Fibromyalgia (FM) is a common and disabling pain condition, which is notoriously difficult to treat. Traditional non-pharmacological therapies for pain, such as cognitive behavioral therapy, are of benefit, but their efficacy may be limited by a failure to directly address stress and emotional dysregulation. A substantial literature reveals that many patients with FM have increased lifetime trauma or stress and emotional regulation problems, and the subsequent failure to process difficult emotional experiences appears to contribute to pain and other symptoms in many individuals with FM. Emotional exposure and processing treatments are highly successful with trauma and anxiety problems-which are common co-morbidities in patients with FM and other chronic pain conditions. We have solid preliminary data on the efficacy of emotion regulation-based interventions for FM, and the proposed research will test an innovative and promising emotional awareness and exposure intervention. This application combines the clinical research, chronic pain, and FM expertise of two research teams to conduct a 2-site, randomized controlled trial of emotional exposure therapy (EET) against both a standard cognitive-behavioral therapy (CBT;pain coping skills training) and control condition (FM education) in a design that controls for non-specific factors and experimenter allegiance to the different treatments. Adults with FM (N = 270) will be randomized to 1 of 3 treatment groups, which will receive 1 individual and 8 group-format treatment sessions. A comprehensive battery of outcome measures, including both psychophysical pain and objective activity measures, will be assessed at baseline and two post-treatment evaluations over a 1-year follow-up. We will test whether both active treatments are more efficacious than the control condition, and whether EET surpasses CBT on affective outcomes and CBT surpasses EET on behavioral outcomes. This study also will test whether the effects of the interventions are mediated by treatment-specific or more general change processes, including improved autonomic regulation as indexed by heart rate variability, increased emotional awareness and expression, and improved pain coping. Finally, because FM is increasingly recognized as heterogeneous and only a subset of patients have any given risk factor-including stress and emotional avoidance-we will explore several proposed moderators of the effects of EET and CBT, including trauma history, emotion regulation abilities, depression, and interpersonal difficulties. This research has the potential to greatly advance treatment options and success rates for FM and other conditions that are influenced by stress and emotional regulation problems, and it will illuminate change processes, individual differences, and treatment matching or tailoring.

Public Health Relevance

Fibromyalgia (FM) is a common and disabling pain condition, and currently available medical and behavioral treatments have limited effect, perhaps because they do not address the unresolved stress and emotion regulation problems that are found in many patients with FM. In a large sample of patients with FM, we will test the effects of an innovative emotional exposure and processing treatment that targets stress resolution, by comparing it with cognitive-behavioral therapy and a placebo control condition. We also will test proposed mediators of the interventions, including improved autonomic regulation, and explore which subgroups of patients benefit the most from each approach.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR057808-04
Application #
8512557
Study Section
Special Emphasis Panel (ZRG1-CFS-M (90))
Program Officer
Serrate-Sztein, Susana
Project Start
2010-08-15
Project End
2015-06-30
Budget Start
2013-07-01
Budget End
2014-06-30
Support Year
4
Fiscal Year
2013
Total Cost
$589,914
Indirect Cost
$86,394
Name
Wayne State University
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
001962224
City
Detroit
State
MI
Country
United States
Zip Code
48202
Lumley, Mark A; Keefe, Francis J; Mosley-Williams, Angelia et al. (2014) The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: a randomized clinical trial. J Consult Clin Psychol 82:644-58
Beyer, Jonathan A; Lumley, Mark A; Latsch, Deborah V et al. (2014) Computer-based written emotional disclosure: the effects of advance or real-time guidance and moderation by Big 5 personality traits. Anxiety Stress Coping 27:477-93
Hijazi, Alaa M; Lumley, Mark A; Ziadni, Maisa S et al. (2014) Brief narrative exposure therapy for posttraumatic stress in Iraqi refugees: a preliminary randomized clinical trial. J Trauma Stress 27:314-22
Slavin-Spenny, Olga; Lumley, Mark A; Thakur, Elyse R et al. (2013) Effects of anger awareness and expression training versus relaxation training on headaches: a randomized trial. Ann Behav Med 46:181-92
Lumley, Mark A; Leisen, James C C; Partridge, R Ty et al. (2011) Does emotional disclosure about stress improve health in rheumatoid arthritis? Randomized, controlled trials of written and spoken disclosure. Pain 152:866-77
Lumley, Mark A; Cohen, Jay L; Borszcz, George S et al. (2011) Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol 67:942-68