Study of fibromyalgia with two psychological treatments

In order to better understand the complexity and affectation that fibromyalgia causes in the lives of people who suffer from it, and to respond to their psychological needs, this work was born, which is divided into two well differentiated studies: Descriptive study of fibromyalgia and Effect of two psychological treatments.

Study of fibromyalgia with two psychological treatments.

The purpose of the first study is to describe the population of people affected by fibromyalgia in relation to historical-biographical factors, the impact of the disease, as well as psychological and psychopathological characteristics. For this purpose, these characteristics are compared in people with and without fibromyalgia.

The second study has the objective of evaluating the efficacy and differential effects of two psychological treatments, in order to design a protocol for psychological assistance that is adapted to the needs of each patient and to an optimal cost-benefit ratio. To this end, two treatments with a cognitive-behavioral approach are compared, one individual with electromyographic biofeedback, and the other group without biofeedback, also comparing the change that patients receiving these treatments have with a control group without treatment.

For this, in study 1 a sample of 190 people was used, of them 140 affected by fibromyalgia, and 50 unaffected.

For its part, in study 2 a sample of 88 affected people was used, divided into three groups: 33 who received individual cognitive-behavioral treatment with biofeedback, 33 who received group cognitive-behavioral treatment, and 22 who did not receive any treatment, constituting the control group.

Methodologically, a descriptive, comparative, cross-sectional design was used in study 1;  and in study 2 an experimental methodology, administering 2 experimental treatments, comparing the effects of both treatments with the control group made up of people affected by the same disease.

Results of Study 1 for Fibromyalgia.

Fibromyalgia symptoms in many of the people affected by this disease (47.1%) develop between the ages of 30 and 49 years. The results of study 1, which analyzes biographical and medical-psychological data of people with fibromyalgia, have highlighted that people with fibromyalgia compared to those without this disease:

1. They have had a level of traumatic situations experienced throughout the life cycle similar to people without fibromyalgia; however, they have had significantly more experiences of emotional shock and whiplash-effect traffic accidents.
2. During childhood they had significantly more pain related to growth, a higher level of nervousness and concentration difficulties, as well as more uncomfortable childhood situations (in hospices, families with serious problems such as violence, alcoholism).
3. They have suffered significantly more illnesses and operations. In addition, they currently manifest significantly more physical symptoms (muscle pain, exhaustion, joint pain, 24-hour discomfort after exertion, headache, tingling or burning, dry mucous membranes, injuries, chest pain, hypersensitivity to temperature, hypersensitivity to sounds, dizziness and nausea, stomach upset, pharyngitis, urge to urinate, cold in extremities, pain in tongue and jaw, swelling of extremities, constipation and rhinitis, restless leg syndrome, allergies, menstrual pain, and lack of appetite), more symptoms psychological problems (anxiety, depression and sleep disorders), more cognitive problems (disorientation, memory loss, poor concentration, difficulty reading and mental confusion).
4. They have visited significantly more professionals of all kinds (traditional doctors, alternative medicine professionals, psychologists, witch doctors), they have a significantly lower level of satisfaction with the traditional doctors consulted, but a similar level of satisfaction to the rest of the professionals (alternative medicine, psychologists, witch doctors).
5. When it comes to family relationships, people with fibromyalgia perceive a significantly greater sense of unconditionality from their partners, but they also show a higher level of discussion with them. However, they have a similar level of breakup or divorce situations. They have significantly more difficulties with children, but the disease does not significantly affect family bonding.
6. They have significantly greater difficulties in friendship relationships, they perceive that the disease prevents them from seeing friends, making new friends, and they do not feel understood by them.
7. They had to give up their work significantly more due to the disability derived from the disease, and they perceive a lower level of support from co-workers.
8. They have suffered a significant decrease in their economic level due to the effect of the disease.
9. They use significantly more positive and negative pain coping strategies.
10. They perceive significantly less control over pain, exhaustion and mood.
11. They have less capacity to be happy due to illness (happiness), more feeling of being victims and of being a burden to others, however, they have a similar level of psychological strength, and less feeling of guilt.
12. They feel significantly less understood by society, health professionals, family, friends and co-workers, yet they feel equally understood by their partner, children and parents.
13. They have a significantly lower perception of their quality of life today, but a similar perception of quality of life in their youth.
14. They have a significantly higher level of functional disability, pain and exhaustion compared to people who do not suffer from this disease.
15. They have a similar level of self-concept; however, they show a significantly lower level of self-esteem.
16. They show a significantly higher capacity for cooperation-empathy (understanding the problems and needs of others and cooperation with them), and for conscientiousness (meticulousness and love of order), while they have a significantly lower level of emotional control ( control of states of tension associated with emotional experiences) and emotional stability (anxiety, vulnerability, emotionality and impulsivity), however, in both conditions average scores are obtained. There are no significant differences in the rest of the personality dimensions (energy: dynamism, dominance; affability: cordiality; tenacity: perseverance; impulse control; open-mindedness: openness to culture, openness to experience).
17. They have significantly higher scores in all the psychopathological symptoms evaluated (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism), as well as in the general symptomatic index (GSI), in the index of positive symptoms (PST) and in the index of distress by the symptoms (PSDI).

