Beyond cognitive-behavioral therapy for fibromyalgia: addressing stress by emotional exposure, processing, and resolution

comment on the well-designed trial by Alda and colleagues reported in a recent issue of Arthritis Research and Therapy which demonstrated some benefits of cognitive-behavioral therapy (CBT) for fibromyalgia (FM). CBT in this and other studies provides statistically significant but rather modest benefits for FM. This may be because CBT does not directly address the high rates of victimization, post-traumatic stress disorder, and emotional avoidance experienced by a substantial number of patients with FM. Interventions that encourage emotional exposure, processing, and resolution of stressful or traumatic experiences and relationships hold potential for larger effects for many patients and need to be tested.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334632/

 

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Meaning-focused coping, pain, and affect: a diary study of hospitalized women with rheumatoid arthritis

Purpose

The aim of the study was to investigate the relationship between affective state, pain, and coping in hospitalized women with rheumatoid arthritis, including both between- and within-person perspectives.

Methods

Participants were 95 female patients between 24 and 82 years of age (M = 50.91; SD = 13.80). For three consecutive days, they rated each night their state affect (positive and negative), pain level, and coping strategies (emotion-, problem- and meaning-focused ones). Relations among variables were tested with a multilevel approach with time included as a covariate.

Results

Within-person meaning-focused coping suppressed the negative pain effect on emotional state, but only for positive affect (Sobel’s z = 2.07, p = .04). Moderators of the pain–affect relationship were between-person differences in pain level (B = −.23, SE = .08, t = −2.884, p = .004) and in meaning-focused coping (B = −.63, SE = .20, t = −2.097, p = .04). Specifically, suppression was significant only for patients who reported lower than sample average pain levels and for patients who reported lower than sample average use of meaning-focused strategies.

Conclusions

Findings indicated that meaning-focused coping can be a crucial strategy for keeping daily positive affect in the face of chronic pain and how this effect is modified by interindividual differences. Even if restricted to the specific context, it may inform an intervention for hospitalized women with rheumatoid arthritis.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4615666/

Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial.

Mindfulness-based stress reduction (MBSR) is a structured 8-week group program teaching mindfulness meditation and mindful yoga exercises. MBSR aims to help participants develop nonjudgmental awareness of moment-to-moment experience. Fibromyalgia is a clinical syndrome with chronic pain, fatigue, and insomnia as major symptoms. Efficacy of MBSR for enhanced well-being of fibromyalgia patients was investigated in a 3-armed trial, which was a follow-up to an earlier quasi-randomized investigation. A total of 177 female patients were randomized to one of the following: (1) MBSR, (2) an active control procedure controlling for nonspecific effects of MBSR, or (3) a wait list. The major outcome was health-related quality of life (HRQoL) 2 months post-treatment. Secondary outcomes were disorder-specific quality of life, depression, pain, anxiety, somatic complaints, and a proposed index of mindfulness. Of the patients, 82% completed the study. There were no significant differences between groups on primary outcome, but patients overall improved in HRQoL at short-term follow-up (P=0.004). Post hoc analyses showed that only MBSR manifested a significant pre-to-post-intervention improvement in HRQoL (P=0.02). Furthermore, multivariate analysis of secondary measures indicated modest benefits for MBSR patients. MBSR yielded significant pre-to-post-intervention improvements in 6 of 8 secondary outcome variables, the active control in 3, and the wait list in 2. In conclusion, primary outcome analyses did not support the efficacy of MBSR in fibromyalgia, although patients in the MBSR arm appeared to benefit most. Effect sizes were small compared to the earlier, quasi-randomized investigation. Several methodological aspects are discussed, e.g., patient burden, treatment preference and motivation, that may provide explanations for differences. In a 3-armed randomized controlled trial in female patients suffering from fibromyalgia, patients benefited modestly from a mindfulness-based stress reduction intervention.

 

https://www.ncbi.nlm.nih.gov/pubmed/21146930

Mindfulness, Self-Care, and Wellness in Social Work: Effects of Contemplative Training

Journal of Religion & Spirituality in Social Work: Social Thought

Volume 30, 2011 – Issue 3: Social Work, Spirituality, and Social Practices

The demands placed on human service workers in supporting people through challenging circumstances can contribute to high levels of stress and burnout. Self-care practices implemented regularly may decrease the impact of the high levels of stress while also serving as strategies for coping during particularly stressful times. The interconnections between contemplative practices, including mindfulness, as coping and preventative strategies for self-care practice among human service workers are beginning to emerge. We used a multimethod study to examine the effectiveness of eight weeks of contemplative practice training in increasing self-care, awareness, and coping strategies for 12 human service workers. Paired t-tests conducted on pre- and post-training scores on the Perceived Stress Scale and the Mindfulness Attention and Awareness Scale showed that mindfulness was significantly increased and that stress significantly decreased over the intervention. Thematic analysis from participant journaling and a focus group discussion suggests that time, permission, and place for learning and practicing mindfulness-based activities are necessary. A meditative model is presented to illustrate how enhanced awareness through mindfulness practice can increase self-care which can, in turn, positively affect the service human service workers provide to their clients.

Mindfulness, Self-Compassion, and Empathy Among Health Care Professionals: A Review of the Literature

Journal of Health Care Chaplaincy

Volume 20, 2014 – Issue 3

 

The relationship between mindfulness and self-compassion is explored in the health care literature, with a corollary emphasis on reducing stress in health care workers and providing compassionate patient care. Health care professionals are particularly vulnerable to stress overload and compassion fatigue due to an emotionally exhausting environment. Compassion fatigue among caregivers in turn has been associated with less effective delivery of care. Having compassion for others entails self-compassion. In Kristin Neff’s research, self-compassion includes self-kindness, a sense of common humanity, and mindfulness. Both mindfulness and self-compassion involve promoting an attitude of curiosity and nonjudgment towards one’s experiences. Research suggests that mindfulness interventions, particularly those with an added lovingkindness component, have the potential to increase self-compassion among health care workers. Enhancing focus on developing self-compassion using MBSR and other mindfulness interventions for health care workers holds promise for reducing perceived stress and increasing effectiveness of clinical care.

Greater strengths of character and recovery from illness

The Journal of Positive Psychology

Dedicated to furthering research and promoting good practice

Volume 1, 2006 – Issue 1

How are character strengths related to recovery? A retrospective web-based study of 2087 adults found small but reliable associations between a history of physical illness and the character strengths of appreciation of beauty, bravery, curiosity, fairness, forgiveness, gratitude, humor, kindness, love of learning, and spirituality. A history of psychological disorder and the character strengths of appreciation of beauty, creativity, curiosity, gratitude, and love of learning were also associated. A history of problems was linked to decreased life satisfaction, but only among those who had not recovered. In the case of physical illness, less of a toll on life satisfaction was found among those with the character strengths of bravery, kindness, and humor, and in the case of psychological disorder, less of a toll on life satisfaction was found among those with the character strengths of appreciation of beauty and love of learning. We suggest that recovery from illness and disorder may benefit character.