Psychological Interventions Effectively Decrease Depression, Anxiety in Patients with Fibromyalgia

Cosmin Octavian Popa, PhD

Credit: ResearchGate

A meta-analysis revealed both cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) were shown to improve depression and anxiety in patients with fibromyalgia, leading investigators to believe psychotherapeutic protocols could be successfully incorporated into the treatment plan, according to a study published in Medicine and Pharmacy Reports.¹

Previous research has demonstrated the success of CBT and ACT as supplemental treatment strategies for chronic pain conditions, such as fibromyalgia. CBT works by focusing on the role of thoughts in the occurrence of emotions and behaviors, particularly when targeting pain catastrophizing. ACT is a “new generation CBT approach” which is used to improve psychological flexibility while reducing rigid behavioral patterns. In this strategy, experiential avoidance, which is the inclination to avoid experiences or activities due to a fear of pain, is replaced with the development of pain acceptance. Patients work on changing their attitude towards their thoughts and use an “observer’s perspective” towards potentially distressing cognitive content. Both treatments were shown to decrease depression and disabilities scores while increasing the acceptance of pain.²

“There is promising evidence related to the ratio between costs and effectiveness of psychological approaches in fibromyalgia, emphasizing their health economic utility and role within an integrated medical care paradigm,” wrote Cosmin Octavian Popa, PhD, of the Department of Ethics and Social Sciences, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania, and colleagues. “Although both CBT and ACT interventions were reliably applied in patients with fibromyalgia syndrome, their implications for anxiety and depression entail further exploration.”

To analyze the efficacy of these treatments for reducing the emotional distress associated with fibromyalgia, investigators performed a database search of PubMed, Web of Science, and Scopus to identify eligible articles published after January 2020. Depression and anxiety scores post-test were evaluated using a meta-analysis and heterogeneity was determined using the Chi2 and I2 indicators.

Eligible studies were randomized clinical trials published in English, comprised of a sample of adult patients with clinically diagnosed fibromyalgia, included ≥ 10 patients and a control group, the efficacy of standard CBT and ACT protocols were determined, and a measure of depression and/or anxiety symptom severity were incorporated.

A total of 17 studies comprised of 1499 patients were included in the review, of which 4 assessed the efficiency of ACT. Patient demographics, such as age, gender, marital status, and occupational status, were generally homogenous throughout the trials.

The overall effect of CBT/ACT interventions was -.31 (95% confidence interval [CI]: -.47 to -.15) for depressive symptoms, and -.15 (95% CI: -.29 to -.02) for anxiety symptoms, which were deemed statistically significant. The studies were unlikely to be affected by publication bias and were considered to be an accurate estimation of the improvements observed from these psychological interventions.

Investigators noted limitations such as the homogeneity among sample characteristics, which hindered generalizability. Broadening the range of inclusion criteria could help address this issue. Additionally, investigators were unable to explore factors such as the reduction of pain catastrophizing in CBT and the increase of pain acceptance in ACT. They encourage future studies to evaluate difference facets of psychological treatments within this patient population and how they impact medication consumption, treatment adherence, and lifestyle modifications.

“The implementation of CBT/ACT interventions in clinical practice could be particularly useful for the augmentation of the standard medical treatment in fibromyalgia associated with emotional disorders,” investigators concluded. “Future research directions include the exploration of change processes and multiple moderators, enabling the development of tailored psychological treatments in fibromyalgia.”

References

1. ^{Cojocaru CM, Popa CO, Schenk A, Suciu BA, Szasz S. Cognitive-behavioral therapy and acceptance and commitment therapy for anxiety and depression in patients with fibromyalgia: a systematic review and meta-analysis. Med Pharm Rep. 2024;97(1):26-34. doi:10.15386/mpr-2661}
2. ^{McCracken LM, Sato A, Taylor GJ. A trial of a brief groupbased form of acceptance and commitment therapy (ACT) for chronic pain in general practice: pilot outcome and process results. J Pain. 2013;14:1398-1406.}