How and for whom does a positive affect intervention work in fibromyalgia: An analysis of mediators and moderators

Abstract

Objectives Psychological interventions designed to enhance positive affect are promising ways to promote adaptive functioning in people with chronic pain. However, few studies have addressed the efficacy of positive affect interventions in chronic pain populations and examined which patients can benefit more from them. The aim of the present study was to identify mediators and moderators of the best possible self intervention (BPS) in fibromyalgia patients. Methods We used data from a previous randomized controlled trial that examined changes in pain interference, depression, self‐efficacy and quality of life after the BPS intervention. Results Mediation analyses showed that depression mediated changes in pain interference. Positive and negative affect were significant mediators of the change in depression and quality of life. No significant mediators of the change in self‐efficacy were found. Baseline levels of quality of life, emotion regulation strategies of negative and positive affect, and rumination moderated the effects of the intervention on depressive symptomatology. Discussion In fibromyalgia patients, the effects of the BPS on the outcomes seem to be more related to changes in affect than to changes in future expectations. Significance This study presents evidence about who can benefit from an intervention designed to augment positive affect and promote positive functioning in FMS patients and how these changes occur. It extends previous findings on patient characteristics associated with the response to pain management interventions.

How do psychologically based interventions for chronic musculoskeletal pain work? A systematic review and meta-analysis of specific moderators and mediators of treatment

“…Two studies examined the indirect effect of changes in measures of mindfulness on disability after CBT (Hedman-Lagerlof et al, 2019) and mindfuness-based therapy (Pérez-Aranda et al, 2019) and reported inconclusive results. Additionally, positive and negative affect were found to mediate changes in disability (Molinari et al, 2019) and pain intensity (Garland et al, 2019) after CBT and mindfulness respectively.…”

“…After the first screening of titles and abstracts, 152 publications were retrieved for full-text screening. Finally, 37 studies were included with a total of 28 mediation analyses (n = 4652) (Cederberg, Cernvall, Dahl, von Essen, & Ljungman, 2016;Chalder, Goldsmith, White, Sharpe, & Pickles, 2015;Coronado et al, 2020;Durá-Ferrandis, Ferrando-García, Galdón-Garrido, & Andreu-Vaillo, 2017;Fordham, Ji, Hansen, Lall, & Lamb, 2017;Garland et al, 2019;Hedman-Lagerlof et al, 2019;Leeuw et al, 2008;Lin, Klatt, McCracken, & Baumeister, 2018;Luciano et al, 2014;Mansell, Hill, Main, Von Korff, & Van Der Windt, 2017;Mansell, Hill, Main, Vowles, & van der Windt, 2016;Mansell, Storheim, Løchting, Werner, & Grotle, 2017;Molinari et al, 2019;O'Neill, O'Sullivan, O'Sullivan, Purtill, & O'Keeffe, 2020;Pérez-Aranda et al, 2019;Simister et al, 2018;Smeets, Vlaeyen, Kester, & Knottnerus, 2006;Sodermark et al, 2020;Spinhoven et al, 2004;Taylor et al, 2018;Trompetter, Bohlmeijer, Fox, & Schreurs, 2015;Turner, Holtzman, & Mancl, 2007;van Koulil et al, 2011;Wetherell et al, 2011;Wiborg, Knoop, Frank, & Bleijenberg, 2012;Wicksell et al, 2013;Wicksell, Olsson, & Hayes, 2010) and 11 moderation analyses (n = 1925) (Broderick et al, 2016;Buckelew et al, 1996;Day et al, 2019;Flink, Boersma, & Linton, 2010;Lawford et al, 2018;...…”

Associations of Cognitive Fusion and Pain Catastrophizing with Fibromyalgia Impact through Fatigue, Pain Severity, and Depression: An Exploratory Study Using Structural Equation Modeling

“…While acknowledging the important role of FM symptomatology (e.g., pain severity, fatigue, and depression) in daily functioning, in the past years, researchers have been encouraged to investigate the mechanisms that explain individual differences in this symptomatology and, ultimately, in overall functioning (i.e., mediators), as these would be the actual targets during interventions [10]. In this sense, several models of pain have pointed to cognitive factors as key elements explaining individual differences in symptomatology and functionality in chronic pain populations, such as FM [11].…”

Positive Psychological Factors and Impairment in Rheumatic and Musculoskeletal Disease: Do Psychopathology and Sleep Quality Explain the Linkage?

“…Similar patterns exist in the extant literature. For instance, in patients with FM, engaging in a "best possible self" intervention resulted in improvements in depression, pain interference, and quality of life via the mediating effects of increased positive, and decreased negative, affect (32). Of note, although a serial mediator, anxiety did not exert a specific indirect effect in the linkage between positive psychological variables and impairment.…”

“…Similar patterns exist in the extant literature. For instance, in patients with FM, engaging in a “best possible self” intervention resulted in improvements in depression, pain interference, and quality of life via the mediating effects of increased positive, and decreased negative, affect (32).…”