Intervención psicológica basada en la terapia de aceptación y compromiso para el sobrepeso y la obesidad: un estudio piloto / Psychological intervention based on acceptance and commitment therapy for overweight and obesity: a pilot study

En la actualidad, las intervenciones conductuales para pérdida de peso en sobrepeso y obesidad presentan problemas para mantener los resultados de pérdida de peso a largo plazo. La terapia de aceptación y compromiso (ACT) podría ser un enfoque adecuado para favorecer la pérdida de peso a largo plazo. El objetivo de este estudio piloto es evaluar la eficacia de una intervención basada en ACT en el cambio del peso corporal al finalizar la intervención y en el seguimiento a los 9 meses, además de analizar los efectos de la intervención en diversas variables de interés. Nueve mujeres (edad: M= 44,11 años; DT= 5,82) participaron en una intervención grupal de 10 diez sesiones semanales, abordando contenidos de hábitos alimentarios, actividad física y ACT. Al finalizar la intervención, la pérdida de peso promedio fue de 2,8%, y en el seguimiento a los 9 meses, fue de 3,9%. A tenor de los resultados, podemos afirmar que el estudio ofrece datos a favor de ACT en las intervenciones de pérdida de peso. (AU)

Current behavioral interventions for weight loss in overweight and obesity present problems in maintaining long-term weight loss results. Acceptance andcommitment therapy (ACT) could be a suitable approach to promote long-term weight loss. The aim of this pilot study is to evaluate the efficacy of an ACT-based intervention on body weight change at the end of the intervention and after a 9-month follow-up, in addition to analyzing the effects of the intervention on several variables of interest. Nine women (Mage= 44.11 years; SD= 5.82) attended a group intervention of 10 weekly sessions, addressing contents of eating habits, physical activity, and ACT. At the end of the intervention, the average weight loss was 2.8%, and after a 9-month follow-up, it was 3.9%. Based on the results, it can be concluded that the study provides evidence in favor of the suitability of ACT to help promote weight loss. (AU)

Assessing Walking Programs in Fibromyalgia: A Concordance Study between Measures.

This study analyzes the degree of agreement between three self-report measures (Walking Behavior, WALK questionnaire and logbooks) assessing adherence to walking programs through reporting their components (minutes, rests, times a week, consecutive weeks) and their concordance with a standard self-report of physical activity (IPAQ-S questionnaire) and an objective, namely number of steps (pedometer), in 275 women with fibromyalgia. Regularized partial correlation networks were selected as the analytic framework. Three network models based on two different times of assessment, namely T1 and T2, including 6 weeks between both, were used. WALK and the logbook were connected with Walking Behavior and also with the IPAQ-S. The logbook was associated with the pedometers (Z-score > 1 in absolute value). When the behavior was assessed specifically and in a detailed manner, participants' results for the different self-report measures were in agreement. Specific self-report methods provide detailed information that is consistent with validated self-report measures (IPAQ-S) and objective measures (pedometers). The self-report measures that assess the behavioral components of physical activity are useful when studying the implementation of walking as physical exercise.

Predicting Abusive Behaviours in Spanish Adolescents' Relationships: Insights from the Reasoned Action Approach.

(1) Background: Partner violence prevention programmes do not produce the expected behavioural changes. Accordingly, experts suggest applying evidence-based behavioural models to identify the determinants of abusive behaviours. In this research, we applied the reasoned action approach (RAA) to predict the performance (boys) and acceptance (girls) of abusive behaviours in adolescents. (2) Method: We designed a questionnaire based on the RAA and performed a cross-sectional study. We analysed the predictive capacity of the RAA constructs on intentions with the sample of single adolescents (n = 1112). We replicated the analysis only with those who were in a relationship (n = 587) and in addition analysed the predictive capacity of intention on future behaviour (3 months later). (3) Results: The hierarchical regression analysis performed with the sample of single adolescents showed that the model explained 56% and 47% of the variance of boys' intentions to perform the controlling and devaluing behaviours, respectively; and 62% and 33% of girls' intention to accept them. With those in a relationship, the model explained 60% and 53% of the variance of boys' intentions to perform the controlling and devaluating behaviour, respectively, and 70% and 38% of girls' intention to accept them. Intention exerted direct effects on boys' performance of controlling and devaluing behaviours (31% and 34% of explained variance, respectively) and on girls' acceptance (30% and 7%, respectively). (4) Conclusions: The RAA seems useful to identify the motivational determinants of abusive behaviours, regardless of adolescents´ relationship status, and for their prediction. Perceived social norms emerge as a relevant predictor on which to intervene to produce behavioural changes with both sexes.

