Online acceptance-based treatment for Fibromyalgia Syndrome: development and evaluation of a new treatment program
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Fibromyalgia Syndrome (FMS) is a disease of unknown etiology that affects up to 3 million Canadians, or 2-10% of the general population (Carruthers & van de Sande, 2005). Acceptance-based behavioural therapy (ABBT) is a relatively recent approach to treating human suffering in general and chronic pain in particular (Hayes, Strosahl, & Wilson, 1999; McCracken, 2005). ABBT treatments have been shown to effectively treat pain, pain-related anxiety, depression, and other behavioural measures of disability (McCracken, 2005; McCracken, Vowles, Gregg, & Almada, 2010; Pear & Simister, 2016, p. 160). In-person treatments can place significant burden on patients and the overall health-care system. Outcomes for online programs can be similar to those for in-person treatment while allowing for increased flexibility for both patients and professionals (Ritterband & Tate, 2009; Strecher, 2007). The current study extended a pilot study (Shay, Tkachuk, Simister, Bailly, & Skrabek, 2011), modifying the previous treatment to a 6 unit program that could be delivered online. Sixty-one participants completed the study, being randomly assigned to an online ABBT plus treatment-as-usual (online ABBT + TAU) group or a treatment-as-usual alone (TAU) group. All participants completed a series of self-report measures at baseline, at post-treatment, and at a 3-month follow-up. Linear mixed modelling supported significant differences between the groups in favour of the ABBT + TAU treatment group on the primary outcome measure (Fibromyalgia Impact Questionnaire-Revised (FIQ-R); F (2, 52.82) = 20.10, p < .0001) following treatment. The online ABBT + TAU group also had significantly greater improvements in depression, pain, acceptance, perceived helplessness, and kinesiophobia. Increased acceptance mediated the effects of treatment on improvements in FMS quality of life and FMS impact, while reduced helplessness mediated the effects of treatment on improvements in level of reported pain. Comments and subjective ratings of improvement were consistent with the quantitative results. Participants rated mindfulness (contact with present moment experience) as the most useful treatment unit.