(495) Emotional abilities moderate responses to different psychological interventions for fibromyalgia

Patients’ abilities for awareness and expression of their emotions are related to fibromyalgia (FM) symptoms (e.g., pain and fatigue), and may influence responses to interventions that differ in emotional and cognitive demands. To test this hypothesis we randomized 230 FM patients (M age = 49; 94% female; 78% White, 18% Black) into a clinical trial comparing emotional awareness and expression therapy (EAET) to cognitive behavioral therapy (CBT) and FM education. At baseline, patients completed the self-report Toronto Alexithymia Scale-20, which assesses difficulties identify and describing one’s feelings and limited introspection, and the performance-based Levels of Emotional Awareness Scale, which assesses awareness and complexity of one’s emotions via written descriptions of patients’ feelings in emotion-provoking scenarios. Measures of pain (BPI) and fatigue (PROMIS) were assessed before and after the 8-week, group-based treatments. Cross-sectionally (at baseline), greater emotional awareness (LEAS) correlated with less pain (r = -.19, p < .01), whereas greater alexithymia correlated with greater fatigue (r = .26, p < .01). More importantly, baseline emotional abilities significantly moderated patients’ responses to the interventions. Greater emotional awareness predicted significant reductions in pain severity in EAET (β = -.29, p = .01), but the opposite in CBT (β = .22, p = .06) and education (β = .12, p = .33). In contrast, alexithymia predicted significant reductions in fatigue in education (β = -.25, p = .03), but the opposite in EAET (β = .17, p = .15) and CBT (β = .16, p = .19). These results suggest that different psychological interventions vary in fit as a function of patients’ emotional abilities. Emotion-focused interventions for FM, such as EAET, may be more beneficial to those with greater emotional awareness, whereas interventions requiring less introspection, such as education, may be more beneficial for those with alexithymia. Funded by NIH R01 AR057808.