Pain-Related Worrying and Goal Preferences Determine Walking Persistence in Women with Fibromyalgia.

Physical activity and exercise are relevant behaviors for fibromyalgia health outcomes; however, patients have difficulties undertaking and maintaining an active lifestyle. With a cross-sectional design, this study explored the role of pain-related worrying and goal preferences in the walking persistence of women with fibromyalgia. The sample included 111 women who attended a tertiary health setting. We adapted the Six-Minute Walk Test where participants decided either to stop or continue walking in five voluntary 6 min bouts. Women who were categorized higher in pain-related worrying reported higher preference for pain avoidance goals (t = -2.44, p = 0.02) and performed worse in the walking task (LongRank = 4.21; p = 0.04). Pain avoidance goal preference increased the likelihood of stopping after the first (OR = 1.443), second (OR = 1.493), and third (OR = 1.540) 6 min walking bout, and the risk of ending the walking activity during the 30 min task (HR = 1.02, [1.0-1.03]). Influence of pain-related worrying on total walking distance was mediated by goal preferences (ab = -3.25). In interventions targeting adherence in physical activity and exercise, special attention is needed for women who are particularly worried about pain to help decrease their preference for short-term pain avoidance goals relative to long-term goals such as being active through walking.

Effects of Walking as Physical Exercise on Functional Limitation through Pain in Patients with Fibromyalgia-How Does Catastrophic Thinking Contribute?

Background: Aerobic exercise has a beneficial impact on physical and mental health. However, patients with fibromyalgia do not always report perceiving these improvements. Objective: The aim of this study was to examine whether catastrophic thinking moderated the effects of perceived pain severity once an active and regular lifestyle had been established on functional limitation in chronic pain patients, in particular in fibromyalgia patients. Methods: The sample consisted of a total of 491 women with fibromyalgia diagnosed according to the criteria of the American College of Rheumatology. Participants completed an ad-hoc item about lifestyle related to walking pattern, the Brief Pain Inventory, the Pain Catastrophization Scale, and the Fibromyalgia Impact Questionnaire-Revised. To examine the relationship between the variables, a moderate mediation analysis was performed through the macro PROCESS (model 14). Results: The relationship between the performance of the recommended walking pattern and functional limitation was mediated by the severity of pain (B = −5.19, SE = 1.59, t = −3.25, 95% CI = [−4.06, −0.28], p < 0.001). Furthermore, it was found that the mediating effect of pain severity was moderated by catastrophic thinking (Index = −0.014, SE = 0.007, 95% CI [0.002, 0.030]). Conclusions: The positive effect of walking on functionality through the reduction of pain levels is favored when patients present low catastrophizing, which affects the relevance of including interventions focused on the reduction of catastrophizing in the prescription of physical exercise in patients with fibromyalgia as the treatment of choice.

Motivational Determinants of Objective Physical Activity in Women with Fibromyalgia Who Attended Rehabilitation Settings.

Being physically active has positive effects on fibromyalgia functioning. However, promoting an active lifestyle in these patients continues to be a relevant clinical challenge. Our aim was to test a motivational model to explain light (LPA) and moderate-vigorous physical activity (MVPA). A cross-sectional prospective study was conducted at a tertiary level of care. Participants completed sociodemographic, clinical, motivational (physical activity self-efficacy and goal preferences) and behavioral measures (activity avoidance). LPA and MVPA were measured with triaxial accelerometers, starting the same day of the aforementioned assessment. Out of 211 women, 183 completed this measure. Structural models were performed. Our results show that the best fit indices (CFI = 0.97, SRMR = 0.04) showed a model with direct influence of PA self-efficacy on MVPA (p < 0.01) and indirect influence on LPA (p < 0.001). LPA received the influence of PA self-efficacy mainly through activity avoidance (p < 0.01). Clinical variables did not have any effect on PA intensities. Thus, the motivational variables showed different paths to explain two PA intensities. Targeting PA self-efficacy in rehabilitation settings is needed to enhance both daily LPA and MVPA intensities.

The Activity Patterns Scale: An Analysis of its Construct Validity in Women With Fibromyalgia.

