Internet-delivered acceptance and values-based exposure treatment for fibromyalgia: a pilot study.
BACKGROUND
Acceptance and commitment therapy (ACT) is a promising treatment option for fibromyalgia (FM). Studies have shown that many cognitive behavioral protocols can be transferred to the Internet with sustained efficacy. However, no study has investigated the effect on an Internet-delivered ACT-based protocol for FM. This study evaluated the efficacy, acceptability, and the health economic effects of an Internet-delivered acceptance and values-based exposure treatment for FM.


METHODS
This open pilot trial included 41 self-referred women with a FM diagnosis. The 10-week Internet-delivered treatment included acceptance, mindfulness, work with life-values, and systematic exposure to FM symptoms and FM-related situations. Participants also had regular contact with an assigned online therapist. Assessments were made at pretreatment, post-treatment, and 6-month follow-up.


RESULTS
The treatment was completed by 70% of the participants. Attrition rates were low, with 98% completing the post-treatment assessment and 90% completing the 6-month follow-up assessment. Multiple imputations were used to replace missing values. Pre- to post-treatment within-group effect sizes were in the moderate to large range (Cohen's d = 0.62-1.56) on measures of FM symptoms and impact, disability, quality of life, depression, anxiety, fatigue, and psychological flexibility. All improvements were maintained at follow-up. Economical analyses revealed significant societal cost reductions that offset the treatment costs within 2 months of treatment completion.


CONCLUSIONS
An Internet-delivered psychological treatment based on acceptance and exposure principles seems to be an efficacious, acceptable, and cost-effective treatment for FM. Randomized controlled trials are needed to confirm these results.
a Department of Clinical Neuroscience , Division of Psychology, Karolinska Institutet , Stockholm , Sweden.
Brjánn
B
Ljótsson
Ehlin
E
Atterlöf
Maria
M
Lagerlöf
Erik
E
Andersson
Susanna
S
Jernelöv
Erik
E
Hedman
Mike
M
Kemani
Rikard K
RK
Wicksell
D064869:Acceptance and Commitment Therapy; D000328:Adult; D005260:Female; D005356:Fibromyalgia / Q000523:psychology / Q000628:therapy*; D006801:Humans; D020407:Internet; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D019114:Remote Consultation / Q000379:methods*; D016896:Treatment Outcome