The whole study population, including the original intervention group and the control group, receiving the intervention after a six-month wait were followed for three years. Each year for three years compared to baseline, ER/outpatient visits and health distress were reduced (p<.05). Disability increased at the expected rate (p<.05). There were no other significant changes in any of the outcome variables. There was evidence that increased perceived self-efficacy was associated with decreased health distress, which in turn was marginally associated with future reductions in outpatient visits.