Brief Acceptance and Commitment Therapy for Fibromyalgia: Feasibility and Effectiveness of a Replicated Single-Case Design

Abstract

Objective. Overall, the literature on the effectiveness of psychological treatments in general and those for fibromyalgia in particular has been dominated by research designs that focus on large groups and explore changes on average, so the treatment impact at the individual level remains unclear. In this quasi-experimental, replicated single-case design, we will test the feasibility and effectiveness of a brief acceptance and committed therapy intervention using ecological momentary assessment supported by technology. Methods. The sample comprised 7 patients (3 in the individual condition and 4 in the group condition) who received a brief, 5-week psychological treatment. Patient evolution was assessed one week prior to treatment onset and during the whole study with a smartphone app. Because ecological momentary assessment and the use of an app are not frequent practices in routine care, we also evaluated the feasibility of this assessment methodology (i.e., compliance with the app). Change was investigated with a nonoverlap of all pairs index. Outcomes were pain interference with sleep and social activities, fatigue, sadness, and pain intensity. Results. Patient change was not uniform across outcomes. Four patients (two in each condition) showed relatively moderate levels of change (approximately 60% nonoverlap in several outcomes). The remaining patients showed more modest improvements which affected a reduced number of outcomes. Based on nonoverlapping indices, there was no clear evidence in favor of any treatment format. Conclusions. An alternative design to large-scale trials, one that focuses on the individual change, exists and it can be implemented in pain research. The use of technology (e.g., smartphones) simplifies such designs by facilitating ecological momentary assessment. Based on our findings showing that changes were not homogeneous across patients or outcomes, more single-case designs and patient-centered analyses (e.g., responder and moderation analyses) are required.

Behavior-analytic intervention for women with fibromyalgia and insomnia: a single subject design

“…The interventions consisted of 10 individual and inperson sessions in each phase (phase A and phase B) and weekly periodicity, corresponding to the number of sessions tested in this target population (Äsenlöf et al, 2005;Gómez-Pérez et al, 2020;Lundervold et al, 2006;Lundervold et al, 2008). The sessions were conducted by an experienced psychologist in the field.…”

“…In a search in the databases of Portal Capes (Index Psi, Pepsic, Scielo, and BVS), using the keywords "single-case AND pain AND behavior analysis," it was possible to verify that only a few behavioral intervention studies using single-case designs were found for people with chronic pain, including FM (Äsenlöf, Denison, & Lindberg, 2005;Gómez-Pérez, García-Palacios, Castilla, Zaragozá, & Suso-Ribera, 2020;Lundervold, Talley, & Buermann, 2006;Lundervold, Talley, & Buermann, 2008). These studies measured, besides the intensity and inability of pain, variables such as anxiety and depression (Gómez-Pérez et al, 2020;Lundervold et al, 2006;Lundervold et al, 2008) and coping with pain strategies (Äsenlöf et al, 2005). Until the present moment, none of the studies proposed the use of sleep and insomnia measures.…”

Effectiveness of Acceptance and Commitment Therapy in Central Pain Sensitization Syndromes: A Systematic Review

“…They were all published between 2012 and 2020. While 5 studies were uncontrolled clinical trials [ 91 , 92 , 93 , 94 , 95 ], the remaining 16 did have one or more control group/s. Ten studies were performed in Europe (Sweden, United Kingdom, Spain, Denmark, Italy, Greece and Cyprus) [ 96 , 97 , 98 , 99 , 100 ], five in the USA [ 101 , 102 , 103 , 104 , 105 ], four in Iran [ 106 , 107 , 108 , 109 ], one in Canada [ 110 ], and one in Japan [ 111 ].…”

“…The 21 selected studies on ACT for CPSS [ 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 ] included 1090 individuals who completed the pre/post-test phases (average of 52 subjects per study; range: 7 to 141 participants). Approximately half of the participants were included in the ACT group ( n = 601) and the others were included in control groups ( n = 487).…”

“…The mean age of the subjects was 42.88 years, and there was no significant age difference between participants in the ACT group and those in the control group in any study, with the exceptions of Aghalar et al [ 106 ], in which the ACT group participants were significantly older than controls, and Kamalinejad et al [ 107 ], in which participant ages were not directly reported. Regarding sex, the samples of seven studies were composed entirely of women [ 93 , 95 , 96 , 97 , 100 , 105 , 109 ], while in ten studies there was a clear female predominance (≥80%) [ 10 , 91 , 92 , 98 , 99 , 100 , 103 , 104 , 108 , 111 ]. Finally, four studies did not report information about subject sex [ 94 , 102 , 106 , 107 ].…”