病史并未对治疗疗效产生调节作用。
结论：相较于WLC组，MBSR与CBT均可带来疼痛干扰方面具有统计学与临床意义的显著改善。MBSR在功能能力与疾病进展恐惧维度上的疗效优于CBT，而CBT在疼痛严重程度改善方面更具优势。本研究的效应量与面对面干预的效应量相当，证实两种在线疗法均对RA患者有效。