Psychological Flexibility Is Key for Reducing the Severity and Impact of Fibromyalgia

Severity of Pain Catastrophizing and Its Associations With Cognitive Flexibility and Self-Efficacy in Patients With Rheumatoid Arthritis

BACKGROUND

Pain catastrophizing in patients with rheumatoid arthritis exacerbates negative pain-related outcomes, such as anxiety, depression, and pain intensity. Therefore, it is essential to investigate the severity of pain catastrophizing and the factors contributing to it among these patients. The present study aimed to assess the severity of pain catastrophizing and its association with cognitive flexibility and self-efficacy in a sample of Iranian patients with rheumatoid arthritis.

METHODS

A descriptive correlational study was conducted on 220 rheumatoid patients referred to a rheumatology clinic affiliated with Birjand University of Medical Sciences, Birjand, Iran. The instruments used to collect data included a demographic form, the Pain Catastrophizing Scale, the Cognitive Flexibility Inventory, and the Arthritis Self-Efficacy Scale. The data were analysed using SPSS version 24.

RESULTS

The mean age of the participants was 53.25 ± 12.41 years, and the mean duration of their disease was 6.63 ± 3.39 years. The majority of participants, specifically 61.8%, reported high levels of pain catastrophizing. An inverse and significant correlation was found between pain catastrophizing and cognitive flexibility (p < 0.001). Likewise, pain catastrophizing exhibited an inverse and significant correlation with self-efficacy and all its dimensions (p < 0.001). The results of the multiple linear regression analysis indicate that the final significant predictors of pain catastrophizing were cognitive flexibility (β = -0.34, p < 0.001) and self-efficacy (β = -0.53, p < 0.001). These predictors were found to significantly explain 51% of the variance in catastrophizing.

CONCLUSIONS

Through psychosocial interventions aimed at enhancing pain self-efficacy and cognitive flexibility, healthcare providers can hope to reduce pain catastrophizing and its adverse effects in patients with rheumatoid arthritis.

How to Promote Walking in Women with Fibromyalgia: A Look at Catastrophizing, Goal Conflict, and Avoidance from a Self-Emotional Regulatory Perspective

The aim of this study was twofold: to explore the concordance between two measures of physical activity (accelerometer and IPAQ) among female fibromyalgia (FM) patients, as well as to examine the impact of psychosocial variables (catastrophism, activity avoidance) on walking among these patients. Helplessness, activity avoidance, and commitment to physical activity were evaluated in 132 FM women. After the first assessment, an accelerometer was placed by a psychologist on each participant for seven consecutive days. Eight days later, accelerometers were collected, and participants were evaluated again using the IPAQ. Two models were tested to analyze mediation and a moderated mediation effect. The mediating role of activity avoidance between helplessness and minutes walked was corroborated regarding the objective measure of walking. The effect of helplessness on minutes walked during a week was mediated by activity avoidance and assessed by accelerometers. Cognitive variables played a contextual role when trying to promote exercise. Activity avoidance must be understood as a key variable in physical activity promotion, specifically in the promotion of walking with the aim to do exercise in individuals with FM.

Which outcome variables are associated with psychological inflexibility/flexibility for chronic pain patients? A three level meta-analysis

The psychological flexibility model can be seen as a basis for an integrated and progressive psychological approach to chronic pain management. Some researchers suggest that psychological flexibility and inflexibility represent distinct processes and constructs. This meta-analysis is the first to provide a summary estimate of the overall effect size for the relationship between psychological (in)flexibility and common outcomes among chronic pain patients. The research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, https://www.crd.york.ac.uk/PROSPERO/), registration number CRD42021285705. Four databases were searched (PsycINFO; PubMed; Web of Science, CINAHL) along with reference lists. Thirty-six cross-sectional studies were included (7,779 participants). Meta-analyses (random effects model) indicated a significant medium negative association between psychological flexibility and pain intensity or functional impairment. The present study also indicated a significant small to medium association between psychological inflexibility and pain intensity, a nearly large association between psychological inflexibility and functional impairment as well as the quality of life, and a large association between psychological inflexibility and anxiety/depression. Due to the limited number of included studies, the relationship between risk behavior and psychological inflexibility may not be significant. Types of countries and instruments measuring psychological inflexibility may explain part of the heterogeneity. These findings may carry significant implications for chronic pain patients regarding the potential relationship between psychological inflexibility or flexibility and these outcomes. It may consequently form the basis for more robust testing of causal and manipulable relationships.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285705.

Coping and Beliefs as Predictors of Functioning and Psychological Adjustment in Fibromyalgia Subgroups

Objectives

Research has pointed to two profiles of persons with fibromyalgia according to differences in functionality, thus distinguishing between functional and dysfunctional patients. The role of psychological factors underlying such clusters is unclear. This study aims to explore the contribution of pain beliefs and coping on fibromyalgia clustering.

Methods

A cluster analysis was performed to classify 238 women with fibromyalgia using the Fibromyalgia Impact Questionnaire and the Beck Depression Inventory as clustering variables. Cluster differences in physical functioning, depression, pain beliefs, coping, and age were then calculated (Student's t-test). Finally, a binary logistic regression was conducted to study the unique contribution of age, beliefs, and coping on cluster classification.

Results

Two clusters were revealed. Cluster 1 had a poor adaptation to fibromyalgia regarding physical functioning and depression. They generally embraced less adaptive beliefs (i.e., disability, harm, emotion, and requests) and coping strategies (i.e., guarding, resting, and asking for assistance). Cluster 2 showed a better adaptation to fibromyalgia and adopted more favorable beliefs (i.e., control) and coping strategies (i.e., exercise and task persistence). Cluster differences in age were significant but small. The backward binary logistic regression suggested a final model with six predictors (guarding, task persistence, harm, emotion, solicitude, and age) that explained 31% of the variance of group membership. Discussion. These results suggest that only a subset of psychological variables uniquely and independently contribute to functional/dysfunctional group membership. The results support the need to address psychological components in the management of fibromyalgia and point to a subset of preferred target beliefs and coping strategies.