(509) The PAST-FM (Pain and Stress Treatment for Fibromyalgia) randomized, controlled trial: main effects of emotional awareness and expression and cognitive-behavioral therapies

Abstract

Trauma, emotional avoidance, and relational conflict are elevated in fibromyalgia (FM) and other chronic pain conditions, precipitating or augmenting symptoms. Cognitive-behavioral therapy (CBT) is modestly effective for FM, but interventions that target disturbed emotional/relational processes may yield stronger effects. We developed Emotional Awareness and Expression Therapy (EAET) and compared it to CBT and an active, education control condition in a multi-site, randomized, allegiance-controlled trial. Patients with FM (N=230) were randomized to the 3 conditions, which had 8, 90-minute, weekly group sessions. Outcomes were assessed at baseline, post-treatment, and 6-month follow-up. Retention to follow-up (91.3%) was excellent. Multilevel modeling (intent-to-treat) compared conditions on change from baseline to post-treatment and follow-up. For pain severity (primary outcome), only EAET had lower mean levels than controls at post-treatment (but not follow-up). Rates of 50% pain reduction at both post-treatment and follow-up were significantly (2 to 3 times) greater for EAET (17%, 22.8%) than CBT (6.1%, 8.5%) and (marginally) education (7.2%, 11.7%). Only EAET improved cognitive functioning, surpassing CBT and controls at post-treatment, and controls at follow-up. Compared to controls, both EAET and CBT reduced sleep problems and depression at post-treatment, and anxiety at follow-up. No significant treatment effects occurred for fatigue and physical functioning. Overall, 33% of EAET patients reported “very much” or “much” improvement at post-treatment and follow-up, significantly outperforming controls (4.1%, 15.3%); CBT was between the two, surpassing controls only at post-treatment (18.8%). We conclude that directly targeting trauma, emotional avoidance, and relational conflict in FM is more effective than not only an active education control condition but also CBT on key outcomes (pain, cognitive functioning). These data suggest that emotional awareness and expression can be effective for FM and other pain disorders (or patients) where there are significant contributions from central nervous system sensitization / augmentation. Funding: NIH AR057808.