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Effectiveness of group acceptance and commitment therapy for fibromyalgia: A 6-month randomized controlled trial (EFFIGACT study)

Luciano, Juan V.a,b,*; Guallar, José A.c; Aguado, Jaumea; López-del-Hoyo, Yolandab,d; Olivan, Bárbarab,d; Magallón, Rosab,e; Alda, Martab,f; Serrano-Blanco, Antonia,b; Gili, Margalidag; Garcia-Campayo, Javierb,f

doi: 10.1016/j.pain.2013.12.029

Summary Acceptance and commitment therapy is effective for improving several clinical outcomes in fibromyalgia patients

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 6 months 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.

aResearch and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi del Llobregat, Spain

bPrimary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain

cRegional Office of Education, Culture, & Sports, Government of Aragon, Zaragoza, Spain

dDepartment of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain

ePrimary Healthcare Center Arrabal, Zaragoza, Spain

fDepartment of Psychiatry, Miguel Servet Hospital, Aragon Institute of Health Sciences (I+CS), Zaragoza, Spain

gInstitut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma, Spain

* Corresponding author at: Research and Development Unit, Parc Sanitari Sant Joan de Déu. C/ Dr. Antoni Pujadas 42, 08830 Sant Boi de Llobregat, Barcelona, Spain. Tel.: +34 936406350x1-2540).


Article history:

Received 8 July 2013

Received in revised form 19 December 2013

Accepted 20 December 2013

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

© 2014 International Association for the Study of Pain
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