Abstract
There is a growing interest in evaluating the effectiveness of compassion interventions for treating psychological disorders. The present study evaluated the effectiveness of "attachment-based compassion therapy" (ABCT) in the treatment of fibromyalgia (FM), and the role of psychological flexibility as a mediator of improvements. A total of 42 patients with FM were randomly assigned to ABCT or relaxation (active control group). Both the intervention and control condition were combined with treatment as usual (TAU). The primary outcome was functional status (FIQ), and the secondary outcomes were clinical severity (CGI-S), pain catastrophizing (PCS), anxiety (HADS-A), depression (HADS-D), quality of life (EQ-5D), and psychological flexibility (AAQ-II). Differences between the groups were estimated using mixed-effects models, and mediation assessments were conducted using path analyses. The ABCT group demonstrated superior outcomes compared to the relaxation group, including better FIQ values after treatment (B = -3.01; p = 0.003). Differences in FIQ were maintained at 3-month follow-up (B = -3.33; p = 0.001). The absolute risk reduction in ABCT compared to relaxation increased by 40.0%, with an NNT = 3 based on criteria of ≥50% FIQ reduction after treatment. Psychological flexibility had a significant mediating effect on improvements. These results suggest that ABCT combined with TAU appears to be effective in the treatment of FM symptoms. http://ClinicalTrials.gov, identifier NCT02454244.
Highlights
Fibromyalgia (FM) is a chronic and debilitating rheumatic condition, which includes symptoms of chronic pain, fatigue, and other physical and/or psychological issues such as disturbed sleep, cognitive problems, and distress [1]
REL, relaxation; attachment-based compassion therapy” (ABCT), attachment-based compassion therapy; Mn, mean; d, Cohen’s d effect size corrected for repeated measures; B, regression coefficient; 95% confidence intervals (95% CI), 95% confidence interval; Z, value of the Z statistic; p, p-value for each comparison; FIQ, Fibromyalgia Impact Questionnaire; Clinical Global Impression-Severity Scale (CGI-S), Clinical Global Impression Severity; PCS, pain catastrophizing scale; HADS-A, Hospital Anxiety and Depression Scale-Anxiety; HADS-D, Hospital Anxiety and Depression Scale-Depression; EQ-5D, Visual Analog Scale of EuroQol; AAQ-II, Acceptance and Action Questionnaire
There were not significant direct effects between study condition and PCS (−3.30; p = 0.274), but there were significant indirect effects through AAQ-II (Table 4). This is the first study to evaluate the efficacy of ABCT for treating FM
Summary
Fibromyalgia (FM) is a chronic and debilitating rheumatic condition, which includes symptoms of chronic pain, fatigue, and other physical and/or psychological issues such as disturbed sleep, cognitive problems, and distress [1]. It is associated with mental health disorders such as anxiety and depression [2]. Multicomponent interventions, including cognitive-behavioral therapy (CBT), seem to represent a more promising approach. CBT, which combines interventions from both cognitive and behavioral therapies, improves pain-coping capacity and reduces depressed mood and health care-seeking behaviors in FM patients [6, 7]. The absence of clear, maintainable effects on the core symptoms of FM do not allow for a definitive statement regarding the effectiveness of this interventional approach [6, 9]
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