UC San Diego

ABSTRACT OF THE DISSERTATION

Feasibility and Acceptability of Graded In-Vivo Exposure Therapy for Fibromyalgia Patients

by

Maya Sarah D’Eon

Doctor of Philosophy in Clinical Psychology

San Diego State University, 2016

University of California, San Diego, 2016

Professor Thereasa Cronan, Chair

Rationale. Fibromyalgia syndrome (FMS) is a chronic pain condition that affects between 1 and 11% of the general population worldwide. Aerobic and strength exercises improve FMS symptoms and reduce physical weakness; however, adherence to exercise programs is low. About 40% of people with FMS have high pain-related fear of movement. The fear-avoidance model proposes that catastrophizing, pain-related fear, and behavioral avoidance lead to the development and maintenance of disability and depression. Graded in-vivo exposure therapy targets these negative components to reduce fear avoidance, and has demonstrated efficacy in improving outcomes in the chronic low back pain population, but has not been examined within the FMS population.

Design. A two-armed pilot trial was conducted to examine the feasibility and acceptability of study procedures and an exposure intervention for FMS patients with moderate to high pain-related fear of movement. The intervention was delivered individually to participants over 13 sessions and was compared to a self-management education condition. Recruitment took place over a 1-year period, and 29 participants were randomly assigned to an intervention condition. Four participants completed the exposure intervention, and eight completed the education condition. Four assessments were conducted to examine changes in process measures, outcome variables, and program satisfaction. The data of primary interest for this dissertation were focused on adherence, attrition, recruitment, eligibility criteria, randomization, assessment measures, treatment trends, and concurrent pharmacological treatment.

Results. As per the CONSORT-modified checklist for reporting feasibility research, threshold criteria were used to determine the feasibility and acceptability of the study components. The results indicated that the feasibility and acceptability criteria were met for eligibility criteria, randomization procedures, and assessment measures. The criteria were not met for recruitment procedures, adherence, and attrition, which suggests the need for modifications in these areas. Examination of treatment trends suggests that the exposure intervention produced improvements in variables of interest. In addition, there was limited evidence of concurrent pharmacological treatment for anxiety symptoms.

Conclusions. Effective interventions are needed to increase physical activity within the FMS population. Based on these findings, a randomized controlled trial to examine treatment efficacy was recommended, after modifications have been made to the study procedures and the intervention protocol.