TEACH combines meditation, education to manage fatigue, pain in childhood-onset lupus
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Key takeaways:
- The Treatment and Education Approach for Childhood-Onset Lupus program is an intervention for children and youth with lupus.
- Researchers aim to enroll 75 patients in a remotely delivered multicenter study.
A program using cognitive behavioral and mindfulness meditation techniques demonstrated early potential to ease fatigue, depression and pain symptoms in childhood-onset systemic lupus erythematosus, according to researchers.
In addition, a remote version of the program is currently being investigated across six pediatric rheumatology centers.
“Our research team developed the Treatment and Education Approach for Childhood-Onset Lupus (TEACH), a tailored [cognitive-behavioral therapy (CBT)] for youth with [childhood-onset SLE (cSLE)] targeting mood symptoms, fatigue and pain,” Natoshia R. Cunningham, PhD, of Michigan State University, and colleagues wrote in Pediatric Rheumatology. “TEACH was originally designed as a six-session, in-person individual treatment. Pilot testing at a single site showed TEACH was potentially beneficial; however, only 50% of patients agreed to participate.
“An advisory co-investigative team including five cSLE patients and caregivers collaborated to refine TEACH to be delivered remotely,” they added. “The team then received funding from the Childhood Arthritis and Rheumatology Research Alliance-Arthritis Foundation (CARRA-AF) to conduct a pilot randomized clinical trial (RCT) to investigate the feasibility of the remotely delivered TEACH plus standard medical treatment as usual (TAU) and its effect on fatigue, depressive symptoms, and pain as compared to TAU alone.”
To investigate the impact of the remote TEACH program in patients with childhood-onset SLE, Cunningham and colleagues plan to conduct a randomized, multicenter clinical trial at six hospitals that operate a pediatric rheumatology center. The researchers aim to enroll 75 patients aged 12 to 22 years. Patients are eligible to enroll in the study if they have been diagnosed with childhood-onset SLE before the age of 18 years and demonstrate clinically relevant activity regarding fatigue, depression or pain.
Patients will be randomly assigned to receive counseling through the TEACH program as well as treatment, or treatment alone. Patients will be evaluated at baseline, 8 weeks and 20 weeks. Cunningham and colleagues will measure feasibility as the primary outcome, as well as the program’s impact on fatigue, pain and mental health scores as a secondary outcome. The feasibility endpoint will be reached if at least 65% of patients participate, and if more than 80% of those patients complete the trial. The researchers will additionally collect qualitative data through interviews following completion of the program.
“While we have demonstrated feasibility of TEACH in a pilot investigation, a rigorous and well-controlled trial of this promising approach is critically needed to advance understanding and improve outcomes for youth with cSLE,” Cunningham and colleagues wrote.
“Since cSLE is a complex condition disproportionately impacting females of color, it is important to test a treatment tailored to meet the needs of these individuals,” they added. “Given the current trial focuses on cSLE, the results will be most applicable to this population. However, the learnings of this trial may provide insights into to developing and testing treatments for other conditions.”
Perspective
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David A. McLain, MD, MACR, FACP, FRCP
Cognitive behavioral therapy (CBT) is a mainstay of this TEACH protocol. CBT was developed in the 1960s by Aaron Beck, MD, who recognized that his patients with depression had “cognitive distortions” in their thinking. Today, CBT is the most extensively researched of all psychotherapies with several evidence-based treatment protocols. It has been found to be effective in a large number of outcome studies for some psychiatric disorders, including depression, anxiety disorders, eating disorders, substance abuse and personality disorders, and as adjunctive therapy for major psychiatric disorders.
Who can provide CBT? In general, this is not psychiatry. Psychiatrists only provide 15% of mental health treatment in the United States. More than half of U.S. counties lack a single psychiatrist. Patients often wait months for an appointment and 60% of psychiatrists are aged 55 years or older — sounds familiar to rheumatology, as we are facing the same issues. Licensed mental health professionals, including psychologists, social workers and professional counselors, typically offer CBT.
Unlike some therapies, there is no mandatory certification for mental health professionals to administer CBT. However, certification can be obtained through the National Association of Cognitive Behavioral Therapists, which requires applicants to hold a master’s or doctoral degree in psychology, counseling or social work, complete supervised hours providing CBT, and obtain letters of recommendation.
CBT operates on core principles addressing faulty thinking patterns and unhelpful behaviors. It empowers individuals to develop more effective coping strategies, alleviating symptoms and enhancing their overall functionality. Advances in CBT have been made based on both research and clinical practice. Notably, CBT distinguishes itself from other psychological treatments by its strong foundation in scientific evidence, validating its transformative methods.
For those seeking CBT services, various online resources list qualified cognitive behavioral therapists in specific areas, facilitating access to this evidence-based therapeutic approach.
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