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BACKGROUND AND OBJECTIVES: Defined by chronic pain, rheumatic diseases are often co-occurring with anxiety and depression. Among the available psychological interventions, cognitive-behavioral therapies have an already-proven efficiency in these cases. However, the need to adjust their structure became ubiquitous during the post-pandemic period. Hence, the objective of this study was to investigate the impact of a single-session, process-based cognitive-behavioral intervention for patients with rheumatic conditions within an in-patient setting. MATERIALS AND METHODS: A total of 31 participants (mean age 58.9 years) completed the single-session intervention. Assessments were conducted prior to the intervention, post-intervention and after one month. RESULTS: Pearson's correlations, paired samples T tests and a covariance analysis based on the Linear Mixed Model were performed for exploring the relations between baseline variables and evaluating the impact of the SSI intervention. Immediately after the intervention, a significant reduction in cognitive fusion (p = 0.001, d = 1.78), experiential avoidance (p = 0.001, d = 1.4) and dysfunctional behavioral processes was observed. At the one-month evaluation, participants reported decreased pain (p = 0.001, d = 1.11), anxiety (p = 0.004, d = 0.55) and depression (p = 0.001, d = 0.72). CONCLUSIONS: The single-session, process-based approach represents a promising intervention in healthcare contexts, as an integrative part of a multimodal rehabilitation treatment in patients with rheumatic conditions.
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Introduction: Defined by chronic, musculoskeletal pain, fibromyalgia is often comorbid with depression and anxiety. In these cases, the first line medical treatment can be successfully combined with psychological interventions. Cognitive-behavioral therapy and acceptance and commitment therapy are among the most widely studied approaches in relation to chronic pain, including fibromyalgia. The objective of this review is to analyze the efficiency of these psychological treatments for alleviating emotional distress in fibromyalgia. Method: The search was conducted on the PubMed, Scopus and Web of Science online databases. Clinical trials that fulfilled eligibility criteria were included in this review. A meta-analysis was performed on depression and anxiety scores at post-test. Heterogeneity was assessed using the Chi2 and I2 indicators. For evaluating publication bias, we resorted to a funnel plot graph. Results: A total of 17 reports were selected, among which 4 articles studied the efficiency of acceptance and commitment therapy. Main demographic characteristics were homogenous throughout the included samples. The overall effect was -0.31 (95% CI: -0.47 to -0.15) for depression, and -0.15 (95%: -0.29 to -0.02), reaching statistical significance. Conclusions: Both psychological interventions proved to be efficient for decreasing depression and anxiety in fibromyalgia. For this reason, we believe psychotherapeutic protocols can be reliably implemented within multicomponent treatments, facilitating emotional adjustment in the context of physical disability and pain. Future research directions include the exploration of change processes and multiple moderators, enabling the development of tailored psychological treatments in fibromyalgia.
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Introduction: Generalized Anxiety Disorder (GAD) is a prevalent emotional disorder associated with increased dysfunctionality, which has a lasting impact on the individual's quality of life. Besides medication, Cognitive-Behavioral Therapy (CBT) represents the golden standard psychotherapeutic approach for GAD, integrating multilevel techniques and various delivery formats that enable the development of tailored treatment protocols. The objective of this study was to compare the efficiency of a standard CBT protocol targeting worries, dysfunctional beliefs, and intolerance of uncertainty with an integrative and multimodal CBT intervention augmented with Virtual Reality (VR). Materials and methods: This study included 66 participants (M age = 22.53 years; SD = 2.21) with moderate GAD symptoms that were randomized to the standard CBT group (CBTs; N = 32) and the Integrative and Multimodal CBT augmented with VR (IM-VRCBT; N = 34) group. The interventions comprised 10 weekly sessions conducted by trained CBT therapists, including cognitive restructuring, problem-solving, behavioral exposure, and relaxation techniques. Baseline and post-assessments were conducted with both groups. Primary outcome measures included the Hamilton Anxiety Rating Scale (HARS) and Penn-State Worry Questionnaire (PSWQ) to evaluate the severity of GAD symptoms and worries, respectively. Secondary outcomes involved the administration of Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Unconditional Self-Acceptance Questionnaire (USAQ). Results: Both interventions determined statistically significant effects on both primary and secondary outcomes (ps < 0.001) in the expected direction. However, CBTs was associated with higher effect sizes for anxiety (Cohen's d = 2.76) and worries (Cohen's d = 1.85), in contrast to IM-VRCBT. Also, secondary analyses revealed positive correlations between changes in anxiety and worries level and the reduction of dysfunctional cognitive processes. Conclusion: This research emphasized the effectiveness of CBT interventions for treating adults with moderate GAD symptomatology. Specifically, both interventions were efficient for reducing anxiety symptomatology present at individuals with GAD. However, regarding cognitive dysfunctions like worries, the standard CBT protocol performed better, as compared to the IM-VRCBT. In addition, we conclude that VR could be integrated within CBT interventions in a single protocol for GAD treatment.
