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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Neural dysregulation in posttraumatic stress disorder: evidence for disrupted equilibrium between salience and default mode brain networks.

Psychosom Med. 2012 Nov-Dec;74(9):904-11. doi: 10.1097/PSY.0b013e318273bf33. Epub 2012 Oct 31.

Sripada RK1, King AP, Welsh RC, Garfinkel SN, Wang X, Sripada CS, Liberzon I.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498527/

ALTERED DEFAULT MODE NETWORK (DMN) RESTING STATE FUNCTIONAL CONNECTIVITY FOLLOWING A MINDFULNESS-BASED EXPOSURE THERAPY FOR POSTTRAUMATIC STRESS DISORDER (PTSD) IN COMBAT VETERANS OF AFGHANISTAN AND IRAQ.

Depress Anxiety. 2016 Apr;33(4):289-99. doi: 10.1002/da.22481.

King AP1,2, Block SR1,2,3, Sripada RK2,4, Rauch S5, Giardino N2, Favorite T1,2,6, Angstadt M2, Kessler D2, Welsh R1,7, Liberzon I1,2,3.

Increased connectivity between DMN and executive control regions following mindfulness training could underlie increased capacity for volitional shifting of attention. The increased PCC-DLPFC rsFC following MBET was related to PTSD symptom improvement, pointing to a potential therapeutic mechanism of mindfulness-based therapies.

https://www.ncbi.nlm.nih.gov/pubmed/27038410

A Network-Based Neurobiological Model of PTSD: Evidence From Structural and Functional Neuroimaging Studies.

Curr Psychiatry Rep. 2017 Sep 19;19(11):81. doi: 10.1007/s11920-017-0840-4.

Akiki TJ1,2, Averill CL1,2, Abdallah CG3,4.

https://www.ncbi.nlm.nih.gov/pubmed/28924828

Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions.

https://www.ncbi.nlm.nih.gov/pubmed/25854674

Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747539/