A therapeutic intervention involving confronting and expressing emotional and traumatic experiences shows greater improvement in fibromyalgia pain. When compared with conventional cognitive-behavioral therapy (CBT), randomized trial results show.
It was also linked to significant pain reductions when offered as a one-time intervention in the primary care setting, researchers report.
“Current evidence-based psychological interventions for fibromyalgia, such as CBT, are relatively weak. We believe, because they do not help patients disclose, target, and resolve their conflicted emotional experiences,” senior author Mark Lumley, PhD, professor of psychology at Wayne State University, Detroit, Michigan, told Medscape Medical News.
“We have demonstrated, however, that doing so leads to improved outcomes for patients with fibromyalgia. Including a substantial minority of patients who no longer meet diagnostic criteria for fibromyalgia.”
The findings, from the Pain and Stress Treatment for Fibromyalgia trial, were presented here at the American Pain Society 35th Annual Scientific Meeting.
Studying Cognitive-Behavioral Therapy
The study included 230 patients with fibromyalgia who were randomly assigned to one of three types of therapy: Emotional Awareness and Expression Therapy (EAET); standard CBT, commonly used in management of fibromyalgia; or a control group of patients receiving education on the latest scientific evidence on fibromyalgia.
The EAET consisted specifically of disclosure of stressful experiences and experiential enactments to increase expression of emotions, as well as expressive writing and encouragement to engage differently in relationships.
“Patients engage in emotional relearning experiences. Which usually involves directly confronting and working through, rather than avoiding, their conflicted thoughts, feelings, and relationships,” Dr Lumley explained.
“This can be done by helping patients disclose their trauma or other struggles. As well as become aware of their hidden emotions. Such emotions such as anger, sadness, guilt, and love. As well as express them in a healthy manner both in therapy and in real life to key people.”
The cognitive-behavioral therapy approach used in the study meanwhile involved cognitive and behavioral exercises to manage fibromyalgia symptoms. This approach used techniques such as relaxation, sleep hygiene, cognitive reappraisal, pleasant activities, memory techniques, and other skills.
Patients in each therapy group had eight group sessions of 90 minutes each, held weekly. They were 94% female and 77.8% white, with a mean age of 49.1 years.
In terms of the primary outcome of 50% pain reduction from baseline, patients in the EAET group had improvement that was as much as two to three times greater at post-treatment and sustained at a 6-month follow-up (17% and 21.9%) compared with CBT (6.1% and 8.5%) and the control group (7.2% and 11.7%).
By Nancy A. Melville
05/19/2016
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