Fifteen women and men seated around a conference table in a New York City hospital listen intently to one of their peers. A 40-year-old elementary school teacher shares her challenges related to the intersection of rheumatoid arthritis (RA) and the responsibilities of a demanding job.* With the support and counsel of fellow group members, the teacher has begun to manage living with RA over the past two years and is feeling more secure in her position at work. Her current challenge centers on whether to accept a promotion that would entail an interesting and better paying job at another school.
Despite economic need and personal ambition, the teacher weighs her hard-won, improved work situation against diminished energy levels and the likelihood of increased stress in a new position. Deciding to stay in her current job, she makes a decision “in favor of self-care and joy,” and commits to rest and prioritizing “discretionary energy” to her passion for cycling.
The scene mentioned above took place at a support and education group for people recently diagnosed with RA at the Hospital for Special Surgery (HSS) in New York. The group is cofacilitated by a clinical social worker and a rheumatology nurse, and represents one of many variations of a powerful, albeit underutilized, modality. Dynamic, efficient and cost-effective, groups are adaptable to multiple practice environments with a range of institutional support, infrastructure and availability of trained group leaders.
A 2016 multidisciplinary European League Against Rheumatism (EULAR) task force included evidence-based recommendations for incorporating patient education as an integral component of standard care for people with inflammatory arthritis.1 A large body of evidence demonstrates the efficacy of specifically targeted approaches. Manualized self-management programs, notably the Stanford Patient Education Research Center’s programs for individuals with chronic illness, which are scripted for both content and process, have reported improved outcomes for pain management and self-efficacy.2 Cognitive behavioral groups have reported improved outcomes for managing fatigue.3 Peer counseling/health education interventions in lupus and other rheumatologic illnesses have reported improved outcomes for mental health status and fatigue.4 Such group interventions can be used with similar outcomes in underserved diverse communities.5
Therapeutic Benefits of Group
Group in all its permutations—psychosocial, support, education, peer, skills-based, self-help and others—offers unique therapeutic features. As described by Yalom and Leszcz, participation in a group contributes to an experience of universality, of not being alone.6 “I feel so much better coming to this group, and learning that other people have similar concerns and challenges,” says Bonnie, a 28-year-old accountant recently diagnosed with RA.