M. Pilar Martínez

Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial

Sleep disturbances play an important role in the exacerbation of pain and other troubling symptoms reported by patients with fibromyalgia (FM). The objective of this trial was to analyze the efficacy of a cognitive-behavioral therapy for insomnia (CBT-I) versus a sleep hygiene (SH) education program at improving sleep and other clinical manifestations in FM. Sixty-four FM women with insomnia were randomly assigned to the CBT-I or the SH groups, and 59 completed the treatments (30 in the CBT-I group and 29 in the SH group). Participants completed several self-report questionnaires at pre-, post-treatment and follow-ups. The CBT-I group reported significant improvements at post-treatment in several sleep variables, fatigue, daily functioning, pain catastrophizing, anxiety and depression. The SH group only improved significantly in subjective sleep quality. Patients in the CBT-I group showed significantly greater changes than those in the SH group in most outcome measures. The findings underscore the usefulness of CBT-I in the multidisciplinary management of FM.

Relationships Between Physical Symptoms, Emotional Distress, and Pain Appraisal in Fibromyalgia: The Moderator Effect of Alexithymia

ABSTRACT Alexithymia is a personality construct that is frequently identified in fibromyalgia (FM). Previous studies have explored the relationship between alexithymia and emotional distress in this disease. Yet, the additional link with factors of pain appraisal is unknown. This study examined the moderating effect of alexithymia in the relationship between emotional distress and pain appraisal in 97 FM women. A control group of 100 healthy women also participated in the study. All participants completed several self-reports about pain experience, sleep quality, impairment, emotional distress, pain appraisal, and alexithymia. FM women showed significantly more difficulty in identifying and describing feelings, but less externally oriented thinking than healthy women. In the clinical group, difficulty in identifying feelings and difficulty in describing feelings significantly correlated with lower sleep quality, higher anxiety and depression, and increased pain catastrophizing and fear of pain. Difficulty in describing feelings significantly correlated with higher pain experience and vigilance to pain. Externally oriented thinking was not correlated with any of the clinical variables. Difficulty in identifying feelings moderated the relationship between anxiety and pain catastrophizing, and difficulty in describing feelings moderated the relationship between anxiety and fear of pain. Implications of the findings for the optimization of care of FM patients are discussed.

Temporal preparation and inhibitory deficit in fibromyalgia syndrome

Cognitive deficits in fibromyalgia may be specifically related to controlled processes, such as those measured by working memory or executive function tasks. This hypothesis was tested here by measuring controlled temporal preparation (temporal orienting) during a response inhibition (go no-go) task. Temporal orienting effects (faster reaction times for targets appearing at temporally attended vs. unattended moments) and response inhibition were impaired in fibromyalgia compared to the control group. It is concluded that frontal networks underlying attentional control (temporal orienting and response inhibition) can be a dysfunctional neurocognitive mechanism in fibromyalgia.

Sleep disturbances in fibromyalgia syndrome: the role of clinical and polysomnographic variables explaining poor sleep quality in patients

BACKGROUND Sleep complaints are one of the most frequent and relevant symptoms that characterize fibromyalgia syndrome (FMS). However, objective sleep disturbances have not been consistently described across FMS studies. It is therefore commonly accepted that FMS patients experience sleep misperception, even though no studies have investigated the contribution of polysomnographic parameters to determine subjective sleep quality in FMS. We aimed to compare sleep variables (polysomnographic parameters and subjective sleep quality) between FMS patients and healthy controls. Furthermore, we also aimed to define the predictors of subjective sleep quality in FMS. METHODS We performed in-home polysomnography to 99 women (53 FMS patients and 36 healthy controls). We also collected subjective ratings of sleep quality, daytime sleepiness, pain, depression, and anxiety. RESULTS Multivariate analysis showed that groups differed in polysomnographic parameters (p = 0.015)--after accounting for age, body mass index, and antidepressant consumption. Specifically, FMS patients exhibited lower sleep efficiency, greater percentage of stage N1 and wakefulness, and more frequent awakenings than controls (p-values < 0.05). Patients also complained about poorer subjective sleep quality (p <0.001). Percentage of time awake (as obtained by polysomnography), depression levels, and antidepressant consumption predicted self-reported sleep quality in FMS patients (adjusted R2 = 0.33, p <0.001). CONCLUSIONS One night of in-home polysomnography supports the hypothesis that women with FMS show polysomnographic alterations compared to age-matched controls. In addition, the time spent awake is the best predictor of subjective sleep quality, although greater levels of depression and antidepressant consumption might result in exaggerated complaints. These findings contribute to our understanding of FMS symptoms and its management.

