Volume 32, Issue 1 (Avicenna Journal of Clinical Medicine-Spring 2025)                   Avicenna J Clin Med 2025, 32(1): 28-36 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Ghorbanzade BorBor A, Soleimani E, Esazadeghan A. Effect of Exposure Therapy and Cognitive Behavioral Therapy for Insomnia on Psychological Distress in Women with Fibromyalgia. Avicenna J Clin Med 2025; 32 (1) :28-36
URL: http://sjh.umsha.ac.ir/article-1-3199-en.html
1- Department of Psychology, Faculty of Literature and Humanities, Urmia University, Urmia, Iran
2- Department of Psychology, Faculty of Literature and Humanities, Urmia University, Urmia, Iran , soleymany.psy@gmail.com
Abstract:   (91 Views)
Background and Objective: Fibromyalgia (FM) is a chronic condition with widespread musculoskeletal pain that is more common in women than men. The present study aimed to compare the effect of exposure therapy (EXP) and cognitive behavioral therapy for insomnia (CBTI) on psychological distress in women with FM.
Materials and Methods: This study was a single-blind, randomized controlled trial that employed a pretest-posttest design with a two-month follow-up conducted online between February and September 2024. The statistical population included Iranian women with FM who were members of Iranian FM virtual groups. The sample included 60 women with FM who were selected via convenience sampling and were randomly assigned to two experimental groups and one control group (20 patients in each group). The experimental groups received EXP and CBTI interventions online. Depression, anxiety, and stress scale (DASS-21) was used to measure the dependent variable. The obtained data were analyzed in SPSS software (version 24).
Results: The three groups were matched in terms of age, marital status, education, socioeconomic status, and duration of illness (P>0.05). The results of repeated measures ANOVA demonstrated that both EXP and CBTI were significantly effective in the mitigation of psychological distress in women with fibromyalgia (P<0.01). There was no significant difference between the effectiveness of the two treatments (P=0.946).
Conclusion: As evidenced by the obtained results, EXP and CBTI are effective in the reduction of psychological distress in women with fibromyalgia, and the online treatment format might be of high clinical utility for these patients
Full-Text [PDF 845 kb]   (38 Downloads)    
Type of Study: Original | Subject: Clinical Psychology

References
1. Masood R, Mandalia K, Pagani NR, Moverman MA, Puzzitiello RN, Menendez ME, et al. Functional somatic syndromes are associated with inferior outcomes and increased complications after hip and knee arthroplasty: a systematic review. Arthroplasty. 2024;6(1):2. PMID: 38173047 DOI: 10.1186/s42836-023-00223-1
2. Abbass A, Lumley MA, Town J, Holmes H, Luyten P, Cooper A, et al. Short-term psychodynamic psychotherapy for functional somatic disorders: A systematic review and meta-analysis of within-treatment effects. J Psychosom Res. 2021 ;145:110473. PMID: 33814192 DOI: 10.1016/j.jpsychores.2021.110473
3. Jurado-Priego LN, Cueto-Ureña C, Ramírez-Expósito MJ, Martínez-Martos JM. Fibromyalgia: A review of the pathophysiological mechanisms and multidisciplinary treatment strategies. Biomedicines. 2024;12(7):1543. PMID: 39062116 DOI: 10.3390/biomedicines12071543
