Catastrophizing, acceptance, and coping have an important predictive value in chronic pain; however, it is not known which of these variables has the greatest contribution in fibromyalgia (FM). This study explored the mediating role of catastrophizing, acceptance, and coping in the relationship between pain and emotional distress/disability in a FM sample. Ninety-two FM patients and 51 healthy participants controls were evaluated on pain- and psychological-related variables. Catastrophizing, acceptance, behavioral coping, and emotional coping were significantly correlated with emotional distress and/or disability. Catastrophizing had a significant effect as a mediator on the relationship between pain and depression/anxiety. The current management of FM could improve by including cognitive techniques aimed at modifying the negative appraisal of pain.

This study examined the relationship between several cognitive-affective factors of the fear-avoidance model of pain, the big five model of personality, and functional impairment in fibromyalgia (FM). Seventy-four FM patients completed the NEO Five-Factor Inventory, the Pain Catastrophizing Scale, the Pain Anxiety Symptoms Scale-20, the Pain Vigilance and Awareness Questionnaire, and the Impairment and Functioning Inventory. Results indicated that the cognitive-affective factors of pain are differentially associated with personality traits. Neuroticism and conscientiousness were significant predictors of pain catastrophizing, and neuroticism, openness, and agreeableness were significant predictors of pain anxiety. Personality traits did not contribute significantly to vigilance to pain. The effect of neuroticism upon pain anxiety was mediated by pain catastrophizing, and neuroticism showed a trend to moderate the relationship between impairment and pain anxiety. Results support the fear-avoidance model of pain. Implications of the findings for the understanding and management of FM are discussed.

published version features the final layout of the paper including the volume, issue and page numbers. Link to publication General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal.If the publication is distributed under the terms of Article 25fa of the Dutch Copyright Act, indicated by the "Taverne" license above, please follow below link for the End User

Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.

Differential responses to treatment between men and women were observed in some sleep- and pain-related variables. Outcomes show the needed to design different treatments for men and women with FM is discussed.

Excessive attention to pain is a common psychological characteristic among people who suffer from chronic pain. The Pain Vigilance and Awareness Questionnaire (PVAQ) is an internationally accepted tool to assess this feature, although there is no validated version of this measure for Spanish people with fibromyalgia. Since this pain syndrome mainly affects women, the aim of this study was to determine the psychometric properties of the PVAQ in Spanish women with fibromyalgia. A group of 242 women diagnosed with fibromyalgia aged between 20 and 66 years participated in the study. The goodness of fit of several structures of the PVAQ reported in previous studies was compared via confirmatory factor analysis. A two-factor solution (active vigilance and passive awareness) of the 9-item shortened version (PVAQ-9) was identified as the most appropriate (RMSEA = .08, NNFI = .96, CFI = .97, GFI = .87). It showed good reliability (internal consistency α = .82), convergent validity and divergent validity (p < .01). The optimal cutoff point for identifying fibromyalgia women with worse daily functioning was a score of 24.5, with a sensitivity of .71 and a specificity of .75. The relevance of vigilance to pain for clinical research in fibromyalgia is discussed.

Fibromyalgia (FM) is a debilitating rheumatic disorder characterized mainly by the presence of continual and widespread musculoskeletal pain, in addition to other disturbing symptoms. There is inconsistent evidence about the effectiveness of the treatments developed so far, making FM a chronic disease that is difficult to treat. The aim of this literature review was to analyze the empirical studies about psychological treatment of FM that have been published over the last twenty years. We conducted a literature search of studies published between 1990 and 2012 using Medline and PsycINFO in the Ovid and ProQuest platforms and hand searching. In total, 58 original studies were identified. The present review presents a comprehensive analysis of the main characteristics of these studies and a description of the interventions developed in order to improve FM symptoms. The most used intervention modality was group treatment with a cognitive-behavioral approach. We also found intensive and remote treatments as well as multimodal therapy, hypnosis, cognitive-behavioral therapy for insomnia, behavioral therapies, mind-body-based techniques, and biofeedback components. Finally, we discuss the clinical relevance of addressing the symptoms of patients with FM and its scientific validation.

Background/Objective : Cognitive-behavioral therapy (CBT) is one of the first-line treatments in the management of fibromyalgia (FM) and it has been applied with considerable success to treat the psychological processes associated with pain and insomnia. We hypothesized that treating sleep and pain jointly with new combined modalities of CBT may offer greater sleep-related benefits to patients. Method : Thirty-nine female patients with FM and insomnia were randomly allocated to receive CBT centered on pain (CBT-P) or combined CBT focused on pain and insomnia (CBT-C). Participants were assessed at baseline and post-treatment with the Pittsburgh Sleep Quality Index and an ambulatory polysomnography. Results : Participants who received CBT-P showed increases in time in bed and total sleep time and decreases in light sleep, but there was no improvement in perceived sleep quality. Participants who received combined CBT-C showed more meaningful improvements related to refreshing sleep (i.e., higher sleep efficiency and less time awake and longer time in Stage 4 sleep), and these changes were concordant with a significant improvement in self-perceived sleep quality. Conclusions : This study suggests that new CBT-C approaches can improve insomnia-related clinical aspects.