Virtual Rheum: The Development of a Virtual Mind-Body Resiliency Intervention for Patients with ANCA-Associated Vasculitis and Systemic Lupus Erythematosus - PROJECT SUMMARY People with ANCA-associated vasculitis (AAV) and Systemic Lupus Erythematosus (SLE), two prevalent and impactful types of systemic autoimmune rheumatic diseases (SARDs), live with relapsing autoimmune disease that can affect nearly any organ, requiring years of close monitoring and immunosuppression, all of which contribute to unique sources of chronic daily stress. Sources of stress in SARDs include internal stimuli related to the toxicities of treatment (e.g., weight gain, fat redistribution, insomnia from steroids) and consequences of the disease and the damage it causes (e.g., pain, fatigue). External stimuli include the uncertainty regarding the risk, timing, and impacts of a relapse, as well as the risks of severe infection with long-term immunosuppression. This chronic stress contributes to poor outcomes for patients with SARDs and related conditions, including worse mental and physical health and greater disability. Despite tremendous advances in immune-targeted treatments for patients with SARDs, there remain no evidence-based interventions that teach multi-modal skills for enhancing resiliency, (i.e., both reducing distress and fostering growth). Virtual, group resiliency interventions may ameliorate the deleterious effects of chronic stress and enhance growth. In this R34, we plan to adapt an evidence-based, group mind-body intervention for virtual delivery in patients with SARDs and to assess its feasibility (primary outcome) in a pilot randomized controlled trial. The proposed aims will yield an adapted resiliency intervention that can be utilized in future randomized controlled trials to assess its efficacy for improving emotional and behavioral health, as well as other key outcomes. In the first aim, we will refine the content and procedures of the Relaxation Response Resiliency Program (3RP) to address the SARDs-related stressors and preferences for participating in a virtual group resiliency intervention. We will use focus groups and individual interviews of patients with SARDs (N=40) as well as expert panels composed of patients and other key stakeholders to achieve this aim. In the second aim, we will evaluate the feasibility of the targeted intervention in a randomized controlled trial (N=96) comparing the adapted intervention to a time and attention-matched active control developed for mind-body program evaluation. Dr. Hall is a clinical health psychologist at Massachusetts General Hospital and Harvard Medical School who has previously led NCCIH- funded trials (T32, K23) testing the 3RP with patients navigating chronic uncertainty and stress. Dr. Jorge is a research leader in the management and study of patients with SLE. The research team also includes developer of the 3RP (Dr. Park) and community partnerships, including with the national VPPRN (Dr. Merkel, site PI at Penn; Dr. Krischer, site PI at USF). Collectively, the proposed aims have high potential for impactful results related to the development of a much-needed, scalable, group mind-body intervention for enhancing resiliency in patients living with rheumatic diseases.
