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Randomized Controlled Trial of Online Acceptance and Commitment Therapy for Fibromyalgia

Published:February 23, 2018DOI:https://doi.org/10.1016/j.jpain.2018.02.004

      Highlights

      • Online acceptance and commitment therapy (ACT) significantly reduced fibromyalgia (FM) impact.
      • Reductions in FM impact were mediated by improvements in pain acceptance.
      • Online ACT appears to be feasible and efficacious for FM.
      • Online delivery platforms may improve access to ACT for FM.

      Abstract

      In this study, 67 participants (95% female) with fibromyalgia (FM) were randomly assigned to an online acceptance and commitment therapy (online ACT) and treatment as usual (TAU; ACT + TAU) protocol or a TAU control condition. Online ACT + TAU participants were asked to complete 7 modules over an 8-week period. Assessments were completed at pre-treatment, post-treatment, and 3-month follow-up periods and included measures of FM impact (primary outcome), depression, pain, sleep, 6-minute walk, sit to stand, pain acceptance (primary process variable), mindfulness, cognitive fusion, valued living, kinesiophobia, and pain catastrophizing. The results indicated that online ACT + TAU participants significantly improved in FM impact, relative to TAU (P <.001), with large between condition effect sizes at post-treatment (1.26) and follow-up (1.59). Increases in pain acceptance significantly mediated these improvements (P = .005). Significant improvements in favor of online ACT + TAU were also found on measures of depression (P = .02), pain (P = .01), and kinesiophobia (P = .001). Although preliminary, this study highlights the potential for online ACT to be an efficacious, accessible, and cost-effective treatment for people with FM and other chronic pain conditions.

      Perspective

      Online ACT reduced FM impact relative to a TAU control condition in this randomized controlled trial. Reductions in FM impact were mediated by improvements in pain acceptance. Online ACT appears to be a promising intervention for FM.

