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Approach as a key for success: Reduced avoidance behaviour mediates the effect of exposure therapy for fibromyalgia
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0003-0088-8719
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Functional Area Medical Psychology, Karolinska University Hospital Solna, Stockholm, Sweden.
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2019 (English)In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 122, article id UNSP 103478Article in journal (Refereed) Published
Abstract [en]

Fibromyalgia (FM) is a prevalent chronic pain disorder associated with large suffering and substantial societal costs. Pain-related avoidance behaviour and hypervigilance to bodily symptoms are common in FM and contribute in maintaining and exacerbating the disorder. Exposure therapy targeting avoidance behaviours and hypervigilance has shown promise in the treatment of FM. The present study investigated mediators of treatment outcome in exposure therapy for FM. We used data from a randomised trial, where 140 participants were allocated to 10-week Internet-delivered exposure therapy or to a waiting-list control condition. The main outcome variable (FM symptoms) and the hypothesized mediators (FM-related avoidance behaviour, mindful non-reactivity and FM-related worry) were measured weekly throughout treatment. Mediation analyses were conducted using linear mixed effects models with bootstrap replication and time-lagged analysis. Results indicated that all three process variables were significant mediators of FM severity. However, in the time-lagged analyses, only FM-related avoidance behaviour displayed a unidirectional relationship over time with FM symptoms, suggesting a causal effect. Thus, results illustrate that changes in avoidance behaviour mediate the outcome of exposure on FM symptoms, which implies that avoidance behaviour is an important treatment target in exposure therapy.

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 122, article id UNSP 103478
Keywords [en]
Mediation analysis, Exposure-based therapy, Fibromyalgia, Avoidance behaviour, Cognitive behaviour therapy
National Category
Psychology
Identifiers
URN: urn:nbn:se:oru:diva-77751DOI: 10.1016/j.brat.2019.103478ISI: 000491674300004PubMedID: 31585343Scopus ID: 2-s2.0-85072727352OAI: oai:DiVA.org:oru-77751DiVA, id: diva2:1368034
Funder
Stockholm County CouncilThe Karolinska Institutet's Research Foundation
Note

Funding Agencies:

Söderstrom Wittig Foundation  

Fredrik and Ingrid Thuring Foundation

Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved

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