Effectiveness of group acceptance and commitment therapy for fibromyalgia: A 6-month randomized controlled trial (EFFIGACT study)

Abstract

In the last decade, there has been burgeoning interest in the effectiveness of third-generation psychological therapies for managing fibromyalgia (FM) symptoms. The present study examined the effectiveness of acceptance and commitment therapy (ACT) on functional status as well as the role of pain acceptance as a mediator of treatment outcomes in FM patients. A total of 156 patients with FM were enrolled at primary health care centers in Zaragoza, Spain. The patients were randomly assigned to a group-based form of ACT (GACT), recommended pharmacological treatment (RPT; pregabalin + duloxetine), or wait list (WL). The primary end point was functional status (measured with the Fibromyalgia Impact Questionnaire, FIQ). Secondary end points included pain catastrophizing, pain acceptance, pain, anxiety, depression, and health-related quality of life. The differences between groups were calculated by linear mixed-effects (intention-to-treat approach) and mediational models through path analyses. Overall, GACT was statistically superior to both RPT and WL immediately after treatment, and improvements were maintained at 6months with medium effect sizes in most cases. Immediately after treatment, the number needed to treat for 20% improvement compared to RPT was 2 (95% confidence interval 1.2-2.0), for 50% improvement 46, and for achieving a status of no worse than mild impaired function (FIQ total score <39) also 46. Unexpectedly, 4 of the 5 tested path analyses did not show a mediation effect. Changes in pain acceptance only mediated the relationship between study condition and health-related quality of life. These findings are discussed in relation to previous psychological research on FM treatment.

Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome – A systematic review and meta‐analysis of randomized controlled trials

“…Only one study had a total treatment time <5 h (Ang et al, 2010) and seven studies had a treatment time of >25 h (Wigers et al, 1996;Soares and Grossi, 2002;Thieme et al, 2003;Thieme et al, 2006;Falcao et al, 2008;Castel et al, 2012;Karlsson et al, 2015). The remaining studies had a treatment time between 5 and 25 h. Fourteen studies reported on average attendance rates of participants (Wigers et al, 1996;Oliver et al, 2001;King et al, 2002;Redondo et al, 2004;Thieme et al, 2006;Rooks et al, 2007;Alda et al, 2011;Luciano et al, 2011Luciano et al, , 2014Miro et al, 2011;Castel et al, 2012;Parra-Delgado and Latorre-Postigo, 2013;Martınez et al, 2014;Karlsson et al, 2015). The median of attended CBTs sessions was 77% (range 42-93%).…”

“…One of these studies was included in the first version of the review (Williams et al, 2010). We included seven new studies (Williams et al, 2002;Parra-Delgado and Latorre-Postigo, 2013;Wicksell et al, 2013;Luciano et al, 2014;Martınez et al, 2014;Garcia-Palacios et al, 2015;Karlsson et al, 2015).One study (Williams et al, 2002) was not included in the first version of this review. These studies added 546 new participants.…”

“…Eighteen studies were conducted in Europe (Burckhardt et al, 1994;Vlaeyen et al, 1996;Wigers et al, 1996;Soares and Grossi, 2002;Thieme et al, 2003Thieme et al, , 2006Redondo et al, 2004;Castel et al, 2009Castel et al, , 2012Alda et al, 2011;Luciano et al, 2011Luciano et al, , 2014Miro et al, 2011;Parra-Delgado and Latorre-Postigo, 2013;Wicksell et al, 2013;Martınez et al, 2014;Garcia-Palacios et al, 2015;Karlsson et al, 2015), of which 10 were conducted in Spain (Redondo et al, 2004;Castel et al, 2009Castel et al, , 2012Alda et al, 2011;Luciano et al, 2011Luciano et al, , 2014Miro et al, 2011;ParraDelgado and Latorre-Postigo, 2013;Martınez et al, 2014;Garcia-Palacios et al, 2015), five in Scandinavian countries (Burckhardt et al, 1994;Wigers et al, 1996;Soares and Grossi, 2002;Wicksell et al, 2013;Karlsson et al, 2015), two studies in Germany (Thieme et al, 2003(Thieme et al, , 2006 and one study in the Netherlands (Vlaeyen et al, 1996). Ten studies were conducted in North America (USA) (Nicassio et al, 1997;Oliver et al, 2001;King et al, 2002...…”

“…Most studies reported the setting in which CBTs were delivered: four studies in primary care settings (Rooks , 2007;Alda et al, 2011;Luciano et al, 2011;Karlsson et al, 2015), by six studies in rheumatology clinics (Burckhardt et al, 1994;Thieme et al, 2003;Redondo et al, 2004;Kashikar-Zuck et al, 2005Woolfolk et al, 2012) by two studies each in pain clinics (Castel et al, 2009(Castel et al, , 2012, psychology departments (Thieme et al, 2006;Martınez et al, 2014) and rehabilitation clinics (Vlaeyen et al, 1996;King et al, 2002) and by one study in the home of the patients (Ang et al, 2010). All studies except six (Oliver et al, 2001;Rooks et al, 2007;Alda et al, 2011;Luciano et al, 2011Luciano et al, , 2014Kashikar-Zuck et al, 2012) were single-centre studies.…”

“…Twenty-three studies provided traditional CBT (Burckhardt et al, 1994;Vlaeyen et al, 1996;Wigers et al, 1996;Nicassio et al, 1997;King et al, 2002;Soares and Grossi, 2002;Williams et al, 2002;Redondo et al, 2004;Edinger et al, 2005;Kashikar-Zuck et al, 2005;Thieme et al, 2006;Falcao et al, 2008;Castel et al, 2009Castel et al, , 2012Ang et al, 2010;Alda et al, 2011;Luciano et al, 2011;Miro et al, 2011;Kashikar-Zuck et al, 2012;Woolfolk et al, 2012;Martınez et al, 2014;Garcia-Palacios et al, 2015;Karlsson et al, 2015), three studies offered acceptance/mindfulness-based therapy (Parra-Delgado and Latorre-Postigo, 2013; Wicksell et al, 2013;Luciano et al, 2014) and two studies each provided self management education (Oliver et al, 2001;Rooks et al, 2007) and operant therapy (Thieme et al, 2003(Thieme et al, , 2006. All studies were conducted by live face-toface contact except one study which was delivered by telephone (voice-to-voice) (Ang et al, 2010).…”