Open Access Highly Accessed Research article

Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: a randomised controlled trial

Marta Alda1, Juan V Luciano2, Eva Andrés3, Antoni Serrano-Blanco2, Baltasar Rodero4, Yolanda López del Hoyo5, Miquel Roca6, Sergio Moreno5, Rosa Magallón7 and Javier García-Campayo1*

Author Affiliations

1 Servicio de Psiquiatría, Hospital Miguel Servet y Universidad de Zaragoza, Instituto Aragonés de Ciencias de la Salud (I+CS), Red de Actividades Preventivas y de Promoción de la Salud (REDIAPP) (G06/170 and RD06/0018/0017), Avda Isabel La Catolica 1, 5009 Zaragoza, Spain

2 Parc Sanitari Sant Joan de Déu, and Fundación Sant Joan de Déu, Red de Actividades Preventivas y de Promoción de la Salud (REDIAPP) (G06/170 and RD06/0018/0017), c/Dr Antoni Pujadas 40, 08830 Sant Boi de Llobregat, Barcelona, Spain

3 Unidad Epidemiología Clínica, Hospital 12 de Octubre, CIBER Epidemiología y Salud Pública, Avda de Córdoba s/n, 28.041 Madrid, Spain

4 Clínica de Neurociencias, Centro Rodero, c/Ruamayor 11, 39008 Santander, Spain

5 Departamento de Psicología y Sociología, Universidad de Zaragoza, Instituto Aragonés de Ciencias de la Salud (I+CS), Red de Actividades Preventivas y de Promoción de la Salud (REDIAPP) (G06/170 and RD06/0018/0017), c/Pedro Cerbuna 12, 50009 Zaragoza, Spain

6 Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Red de Actividades Preventivas y de Promoción de la Salud (REDIAPP) (G06/170 and RD06/0018/0017), c/Andrea Doria 55, 07014 Palma de Mallorca, Spain

7 Centro de Salud Arrabal, Instituto Aragonés de Ciencias de la Salud (I+CS), Red de Actividades Preventivas y de Promoción de la Salud (REDIAPP) (G06/170 and RD06/0018/0017), Andador Aragües del Puerto 2-4, 50015 Zaragoza, Spain

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Arthritis Research & Therapy 2011, 13:R173  doi:10.1186/ar3496

Published: 23 October 2011

Abstract

Introduction

No randomised, controlled trials have been conducted to date on the efficacy of psychological and pharmacological treatments of pain catastrophising (PC) in patients with fibromyalgia. Our aim in this study was to assess the effectiveness of cognitive-behaviour therapy (CBT) and the recommended pharmacological treatment (RPT) compared with treatment as usual (TAU) at the primary care level for the treatment of PC in fibromyalgia patients.

Methods

We conducted a six-month, multicenter, randomized, blinded, parallel group, controlled trial in which patients were randomly assigned to one of three study arms: CBT (n = 57), RPT (n = 56) and TAU at the primary care level (n = 56). The major outcome of this study was PC in patients with fibromyalgia. The secondary variables were pain acceptance, depression, anxiety, pain, global function and quality of life.

Results

CBT significantly decreased global PC at the six-month follow-up examination with effect sizes of Cohen's d = 0.73 and 1.01 compared with RPT and TAU, respectively. CBT was also more effective than RPT and TAU at increasing pain acceptance at the six-month follow-up examination (effect sizes of Cohen's d = 0.77 and 0.80, respectively). Compared with RPT and TAU, CBT was more effective at improving global function based on the Fibromyalgia Impact Questionnaire (six-month effect sizes Cohen's d = 0.44 and 0.53, respectively) and quality of life based on the European Quality of Life Scale (six-month effect sizes Cohen's d = 0.11 and 0.40, respectively). There were no differences among the three treatments with regard to pain and depression.

Conclusions

CBT shows higher efficacy than RPT and TAU not only in key outcomes in FM, such as function and quality of life, but also in relevant mediators of treatment effects, such as pain catastrophising and pain acceptance.

Trial registration

ISRCTN: ISRCTN10804772

Keywords:
catastrophisation; fibromyalgia; randomised controlled trial; cognitive-behaviour therapy