Shared and distinct effect mediators in exposure-based and traditional cognitive behavior therapy for FM: Secondary analysis... 2024 Hedman-Lagerlöf

Full title: Shared and distinct effect mediators in exposure-based and traditional cognitive behavior therapy for fibromyalgia: Secondary analysis of a randomized controlled trial

Highlights

• Mediators in exposure-based and traditional CBT for fibromyalgia were studied.
  
  
• Three of them were significant mediators in both treatments.
  
  
• These were pain-related avoidance behavior, hypervigilance and pain catastrophizing.
  
  
• Pacing and overdoing were mediators in traditional CBT only.
  
  
• Exposure-based and traditional CBT for fibromyalgia appear to share common mediators.
  

Abstract

Fibromyalgia is a chronic pain condition associated with substantial suffering and societal costs. Traditional cognitive behavior therapy (T-CBT) is the most evaluated psychological treatment, but exposure therapy (Exp-CBT) has shown promise with a pronounced focus on the reduction of pain-related avoidance behaviors. In a recent randomized controlled trial (N = 274), we found that Exp-CBT was not superior to T-CBT (d = −0.10) in reducing overall fibromyalgia severity.

This study investigated pain-related avoidance behaviors, pain catastrophizing, hypervigilance, pacing, overdoing and physical activity as potential mediators of the treatment effect. Mediation analyses were based on parallel process growth models fitted on 11 weekly measurement points, and week-by-week time-lagged effects were tested using random intercepts cross-lagged panel models.

Results indicated that a reduction in avoidance behaviors, pain catastrophizing, and hypervigilance were significant mediators of change in both treatments. An increase in pacing and a reduction in overdoing were significant mediators in T-CBT only. Physical activity was not a mediator. In the time-lagged analyses, an unequivocal effect on subsequent fibromyalgia severity was seen of avoidance and catastrophizing in Exp-CBT, and of overdoing in T-CBT. Exposure-based and traditional CBT for fibromyalgia appear to share common treatment mediators, namely pain-related avoidance behavior, catastrophizing and hypervigilance.

Open access, https://www.sciencedirect.com/science/article/pii/S0005796724000731

 

Previous paper from same team, Effect of exposure-based vs traditional cognitive behavior therapy for [FM]: a two-site single-blind randomized controlled trial 2023 Hedman-Lagerlöf