In addition, the results of study 1 that analyzes biographical and medical-psychological data, show that in people with fibromyalgia:

1. 1% have or have had a family member with fibromyalgia or affected by similar symptoms.
2. 1% have or have had a family member with fibromyalgia or affected by similar symptoms.
3. 6% of those affected had a psychological or psychiatric history prior to this disease while 76.4% did not present a psychological or psychiatric history before suffering it.
4. In 64.3% the symptoms develop progressively together with a triggering event, in 32.9% of cases the evolution is progressive and without any triggering event, and only in 1.4% fibromyalgia is triggered suddenly.
5. Regarding the age of onset of symptoms, in 10.7% of cases they appear during childhood-adolescence, 20% between 20 and 30 years, 47.1% between 30 and 50 years, and 12.7% after 50 years. Consequently, symptoms in many of the people affected by this disease (47.1%) develop between the ages of 30 and 49 years.
6. The mean time between the onset of symptoms and the diagnosis of fibromyalgia was 10 years. The number of tests performed to diagnose it ranged from 2 to 17, with a mean of 9; and 59.3% received from 2 to 5 diagnoses, with 4 being the mean number of diagnoses received.
7. The number of symptoms suffered by people with this disease, experiences a considerable increase over time (13%).
8. Fibromyalgia has a high comorbidity with other syndromes and diseases. 56.4% of people say they suffer or have suffered between 4 and 6 different diseases, while only 1.4% have not suffered any disease other than fibromyalgia. The most frequent diseases were: chronic fatigue syndrome(70.7%), irritable bowel syndrome (61.3%), restless leg syndrome (55%), myofascial pain (50%), irritable bladder (40, 7%), rheumatic arthritis (36.4%), night apnea (32.2%), thyroidism (17.2%), Rinaud’s syndrome (5.7%), and diabetes (4.2%).
9. Regarding the treatments received and their efficacy, a high percentage of the people in this study (46.4%) have tried between 4 and 6 different pharmacological treatments.  29.3% say they have improved due to personal causes and circumstances, 25% due to traditional medical treatment and 13.6% due to alternative treatment. When asked if they wish to receive psychological treatment, if they have not received it yet, only 15.7% reject psychological treatment.
10. The activities that people with fibromyalgia do the most are walking, swimming, gymnastics, yoga and cycling, having a medium-high level (5-7.8) of satisfaction in them.
11. The coping strategies most used by people with this disease: medication (75.7%), distraction through thinking (64.3%), carrying out some activity (57.1%), thinking- positive visualization (43.6%), paying attention to pain or monitoring changes, and setting small challenges (42.1%).
12. In general, affected people are quite focused on the disease (almost 23% of those affected thinks about the disease between 30 and 50% of the day; and a similar percentage think between 60 and 100% of the time).
13. 7% of people with fibromyalgia believe that its etiology is related to psychological or personal factors, 13.6% to physical factors, and 12.1% to the interaction of both factors. And 69.3% consider that personal factors or circumstances influence their disease.
14. 52% accept the disease in a high degree (7-10), and 25.8% in a medium degree (4-6), only 18.6% of people with fibromyalgia have a low level of acceptance (0- 3) of the disease.
15. 6% have been granted a disability, 21.6% have a work disability and 36.4% receive some help for their illness (whether economic, fiscal, or functional, such as parking).

Results of Study 2 for Fibromyalgia.

The results of study 2, in which the efficacy of two psychological treatments is analyzed by comparing them with a control group, confirm that patients who underwent some treatment compared to control significantly:

• Their feelings of well-being in their relationship increased.
• They lowered their anxiety level.
• Their level of anxiety as a personality trait decreased.
• They decreased the expression of angry feelings in angry situations.
• Their stress level decreased (unpleasant feelings of bodily excitement, related to the context, maladaptation; feelings of tension, restlessness, agitation).
• They increased the level of arousal (cortical alert that affects the circadian rhythms of wakefulness-sleep, regardless of the context; feeling of being clear, fresh).

Complementarily, the results of the analysis of variance also showed that the experimental participants showed a trend significant change in the following variables: psychological well-being, anxiety symptoms, hostility symptoms, index of positive symptoms and depression.

On the other hand, the comparison of the differential effects of both treatments did not confirm statistically significant differences between both. However, and although the differences were not statistically significant, it was highlighted that the patients of experimental treatment 1 (individual treatment with electromyographic biofeedback) improved more in the level of functional disability, pain and exhaustion, the expression of anger and arousal level; while the patients of experimental treatment 2 (group treatment without biofeedback), improved more in self-concept, subjective psychological well-being, and the number of psychopathological symptoms; and the level of stress.

The discussion emphasizes the relevance of continuing to deepen the understanding of the disease, as well as the development of proposals for complementary psychological intervention with medical treatments.