      Key words

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      References

        • Baer R.A.
        • Smith G.T.
        • Hopkins K.
        • Krietmeyer J.
        • Toney L.
        Using self-report assessment to explore facets of mindfulness.
        Assessment. 2006; 13: 27-45
        • Baer R.A.
        • Smith G.T.
        • Lykins E.
        • Button D.
        • Krietemeyer J.
        • Saver S.
        • Walsh E.
        • Duggan D.
        • Williams J.M.
        Construct validity of the Five Facet Mindfulness Questionnaire in meditating and nonmeditating samples.
        Assessment. 2008; 15: 329-342
        • Bender J.L.
        • Radhakrishnan A.
        • Diorio C.
        • Englesakis M.
        • Jadad A.R.
        Can pain be managed through the internet? A systematic review of randomized controlled trials.
        Pain. 2011; 152: 1740-1750
        • Bennett R.M.
        • Bushmakin A.G.
        • Cappelleri J.C.
        • Zlateva G.
        • Sadosky A.B.
        Minimal clinically important difference in the Fibromyalgia Impact Questionnaire.
        J Rheumatol. 2009; 36: 1304-1311
        • Bennett R.M.
        • Friend R.
        • Jones K.D.
        • Ward R.
        • Han B.K.
        • Ross R.L.
        The revised Fibromyalgia Impact Questionnaire (FIQ-R): Validation and psychometric properties.
        Arthritis Res Ther. 2009; 11: R120
        • Bernardy K.
        • Klose P.
        • Busch A.J.
        • Choy E.H.
        • Häuser W.
        Cognitive behavioural therapies for fibromyalgia.
        Cochrane Database Syst Rev. 2013; (CD009796)
        • Buhrman M.
        • Skoglund A.
        • Husell J.
        • Bergström K.
        • Gordh T.
        • Hursti T.
        • Bendelin N.
        • Furmark T.
        • Andersson G.
        Guided internet-delivered acceptance and commitment therapy for chronic pain patients: A randomized controlled trial.
        Behav Res Ther. 2013; 51: 307-315
        • Burckhardt C.S.
        • Clark S.R.
        • Bennett R.M.
        The Fibromyalgia Impact Questionnaire: Development and validation.
        J Rheumatol. 1991; 18: 728-733
        • Buysse D.J.
        • Reynolds C.F.
        • Monk T.H.
        • Berman S.R.
        • Kupfer D.J.
        The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice.
        Psychiatry Res. 1989; 28: 193-213
        • Cuijpers P.
        • van Straten A.
        • Andersson G.
        Internet-administered cognitive behavior therapy for health problems: A systematic review.
        J Behav Med. 2008; 31: 169-177
        • Dahl J.C.
        • Wilson K.G.
        • Luciano C.
        • Hayes S.C.
        Acceptance and Commitment Therapy for Chronic Pain.
        Context Press, Reno, NV2005
        • Eccleston C.
        • Fisher E.
        • Craig L.
        • Duggan G.B.
        • Rosser B.A.
        • Keogh E.
        Psychological therapies (internet delivered) for the management of chronic pain in adults.
        Cochrane Database Syst Rev. 2014; (CD010152)
        • Ehde D.M.
        • Dillworth T.M.
        • Turner J.A.
        Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research.
        Am Psychol. 2014; 69: 153-166
        • Fox M.P.
        A systematic review of the literature reporting on studies that examined the impact of interactive, computer-based patient education programs.
        Patient Educ Couns. 2009; 77: 6-13
        • Gillanders D.T.
        • Bolderston H.
        • Bond F.W.
        • Dempster M.
        • Flaxman P.E.
        • Campbell L.
        • Kerr S.
        • Tansey L.
        • Noel P.
        • Ferenbach C.
        • Masley S.
        • Roach L.
        • Lloyd J.
        • May L.
        • Clarke S.
        • Remington B.
        The development and initial validation of the Cognitive Fusion Questionnaire.
        Behav Ther. 2014; 45: 83-101
        • Griffiths F.
        • Lindenmeyer A.
        • Powell J.
        • Lowe P.
        • Thorogood M.
        Why are health care interventions delivered over the internet? A systematic review of the published literature.
        J Med Internet Res. 2006; 8: e10
        • Guyatt G.H.
        • Sullivan M.J.
        • Thompson P.J.
        • Fallen E.L.
        • Pugsley S.O.
        • Taylor D.W.
        • Berman L.B.
        The 6-minute walk: A new measure of exercise capacity in patients with chronic heart failure.
        Can Med Assoc J. 1985; 132: 919
        • Hann E.J.
        • McCracken L.M.
        A systematic review of randomized controlled trials of acceptance and commitment therapy for adults with chronic pain: Outcome domains, design quality, and efficacy.
        J Context Behav Sci. 2014; 3: 217-227
        • Harding V.R.
        • de Williams A.C.
        • Richardson P.H.
        • Nicholas M.K.
        • Jackson J.L.
        • Richardson I.H.
        • Pither C.E.
        The development of a battery of measures for assessing physical functioning of chronic pain patients.