Understanding the relationship between attachment style, pain appraisal and illness behavior in women

Insecure attachment has been hypothesized to be an important factor for understanding the experience of pain. Considering the Attachment-Diathesis Model of Chronic Pain developed by Meredith, Ownsworth, and Strong (2008), this cross-sectional study examines the relationship between attachment style, pain appraisal, and illness behavior. Two hundred healthy women recruited from community contexts completed a battery of self-report measures including the Short-form McGill Pain Questionnaire, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Vigilance and Awareness Questionnaire, Illness Attitude Scales, Beck Anxiety Inventory, Beck Depression Inventory, and the Experiences in Close Relationships Questionnaire-Revised. The results showed that attachment anxiety was significantly correlated with pain catastrophizing, pain-related fear, depression, and illness behavior. However, attachment anxiety and avoidance were not associated with pain intensity. Attachment anxiety moderated the relationship between pain catastrophizing and illness behavior, and between pain hypervigilance and illness behavior. Pain catastrophizing and pain-related fear partially mediated the effect of attachment anxiety on illness behavior. The findings highlight potential contributions of attachment style and pain appraisal for explaining illness behavior. This study supports earlier reports and suggests the usefulness of assessing attachment style for early identification of people who might exhibit a high risk of dysfunctional responses to pain. Our findings also suggest that increasing peoples insight about their attachment style and modifying some associated dysfunctional responses may be important in the treatment of chronic pain.

Somatosensory amplification in hypochondriasis and panic disorder

The aim of this study is to explore the differences and similarities of Somatic Amplification (SA) in both panic and hypochondriasis disorders. An additional objective is to validate the Somatosensory Amplification Scale (SSAS) for use in our cultural context. For these purposes, 34 patients (17 with hypochondriasis and 17 with panic disorder; DSM-III-R criteria) completed the following questionnaires: SSAS, State–Trait Anxiety Inventory, Beck Depression Inventory, MMPI Hypochondriasis Scale, Illness Attitude Scales and Illness Behaviour Questionnaire. The SSAS showed a satisfactory internal consistency (Cronbachs α=0·83), and revealed two components: ‘Internal Stimulus Amplification’ and ‘External Stimulus Amplification’. No significant differences were observed between patients with hypochondriasis and patients with panic disorder on the SSAS. In both groups the SSAS was associated with health concerns (Illness Attitude Scales). The best predictors of SA were Bodily Preoccupation (Illness Attitude Scales) in the hypochondriasis group, and Depression in the panic disorder group. Copyright

An exploratory study of the efficacy of a Cognitive–Behavioral Treatment for hypochondriasis using different measures of change

Abstract The authors analyzed the efficacy of a cognitive–behavioral treatment applied to 12 patients diagnosed as suffering from hypochondriasis. The therapeutic procedure used was an adaptation of the program developed by Salkovskis and Warwick (Salkovskis, 1989; Salkovskis & Warwick, 1986; Warwick, 1989; Warwick & Salkovskis, 1989 1990). Several methods of assessment (statistical significance and clinical significance) were used to evaluate changes. As a group, the patients in the posttreatment phase showed significant improvement both statistically and clinically, and this was maintained at 2- and 6-month follow-up. Likewise, normalization of the scores was achieved in several of the measures. At an individual level and according to the Reliable Change Index (Jacobson & Truax, 1991), 75% of the patients showed noticeable improvements in hypochondriacal attitudes. Future lines of investigation in the evaluation of change in hypochondriacal preoccupations are suggested.

Spanish version of the Pain Vigilance and Awareness Questionnaire: psychometric properties in a sample of women with fibromyalgia

Excessive attention to pain is a common psychological characteristic among people who suffer from chronic pain. The Pain Vigilance and Awareness Questionnaire (PVAQ) is an internationally accepted tool to assess this feature, although there is no validated version of this measure for Spanish people with fibromyalgia. Since this pain syndrome mainly affects women, the aim of this study was to determine the psychometric properties of the PVAQ in Spanish women with fibromyalgia. A group of 242 women diagnosed with fibromyalgia aged between 20 and 66 years participated in the study. The goodness of fit of several structures of the PVAQ reported in previous studies was compared via confirmatory factor analysis. A two-factor solution (active vigilance and passive awareness) of the 9-item shortened version (PVAQ-9) was identified as the most appropriate (RMSEA = .08, NNFI = .96, CFI = .97, GFI = .87). It showed good reliability (internal consistency α = .82), convergent validity and divergent validity (p < .01). The optimal cutoff point for identifying fibromyalgia women with worse daily functioning was a score of 24.5, with a sensitivity of .71 and a specificity of .75. The relevance of vigilance to pain for clinical research in fibromyalgia is discussed.

Catastrophizing, Acceptance, and Coping as Mediators Between Pain and Emotional Distress and Disability in Fibromyalgia

Catastrophizing, acceptance, and coping have an important predictive value in chronic pain; however, it is not known which of these variables has the greatest contribution in fibromyalgia (FM). This study explored the mediating role of catastrophizing, acceptance, and coping in the relationship between pain and emotional distress/disability in a FM sample. Ninety-two FM patients and 51 healthy participants controls were evaluated on pain- and psychological-related variables. Catastrophizing, acceptance, behavioral coping, and emotional coping were significantly correlated with emotional distress and/or disability. Catastrophizing had a significant effect as a mediator on the relationship between pain and depression/anxiety. The current management of FM could improve by including cognitive techniques aimed at modifying the negative appraisal of pain.