Academic journal article The International Journal of Behavioral Consultation and Therapy

Effect of Behavioral Activation Treatment on Fibromyalgia-Related Pain Anxiety Cognition

Academic journal article The International Journal of Behavioral Consultation and Therapy

Effect of Behavioral Activation Treatment on Fibromyalgia-Related Pain Anxiety Cognition

Article excerpt

Abstract

Effects of Behavioral Activation Treatment (BAT) on pain anxiety, depression, and pain interference on a 43-year-old female with an 11-year history of chronic fibromyalgia pain are described. Analgesic, anxyiolytic, and antidepressant medications were stabilized prior to participation. Dependent measures were the Behavioral Relaxation Scale, a direct observation measure of relaxed behavior, and self-report measures of depression, pain anxiety and pain interference. A within session pre-post training assessment, embedded in a multiple-baseline-across-relaxed-positions single-subject experimental design, was used. BAT, based on the matching law, was comprised of behavioral relaxation training (BRT), activity-relaxation cycles, engaging in valued activities, and visual feedback of functioning. BRT resulted in an immediate increase in reclined relaxed behaviors with generalization to the upright relaxed position. A 100% improvement from baseline pain interference ratings was obtained following BAT. All four dimensions of pain anxiety declined to normative levels following BAT. Pain anxiety cognition declined without direct intervention. Depression declined to normative levels. Medication usage decreased from beginning to end-of-intervention but rose at follow up. Results were maintained at three-month follow up. Pain anxiety cognition was conceptualized verbal behavior that functioned as an establishing operation (EO) affecting consequences of overt and visceral (emotional) pain behavior. Altering contingencies related to overt healthy behavior delimits the effectiveness of the EO. Further research on BAT and pain anxiety cognition EOs is needed with chronic pain patients with fibromyalgia.

Keywords: Behavioral Relaxation Training (BRT), fibromyalgia, chronic pain patients. pain anxiety.

Introduction

Fibromyalgia (FM) is a rheumatic disorder characterized by a constellation of physical symptoms including chronic, diffuse musculoskeletal pain, "tender points" at various bodily locations, fatigue and sleep disturbance (Wolfe, Smythe, Yunus, et al., 1990). Behavioral complaints include depression, memory deficits and "fibro fog" (Baumstark & Buckelew, 1992). According to White, Speechley, Harth, and Ostbye (1995), FM is one of the most common disorders treated in rheumatology clinics in North America. It is estimated that 5% of women and 1.6% of men suffer from FM (White, Speechley, Harth, & Ostbye, 1999). In addition, FM patients are high utilizers of health care (Bombardier & Buchwald, 1996; Penrod et al., 2004). Unfortunately, there is no definitive physical pathology regarding FM; however, evidence suggests a number of physiological mechanisms including dysregulated pain modulation within the central nervous system, alteration of brainwave patterns affecting sleep, and a hyperalgesic response to nociception (Kosek, Ekholm & Hannson, 1996; Okifuji, Turk, & Marcus, 1999). Environmental causes of altered physiologic function include flu-like illness, physical trauma, for example, automobile accident, or emotional distress (Clauw & Chrousos, 1997; Turk, Okifuji, Starz, & Sinclair, 1996). Stress has been reported to exacerbate FM symptoms. Dysregulation of the autonomic nervous system and hypothalamic-pituitary-adrenal axis has been reported (Crofford, Engleberg, & Demitrack, 1996; Bennett, Clark, Campbell & Burckhardt, 1992).

Current psychological conceptualizations of chronic pain include consideration of bioenvironmental variables and their effect on motor, emotional, verbal behavior of pain patients and their social relationships. At present, there is no definitive psychological intervention for FM. Current research indicates that cognitive behavioral and "pure" operant procedures are effective in decreasing pain and disability (Rossy, Buckelew, Dorr et al., 1999; Thieme, Gromnica-Ihle, & Flor, 2003). Further research is needed in this area. …

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