Eficacia de la psicoterapia grupal de aceptación y compromiso -act- en pacientes de fibromialgia: un estudio controlado randomizado a 6 meses
- Autores: José Antonio Guallar Claver
- Directores de la Tesis: Santiago Gascón Santos (dir. tes.), Javier García Campayo (dir. tes.)
- Lectura: En la Universidad de Zaragoza ( España ) en 2014
- Idioma: español
- Tribunal Calificador de la Tesis: Jorge Javier Osma López (presid.), Cruz Bartolomé Moreno (secret.), Marcelo Marcos Piva Demarzo (voc.)
- Materias:
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- Resumen
In the last decade, there has been a burgeoning interest about 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 and the role of pain acceptance as a mediator of treatment outcomes in FM.
With the arrival of the third wave of behavior modification, after the call cognitive revolution, there have been a series of experiential and contextual therapies, such as Behavioral Dialectical Therapy -DBT-, Functional Analytic Psychotherapy -FAP-, Integrative Therapy Couple -IBCT-, Mindfulness Based Cognitive Therapy -MBCT-, among several others. They share have been introduced into fields hitherto were treated farthest therapies a basically empirical approach and emphasize elements such as acceptance, mindfulness, cognitive deactivation, dialectics, values or spirituality. The Acceptance and Commitment Therapy -ACT- (Hayes et al, 1999; Luciano and Wilson, 2002) has been developed from this perspective and is very powerful for any psychotherapeutic process framework.
A total of 156 patients with FM according to 1990 ACR criteria were enrolled at primary healthcare centres in the city of Zaragoza (Spain). Patients were randomly assigned to group ACT (GACT), recommended pharmacological treatment (RPT; pregabalin + duloxetine), and wait-list (WL). The primary endpoint was functional status. Secondary endpoints included catastrophising, pain acceptance, pain, anxiety, depression, and HRQoL. The differences between groups were calculated by means of linear mixed-effects models (Intention-to-Treat approach) and the mediational models through path analyses.
Significant improvements in all study variables were obtained in patients receiving GACT compared with RPT and WL (medium-large effect size in most variables). The proportion of FM patients with 20% functional status improvement at post-treatment was 80% for GACT and 15% for RPT. The absolute risk reduction with GACT was 65.2% (95%CI 49.8% -80.7%) and the number needed to treat was 2 (95%CI 1.2-2.0). Changes in pain acceptance significantly and partially mediated the relationship between study condition and HRQoL.
The results of the present study, combined with findings from a previous RCT, confirm that ACT is effective for improving several aspects of FM patients. These findings are discussed in relation to previous research on FM treatment.
