Differential efficacy of written emotional disclosure for subgroups of fibromyalgia patients.

Br J Health Psychol. Author manuscript; available in PMC 2009 Oct 8.
Published in final edited form as:

Objectives

To identify differential health benefits of written emotional disclosure (ED).

Methods

Pain-coping style and demographic characteristics were examined as potential moderators of ED treatment efficacy in a randomized controlled trial with female fibromyalgia patients.

Results

Of three pain-coping styles, only patients classified as interpersonally distressed (ID) experienced significant treatment effects on psychological well-being, pain, and fatigue. Treatment effects on psychological well-being were also significantly greater for patients with a high level of education.

Conclusions

Patients with an ID-coping style and/or high education appear to benefit most from ED.

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Sustained pain reduction through affective self-awareness in fibromyalgia: a randomized controlled trial.

J Gen Intern Med. 2010 Oct;25(10):1064-70. doi: 10.1007/s11606-010-1418-6. Epub 2010 Jun 8.

Hsu MC1, Schubiner H, Lumley MA, Stracks JS, Clauw DJ, Williams DA.

Affect and how it is regulated plays a role in pain perception, maintenance of pain, and its resolution. This randomized, controlled trial evaluated an innovative affective self-awareness (ASA) intervention, which was designed to reduce pain and improve functioning in individuals with fibromyalgia.

PARTICIPANTS AND METHODS:

Forty-five women with fibromyalgia were randomized to a manualized ASA intervention (n = 24) or wait-list control (n = 21). The intervention began with a one-time physician consultation, followed by 3 weekly, 2-h group sessions based upon a mind-body model of pain. Sessions focused on structured written emotional disclosure and emotional awareness exercises. Outcomes in both conditions were measured by a blinded assessor at baseline, post-intervention, and 6-month follow-up.

MEASURES:

The primary outcome was pain severity (Brief Pain Inventory); secondary outcomes included tender-point threshold and physical function (SF-36 Physical Component Summary). Intent-to-treat analyses compared groups on outcomes using analysis of covariance and on the proportion of patients achieving ≥ 30% and ≥ 50% pain reduction at 6 months.

RESULTS:

Adjusting for baseline scores, the intervention group had significantly lower pain severity (p < 0.001), higher self-reported physical function (p < 0.001), and higher tender-point threshold (p = 0.02) at 6 months compared to the control group. From baseline to 6 months, 45.8% of the ASA intervention group had ≥ 30% reduction in pain severity, compared to none of the controls (p < 0.001).

CONCLUSIONS:

The affective self-awareness intervention improved pain, tenderness, and self-reported physical function for at least 6 months in women with fibromyalgia compared to wait-list control. This study suggests the value of interventions targeting emotional processes in fibromyalgia, although further studies should evaluate the efficacy of this intervention relative to active controls.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955480/

Emotional disclosure interventions for chronic pain: from the laboratory to the clinic.

Transl Behav Med. 2012 Mar;2(1):73-81. doi: 10.1007/s13142-011-0085-4.

Lumley MA1, Sklar ER, Carty JN.

Life stress and the avoidance of negative emotions may contribute to chronic pain. The technique of written or spoken emotional disclosure can reverse emotional avoidance and improve health, and 18 randomized studies have tested it among people with chronic pain. We review these studies to provide guidance for the clinical use of this technique. The benefits of emotional disclosure for chronic pain are quite modest overall. Studies in rheumatoid arthritis show very limited effects, but two studies in fibromyalgia suggest that disclosure may be beneficial. Effects in other populations (headaches, cancer pain, pelvic pain, abdominal pain) are mixed. Moderator findings suggest that some patients are more likely to benefit than others. Emotional disclosure has been tested in well-controlled efficacy trials, leaving many unanswered questions related to translating this technique to practice. Issues needing further study include determining disclosure’s effects outside of randomized controlled trials, identifying the optimal pain populations and specific individuals to target for disclosure, presenting a valid rationale for disclosure, selecting the location and method of disclosure, and choosing between cognitive-behavioral or emotional disclosure techniques.

https://www.ncbi.nlm.nih.gov/pubmed/22905067

full text

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419371/