        Pain. 1994; 58: 367-375
        • Hayes A.F.
        Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach.
        Guilford Press, New York2013
      1. Hayes S.C. Barnes-Holmes D. Roche B. Relational Frame Theory: A Post-Skinnerian Account of Human Language and Cognition. Kluwer Academic/Plenum Publishers, New York2001
        • Hayes S.C.
        • Strosahl K.D.
        • Wilson K.G.
        Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change.
        2nd ed. Guilford Press, New York2012
        • Hughes L.S.
        • Clark J.
        • Colclough J.A.
        • Dale E.
        • McMillan D.
        Acceptance and commitment therapy (ACT) for chronic pain: A systematic review and meta-analysis.
        Clin J Pain. 2017; 33: 552-568
        • Jensen K.B.
        • Kosek E.
        • Wicksell R.
        • Kemani M.
        • Olsson G.
        • Merle J.V.
        • Kadetoff D.
        • Ingvar M.
        Cognitive behavioral therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia.
        Pain. 2012; 153: 1495-1503
        • Jerant A.F.
        • von Friederichs-Fitzwater M.M.
        • Moore M.
        Patients' perceived barriers to active self-management of chronic conditions.
        Patient Educ Couns. 2005; 57: 300-307
        • King S.J.
        • Wessel J.
        • Bhambhani Y.
        • Sholter D.
        • Maksymowych W.
        The effects of exercise and education, individually or combined, in women with fibromyalgia.
        J Rheumatol. 2002; 29: 2620-2627
        • Ljótsson B.
        • Atterlöf E.
        • Lagerlöf M.
        • Andersson E.
        • Jernelöv S.
        • Hedman E.
        • Kemani M.
        • Wicksell R.K.
        Internet-delivered acceptance and values-based exposure treatment for fibromyalgia: A pilot study.
        Cogn Behav Ther. 2014; 43: 93-104
        • Luciano J.V.
        • Guallar J.A.
        • Aguado J.
        • López-del-Hoyo Y.
        • Olivan B.
        • Magallón R.
        • Alda M.
        • Serrano-Blanco A.
        • Gili M.
        • Garcia-Campayo J.
        Effectiveness of group acceptance and commitment therapy for fibromyalgia: A 6-month randomized controlled trial (EFFIGACT study).
        Pain. 2014; 155: 693-702
        • Macea D.D.
        • Gajos K.
        • Daglia Calil Y.A.
        • Fregni F.
        The efficacy of web-based cognitive behavioral interventions for chronic pain: A systematic review and meta-analysis.
        J Pain. 2010; 11: 917-929
        • Martens M.P.
        • Parker J.C.
        • Smarr K.L.
        • Hewett J.E.
        • Slaughter J.R.
        • Walker S.E.
        Assessment of depression in rheumatoid arthritis: A modified version of the Center for Epidemiologic Studies Depression Scale.
        Arthritis Rheum. 2003; 49: 549-555
        • McCracken L.M.
        Contextual Cognitive-Behavioral Therapy for Chronic Pain.
        IASP Press, Seattle, WA2005
        • McCracken L.M.
        • DaSilva P.
        • Skillicorn B.
        • Doherty R.
        The Cognitive Fusion Questionnaire: A preliminary study of psychometric properties and prediction of functioning in chronic pain.
        Clin J Pain. 2014; 30: 894-901
        • McCracken L.M.
        • Gauntlett-Gilbert J.
        • Vowles K.E.
        The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability.
        Pain. 2007; 131: 63-69
        • McCracken L.M.
        • Morley S.
        The psychological flexibility model: A basis for integration and progress in psychological approaches to chronic pain management.
        J Pain. 2014; 15: 221-234
        • McCracken L.M.
        • Sato A.
        • Taylor G.J.
        A trial of a brief group-based form of acceptance and commitment therapy (ACT) for chronic pain in general practice: Pilot outcome and process results.
        J Pain. 2013; 14: 1398-1406
        • McCracken L.M.
        • Vowles K.E.
        Acceptance and commitment therapy and mindfulness for chronic pain.
        Am Psychol. 2014; 69: 178-187
        • McCracken L.M.
        • Vowles K.E.
        • Eccleston C.
        Acceptance of chronic pain: Component analysis and revised assessment method.
        Pain. 2004; 107: 159-166
        • McCracken L.M.
        • Vowles K.E.
        • Eccleston C.
        Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase.
        Behav Res Ther. 2005; 43: 1335-1346
        • Melzack R.
        The short-form McGill Pain Questionnaire.
        Pain. 1987; 30: 191-197
        • Melzack R.
        • Katz J.
        The McGill Pain Questionnaire: Appraisal and current status.
        in: Turk D.C. Melzack R. Handbook of Pain Assessment. 2nd ed. Guilford Press, New York, NY2001: 35-52
        • Nuesch E.
        • Hauser W.
        • Bernady K.
        • Barth J.
        • Juni P.
        Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: Network meta-analysis.
        Ann Rheum Dis. 2013; 72: 955-962