4. Queiroz LP. Worldwide epidemiology of fibromyalgia. Curr Pain Headache Rep. 2013;17(8):356. PMID: 23801009 DOI: 10.1007/s11916-013-0356-5
5. Celepkolu T, Gamze Erten Bucaktepe P, Yilmaz A, Pervane VD, Batmaz I, Sariyildiz MA. Assessment of quality of life, anxiety, depression, and sleep quality in women with fibromyalgia and their spouses. Eur Rev Med Pharmacol Sci. 2021;25(13):4506-4513. PMID: 34286508 DOI: 10.26355/eurrev_202107_26242
6. Pérez-Aranda A, D'Amico F, Feliu-Soler A, McCracken LM, Peñarrubia-María MT, Andrés-Rodríguez L, et al. Cost-utility of mindfulness-based stress reduction for fibromyalgia versus a multicomponent intervention and usual care: A 12-month randomized controlled trial (EUDAIMON Study). J Clin Med. 2019;8(7):1068. PMID: 31330832 DOI:10.3390/jcm8071068
7. Galvez-Sánchez CM, Duschek S, Reyes Del Paso GA. Psychological impact of fibromyalgia: current perspectives. Psychol Res Behav Manag. 2019;12:117-127. PMID:30858740 DOI: 10.2147/PRBM.S178240
8. Zhu Y, Jha SC, Shutta KH, Huang T, Balasubramanian R, Clish CB, et al. Psychological distress and metabolomic markers: A systematic review of posttraumatic stress disorder, anxiety, and subclinical distress. Neurosci Biobehav Rev. 2022;143:104954. PMID: 36368524 DOI: 10.1016/j.neubiorev.2022.104954
9. Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328. DOI: 10.1136/annrheumdis-2016-209724 PMID: 27377815
10. Bernardy K, Klose P, Welsch P, Häuser W. Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome - A systematic review and meta-analysis of randomized controlled trials. Eur J Pain. 2018;22(2):242-260. PMID: 28984402 DOI: 10.1002/ejp.1121
11. Thoma M, Froehlich L, Hattesohl DBR, Quante S, Jason LA, Scheibenbogen C. Why the psychosomatic view on myalgic encephalomyelitis/chronic fatigue syndrome is inconsistent with current evidence and harmful to patients. Medicina (Kaunas). 2023;60(1):83. PMID: 38256344 DOI: 10.3390/medicina60010083
12. Geraghty K, Jason L, Sunnquist M, Tuller D, Blease C, Adeniji C. The 'cognitive behavioural model' of chronic fatigue syndrome: Critique of a flawed model. Health Psychol Open. 2019;6(1):2055102919838907. PMID: 31041108 DOI: 10.1177/2055102919838907
13. Hedman-Lagerlöf M, Hedman-Lagerlöf E, Axelsson E, Ljótsson B, Engelbrektsson J, Hultkrantz S, et al. Internet-delivered exposure therapy for fibromyalgia: A randomized controlled trial. Clin J Pain. 2018;34(6):532-542. PMID: 29077623 DOI: 10.1097/AJP.0000000000000566
14. Hedman-Lagerlöf M, Andersson E, Hedman-Lagerlöf E, Wicksell RK, Flink I, Ljótsson B. Approach as a key for success: Reduced avoidance behaviour mediates the effect of exposure therapy for fibromyalgia. Behav Res Ther. 2019;122:103478. PMID: 31585343 DOI: 10.1016/j.brat.2019.103478
15. Hedman-Lagerlöf M, Gasslander N, Ahnlund Hoffmann A, Bragesjö M, Etzell A, Ezra S, et al. Effect of exposure-based vs traditional cognitive behavior therapy for fibromyalgia: a two-site single-blind randomized controlled trial. Pain. 2024;165(6):1278-1288. PMID: 38131181 DOI: 10.1097/j.pain.0000000000003128
16. Climent-Sanz C, Valenzuela-Pascual F, Martínez-Navarro O, Blanco-Blanco J, Rubí-Carnacea F, García-Martínez E, et al. Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis. Disabil Rehabil. 2022;44(20):5770-5783. PMID: 34297651 DOI: 10.1080/09638288.2021.1954706
