Sickle cell disease: cognitive coping training led to fewer negative thoughts.

Clinical bottom line (level 2b)

  1. African American adults with sickle cell anaemia who were given cognitive coping training, used more coping strategies and had slightly fewer negative thoughts after one month, than those given disease education.
  2. Patients given cognitive coping training had better sensory discrimination for pain.
Gil et al: Health Psychology 1996; 15 (1): 3-10
Expires February 2003

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: university sickle cell centre, USA

85 patients (aged mean 33 years, 58% female) African-Americans with sickle cell anaemia

Excluded if
  • cerebrovascular disease


    • Control Group: (n = 43, 32 analysed): Received disease education skills sessions (three times a week for 45 minutes)- didactic lectures on sickle cell anaemia. Sessions focused on the hereditary nature of the disease, importance of regular health care maintenance, incidence of painful episodes, medical treatments for pain and the consequences of pain on other psychosocial adjustment.
    Experimental Group: (n = 42, 32 analysed): Received cognitive coping skills sessions (three times a week for 45 minutes)- training in six cognitive therapy techniques. Patients were trained to use six relaxation and distraction strategies. First, a definition and explanation of how cognitive coping strategies can reduce pain was provided. Second, each strategy was described, modelled and practiced with the patient. The strategies were breathing relaxation, pleasant imagery, counting backward slowly, focusing on physical aspects of surroundings, reinterpreting pain sensations and calming self-statements.
    All sessions were on a one-to-one basis, and were performed by a behavioural psychologist.
    75% followed for 1 months

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    coping attempts 94.0
    (5.00)     		112
    (6.00)     		-18.0
    (-20.8 to -15.2)
    negative thoughts 97.0
    (7.00)     		91.0
    (6.00)     		6.00
    (2.74 to 9.26)
    sensory pain discrimination (high-pitched noise compared with low-pitch) 0.70
    (0.01)     		0.75
    (0.01)     		-0.05
    (-0.06 to -0.05)

  • There was no difference in acute complications (data not given).

    • Comments

    1. Results were taken from a diagram and not formally given in the text.
    2. Are these clinically useful outcomes- did the patients feel better and did their attendance rate for minor problems fall?
    3. How long does this small benefit last for?

    Citation

    1. Gil KM, Wilson JJ, Orringer E, et al: Effects of cognitive coping skills training on coping strategies and experimental pain sensitivity in African American adults with sickle cell disease. Health Psychology 1996; 15 (1): 3-10
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient sickle cell anaemia
    Intervention or Exposure cognitive coping skills sessions
    Comparison disease education skills sessions
    Outcome mental health