title: 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.
authors.affiliation: Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi del Llobregat, Spain Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain Regional Office of Education, Culture, & Sports, Government of Aragon, Zaragoza, Spain Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain Primary Healthcare Center Arrabal, Zaragoza, Spain Department of Psychiatry, Miguel Servet Hospital, Aragon Institute of Health Sciences (I+CS), Zaragoza, Spain Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma, Spain.
authors.forename: Juan V
authors.initials: JV
authors.lastname: Luciano
authors.forename: José A
authors.initials: JA
authors.lastname: Guallar
authors.forename: Jaume
authors.initials: J
authors.lastname: Aguado
authors.forename: Yolanda
authors.initials: Y
authors.lastname: López-Del-Hoyo
authors.forename: Bárbara
authors.initials: B
authors.lastname: Olivan
authors.forename: Rosa
authors.initials: R
authors.lastname: Magallón
authors.forename: Marta
authors.initials: M
authors.lastname: Alda
authors.forename: Antoni
authors.initials: A
authors.lastname: Serrano-Blanco
authors.forename: Margalida
authors.initials: M
authors.lastname: Gili
authors.forename: Javier
authors.initials: J
authors.lastname: Garcia-Campayo
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000379:methods*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D058443:Catastrophization; D000068736:Duloxetine Hydrochloride; D005260:Female; D005356:Fibromyalgia / Q000188:drug therapy / Q000523:psychology* / Q000534:rehabilitation*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010349:Patient Compliance; D000069583:Pregabalin; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D013876:Thiophenes / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D013876:Thiophenes; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000068736:Duloxetine Hydrochloride
keywords: Acceptance and commitment therapy; Fibromyalgia; Pain acceptance; Psychological therapy