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In this issue of The Journal , Shadick and colleagues1 conduct a proof-of-concept study investigating the efficacy of a novel psychosocial intervention for patients with rheumatoid arthritis (RA): Internal Family Systems-based Psychotherapy (IFS). IFS has not previously been the subject of randomized controlled trials (RCT) and therefore its potential efficacy is unknown. Group differences favoring the IFS group over a group receiving routine care were found for pain severity and physical function at posttreatment, and for joint function (self-assessed), depression, and self-compassion at 1 year followup. Hence, this trial has established proof of concept for the potential efficacy of IFS in RA. But what is IFS and how is it related to existing evidence-based treatments?Internal family systems therapy was developed and articulated by Schwartz2, and his book indicates that much of the influence for IFS has come from work in family therapy3,4. However, IFS is not a form of family therapy per se , because patients were seen in groups without other members of their family present. Shadick, et al 1 described the processes: (a) IFS “teaches patients to attend to and interact mindfully” with their internal experiences; and (b) IFS “recruits self-compassion and conceptualizes parts of a person as subpersonalities, in which they are encouraged to engage in a dialogue with polarized thinking.” According to Shadick, et al 1, patients are encouraged to identify situations with their concomitant thoughts and emotions. Patients are then asked to identify the origin of these experiences, allowing them to change their response and identify compromise positions to allow them to behave differently. From this description, it is clear that IFS shares overlap with numerous other models of psychotherapy, many of which have been previously used in RA.It is important to determine the … Address correspondence to L. Sharpe. E-mail: louises{at}psych.usyd.edu.au

Psychological Treatment for Rheumatoid Arthritis Works: Now We Need to Know What Elements Are Most Effective and for Whom