17. Palagini L, Carmassi C, Conversano C, Gesi C, Bazzichi L, Giacomelli C, et al. Transdiagnostic factors across fibromyalgia and mental disorders: sleep disturbances may play a key role. A clinical review. Clin Exp Rheumatol. 2016;34(2 Suppl 96): S140-144. PMID: 27157399
18. Tang NKY, Goodchild CE, Webster LR. Sleep and chronic pain. In: Treatment of Chronic Pain by Integrative Approaches. Springer (New York, NY, USA); Publisher. 2015: 203–217. DOI:10.1007/978-1-4939-1821-8_16
19. McCrae CS, Williams J, Roditi D, Anderson R, Mundt JM, Miller MB, et al. Cognitive behavioral treatments for insomnia and pain in adults with comorbid chronic insomnia and fibromyalgia: clinical outcomes from the SPIN randomized controlled trial. Sleep. 2019;42(3):zsy234. PMID: 30496533 DOI:10.1093/sleep/zsy234
20. Donisi V, De Lucia A, Pasini I, Gandolfi M, Schweiger V, Del Piccolo L, et al. e-health interventions targeting pain-related psychological variables in fibromyalgia: A systematic review. Healthcare (Basel). 2023;11(13):1845. PMID: 37444679 DOI: 10.3390/healthcare11131845
21. The latest statistics on Iranians' use of messaging apps and social networks [Internet]. 2024. Link
22. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther. 1995;33(3):335-43. PMID: 7726811 DOI: 10.1016/0005-7967(94)00075-u
23. Soria-Reyes LM, Alarcón R, Cerezo MV, Blanca MJ. Psychometric properties of the depression anxiety stress scales (DASS-21) in women with breast cancer. Sci Rep. 2024;14(1):20473. PMID: 39227677 DOI: 10.1038/s41598-024-68814-9
24. Senobar L, Atadokht A, Narimani M, Hajloo N. Comparison of the effect of transcranial direct current stimulation of the brain from the skull and psychodrama on psychological distress in adolescents with mild traumatic brain injury. Adv Cognitive Sci. 2024; 26 (2) :16-30. DOI: 10.30514/icss.26.2.16
25. Beaufort IN, De Weert-Van Oene GH, Buwalda VAJ, de Leeuw JRJ, Goudriaan AE. The depression, anxiety and stress scale (DASS-21) as a screener for depression in substance use disorder inpatients: A pilot study. Eur Addict Res. 2017;23(5):260-268. PMID: 29224000 DOI: 10.1159/000485182
26. Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. J Iran Psychol. 2005; 1(4): 36-54. Link
27. McCrae CS, Curtis AF, Craggs J, Deroche C, Sahota P, Siva C, et al. Protocol for the impact of CBT for insomnia on pain symptoms and central sensitisation in fibromyalgia: a randomised controlled trial. BMJ Open. 2020;10(9): e033760. PMID:32933953 DOI: 10.1136/bmjopen-2019-033760
28. Cojocaru CM, Popa CO, Schenk A, Suciu BA, Szasz S. Cognitive-behavioral therapy and acceptance and commitment therapy for anxiety and depression in patients with fibromyalgia: a systematic review and meta-analysis. Med Pharm Rep. 2024;97(1):26-34. PMID: 38344332 DOI: 10.15386/mpr-2661 .
29. Lumley MA, Cohen JL, Stout RL, Neely LC, Sander LM, Burger AJ. An Emotional Exposure-Based Treatment of Traumatic Stress for People with Chronic Pain: Preliminary Results for Fibromyalgia Syndrome. Psychotherapy (Chic). 2008;45(2):165-172. PMID: 20808734 DOI: 10.1037/0033-3204.45.2.165
30. Hope DA, Heimberg RG, Turk CL. Exposure and cognitive restructuring: ongoing exposure. Managing Social Anxiety, Therapist Guide: A Cognitive-Behavioral Therapy Approach, 3th ed. Treatments That Work (New York. 2019; online ed, Oxford Academic). 2019. DOI:10.1093/med-psych/9780190247591.003.0008

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2025 CC BY-NC 4.0 | Avicenna Journal of Clinical Medicine

Designed & Developed by : Yektaweb