        • Radloff L.S.
        The CES-D Scale: A self-report depression scale for research in the general population.
        Appl Psychol Measure. 1977; 1: 385-401
        • Ritterband L.M.
        • Tate D.F.
        The science of internet interventions.
        Ann Behav Med. 2009; 38: 1-3
        • Sanchez R.J.
        • Uribe C.
        • Li H.
        • Alvir J.
        • Deminski M.
        • Chandran A.
        • Palacio A.
        Longitudinal evaluation of health care utilization and costs during the first three years after a new diagnosis of fibromyalgia.
        Curr Med Res Opin. 2011; 27: 667-671
        • Segura-Orti E.
        • Martinez-Olmos F.
        Test-retest reliability and minimal detectable change scores for sit-to-stand-to-sit tests, the six-minute walk test, the one-leg heel-rise test, and handgrip strength in people undergoing hemodialysis.
        Phys Ther. 2011; 91: 1244-1252
        • Steiner J.L.
        • Bogusch L.
        • Bigatti S.M.
        Values-based action in fibromyalgia: Results from a randomized pilot of acceptance and commitment therapy.
        Health Psychol Res. 2013; 23: e34
        • Strecher V.
        Internet methods for delivering behavioral and health-related interventions (eHealth).
        Annu Rev Clin Psychol. 2007; 3: 53-76
        • Sullivan M.J.
        • Bishop S.
        • Pivik J.
        The Pain Catastrophizing Scale: Development and validation.
        Psychol Assess. 1995; 7: 524-532
        • Tkachuk G.A.
        • Harris C.A.
        Psychometric properties of the Tampa Scale for Kinesiophobia-11 (TSK-11).
        J Pain. 2012; 13: 970-977
        • Trompetter H.R.
        • Bohlmeijer E.T.
        • Veehof M.M.
        • Schreurs K.M.
        Internet-based guided self-help intervention for chronic pain based on acceptance & commitment therapy: A randomized controlled trial.
        J Behav Med. 2015; 38: 66-80
        • Turk D.C.
        • Okifuji A.
        Detecting depression in chronic pain patients: Adequacy of self-reports.
        Behav Res Ther. 1994; 32: 9-16
        • Veehof M.M.
        • Trompetter H.R.
        • Bohlmeijer E.T.
        • Schreurs K.M.
        Acceptance- and mindfulness-based interventions for the treatment of chronic pain: A meta-analytic review.
        Cogn Behav Ther. 2016; 45: 5-31
        • Vowles K.E.
        • McCracken L.M.
        Acceptance and values-based action in chronic pain: A study of treatment effectiveness and process.
        J Consult Clin Psychol. 2008; 76: 397-407
        • Vowles K.E.
        • McCracken L.M.
        • McLeod C.
        • Eccleston C.
        The Chronic Pain Acceptance Questionnaire: Confirmatory factor analysis and identification of patient subgroups.
        Pain. 2008; 140: 284-291
        • Walitt B.
        • Nahin R.L.
        • Katz R.S.
        • Bergman M.J.
        • Wolfe F.
        The prevalence and characteristics of fibromyalgia in the 2012 national health interview survey.
        PLoS One. 2015; 10 (e0138024)
        • Weissman M.M.
        • Sholomskas D.
        • Pottenger M.
        • Prusoff B.A.
        • Locke B.Z.
        Assessing depressive symptoms in five psychiatric populations: A validation study.
        Am J Epidemiol. 1977; 106: 203-214
        • Wetherell J.L.
        • Afari N.
        • Rutledge T.
        • Sorrell J.T.
        • Stoddard J.A.
        • Petkus A.J.
        • Solomon B.C.
        • Lehman D.H.
        • Liu L.
        • Lang A.J.
        A randomized controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain.
        Pain. 2011; 152: 2098-2107
        • Wicksell R.K.
        • Kemani M.
        • Jensen K.
        • Kosek E.
        • Kadetoff D.
        • Sorjonen K.
        • Ingvar M.
        • Olsson G.L.
        Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial.
        Eur J Pain. 2013; 17: 599-611
        • Wilson K.G.
        • Sandoz E.K.
        • Kitchens J.
        • Roberts M.
        The Valued Living Questionnaire: Defining and measuring valued action within a behavioral framework.
        Psychol Record. 2010; 60: 249-272
        • Woby S.R.
        • Roach N.K.
        • Urmston M.
        • Watson P.J.
        Psychometric properties of the TSK-11: A shortened version of the Tampa Scale for Kinesiophobia.
        Pain. 2005; 117: 137-144
        • Wolfe F.
        • Brähler E.
        • Hinz A.
        • Häuser W.
        Fibromyalgia prevalence, somatic symptom reporting, and the dimensionality of polysymptomatic distress: Results from a survey of the general population.
        Arthritis Care Res. 2013; 65: 777-785
        • Wolfe F.
        • Clauw D.J.
        • Fitzcharles M.A.
        • Goldenberg D.L.
        • Katz R.S.
        • Mease P.
        • Russell A.S.
        • Russell I.J.
        • Winfield J.B.
        • Yunus M.B.
        The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.
        Arthritis Care Res. 2010; 62: 600-610