Acceptance and commitment therapy for fibromyalgia: A randomized controlled trial

Authors

  • R. K. Wicksell,

    Corresponding author
    1. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    • Behavior Medicine Pain Treatment Service, Karolinska University Hospital, Stockholm, Sweden
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  • M. Kemani,

    1. Behavior Medicine Pain Treatment Service, Karolinska University Hospital, Stockholm, Sweden
    2. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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  • K. Jensen,

    1. Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
    2. Athinoula A. Martinos Center for Biomedical Imaging, Boston, USA
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  • E. Kosek,

    1. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    2. Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
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  • D. Kadetoff,

    1. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    2. Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
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  • K. Sorjonen,

    1. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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  • M. Ingvar,

    1. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    2. Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
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  • G. L. Olsson

    1. Behavior Medicine Pain Treatment Service, Karolinska University Hospital, Stockholm, Sweden
    2. Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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  • Funding sources

    One author (E. K.) received support from the Swedish Research Council, Project No. K2009-53X-21070-01-3, the Stockholm County Council, and the Swedish Rheumatism Association.

  • Conflicts of interest

    The present manuscript is submitted exclusively to European Journal of Pain and is not under consideration in any other journal. There are no financial or other relationships that might lead to a conflict of interest.

Correspondence

Rikard K. Wicksell

E-mail: rikard.wicksell@karolinska.se

Abstract

Background

Fibromyalgia (FM) is characterized by widespread pain and co-morbid symptoms such as fatigue and depression. For FM, medical treatments alone appear insufficient. Recent meta-analyses point to the utility of cognitive behaviour therapy (CBT), but effects are moderate. Within the continuous development of CBT, the empirical support for acceptance and commitment therapy (ACT) has increased rapidly. ACT focuses on improving functioning by increasing the patient's ability to act in accordance with personal values also in the presence of pain and distress (i.e., psychological flexibility). However, no study has yet explored the utility of ACT in FM.

Objectives

To evaluate the efficacy of ACT for FM and the role of psychological inflexibility as a mediator of improvement.

Methods

In this randomized controlled trial, ACT was evaluated in comparison to a waiting list control condition. Forty women diagnosed with FM participated in the study. Assessments were made pre- and post-treatment and at 3 months of follow-up. The ACT intervention consisted of 12 weekly group sessions.

Results

Significant differences in favour of ACT were seen in pain-related functioning, FM impact, mental health-related quality of life, self-efficacy, depression, anxiety and psychological inflexibility. Changes in psychological inflexibility during the course of treatment were found to mediate pre- to follow-up improvements in outcome variables.

Conclusions

The results correspond with previous studies on ACT for chronic pain and suggest the utility of ACT for FM as well as the role of psychological inflexibility as a mediator of improvement.

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