Cognitive-behavioural correlates of adjustment to disease in rheumatoid arthritis

Heterogeneity in the adjustment to chronic disease between individuals and across the course of disease has major implications for health outcomes and well-being. Recent comprehensive theoretical models of adjustment to chronic disease propose that cognitive and behavioural processes play a central role in shaping adaptation and represent potentially modifiable targets for intervention. Understanding the contribution of these factors is therefore essential for the development of interventions that promote successful adaptation and effective disease self-management. Guided by a theory-driven framework, this cross-sectional study aimed to assess the contribution of cognitive-behavioural factors to three core adjustment outcomes—functional disability, psychological distress, and satisfaction with life—in patients with rheumatoid arthritis (RA), above and beyond the influence of macro-level contextual and disease-related factors. The sample consisted of 297 consecutive patients recruited from rheumatology outpatient clinics (81% females, mean age = 56 ± 12 years). Patients underwent a routine rheumatology check and completed self-reports regarding adjustment to disease, coping self-efficacy, mastery, and social support. Data were analysed using correlational and hierarchical multiple linear regression analyses (IBM SPSS v.31). The final regression models explained between 29% and 50% of the variance in adjustment outcomes. Cognitive-behavioural variables accounted for a unique explained variance in functional disability (ΔR 2 =2–4%, p < 0.05), psychological distress (ΔR=20–26%, p < 0.001), and satisfaction with life (ΔR 2 =17–19%, p < 0.001), beyond that explained by contextual and disease-related factors. Coping self-efficacy emerged as a key factor associated with negatively framed adjustment outcomes (functional disability: β=-0.14 to -0.21, p < 0.05; psychological distress: β=- 0.33 to -0.41, p < 0.001, across the three self-efficacy subscales), while perceived social support was associated with positively framed adjustment outcomes (satisfaction with life: β = 0.27 to 0.30, p < 0.001). Our findings underpin the importance of cognitive-behavioural dynamics in understanding individual differences in adjustment to disease. The outcomes also highlight the multifaceted nature of adjustment to chronic disease, with positive and negative adjustment outcomes representing relatively distinct dimensions. Such specificity should prove useful in designing effective, tailored, cognitive-behavioural, non-pharmacological interventions to assist those who are not adjusting well in a certain domain, with the ultimate aim to improve patients’ health outcomes and quality of life.