OBJECTIVES: Avoidance, persistence, and pacing are activity patterns that have different adaptive effects in chronic pain patients. Some inconsistent findings have been explained from a contextual perspective that underlines the purpose of the activity. In this way, avoidance, persistence, and pacing are multidimensional constructs, nuanced by their goals. This multidimensionality has been supported with a new instrument, the Activity Patterns Scale, in heterogeneous chronic pain samples. Owing to the clinical implications of this conceptualization, the complexity of the activity patterns and their relationships with health outcomes in fibromyalgia (FM), our aim was to explore the construct validity of this scale in this pain problem, testing its internal structure and the relationships with other constructs. MATERIALS AND METHODS: The sample included 702 women with diagnosis of FM from tertiary (53.3%) and community settings (46.7%). Confirmatory factor analysis was conducted to test different factor structures of the activity patterns and Pearson correlation to explore the relationships with health outcomes and psychosocial variables. RESULTS: A 6-factor structure showed acceptable fit indices (standardized root mean square residual=0.062; root mean-square error of approximation=0.066; comparative fit index=0.908). The highest significant relationships for health outcomes was between activity avoidance and FM impact (r=0.36) and excessive persistence and negative affect (r=0.41). DISCUSSION: Avoidance and persistence activity patterns are shown as multidimensional constructs but not pacing. The ongoing pain in these women may make it difficult to regulate their activity taking into account other goals not contingent on pain fluctuations.

The Role of Acceptance in Eating Behaviors-Spanish Validation of Food Craving Acceptance and Action Questionnaire (FAAQ-S).

Background: The Food Craving Acceptance and Action Questionnaire (FAAQ) was developed to measure food craving acceptance, but has not yet been adapted to Spanish. The aim of this study was to validate the FAAQ to the Spanish population and to analyze its psychometric properties. Method: Two studies were conducted. In the first study, the sample consisted of 224 undergraduate students who participated in the comprehension of the Spanish version and the Confirmatory Factor Analysis (CFA). The second sample consisted of 378 participants from a community sample who completed the refined version of the FAAQ and similar and dissimilar measures. Results: Study (1) The CFA was conducted, showing an inadequate fit of the model (CFI = 0.74, RMSEA = 0.18). Therefore, FAAQ was refined and it was administered to the community sample. Study (2) After an exploratory factor analysis, two factors were obtained as in the original FAAQ, Acceptance (30.92% variance explained) and Willingness (36.05%). The internal consistency was adequate for both subscales (ω = 0.88 and ω = 0.87, respectively). Correlation between the factors was r = 0.07, which provides evidence that Acceptance and Willingness are different constructs. Correlations of Acceptance with similar variables (r between -0.30 and -0.52) were stronger than the dissimilar measures (r between -0.26 and 0.24). This did not occur for the Willingness subscale, since correlations were low in all cases (r between -0.22 and 0.25). Conclusions: Spanish version of the FAAQ showed evidence of its reliability and validity, and may be a measure to provide a better understanding of how acceptance of thoughts and emotions concerning food and willingness impact eating management behaviors.

Cultural Adaptation and Psychometric Properties of the Spanish Version of the Occupational Balance Questionnaire: An Instrument for Occupation-Based Research.

Occupational balance (OB) may be a major determinant of health outcomes due to its role in bringing a sense of purpose in the occupations that are personally experienced as a process of getting health and wellness. The Occupational Balance Questionnaire (OBQ) is a reliable instrument for measuring OB, although it has not been adapted and validated in Spain so far; therefore, this study had a double aim: (1) to translate and cross-culturally adapt the original OBQ version into Spanish (OBQ-E); (2) to analyze the psychometric properties for its use in the Spanish population. Standard procedures were used for the cross-adaptation process and pilot testing was carried out using three different samples to extend the applicability of the OBQ-E. Validation measures of the final version of the OBQ-E were conducted in a sample of 219 participants. The OBQ-E showed that items and instructions were culturally appropriate and written clearly. Psychometric testing showed excellent internal consistency (Cronbach's alpha = 0.87; Guttman split-half coefficient = 0.85), good test-retest reliability (rs (Spearman rho) = 0.73), and acceptable convergent validity (overall status, rs = 0.37; Related Quality of Life, rs = 0.42; Satisfaction with Life Scale, rs = 0.54). The findings suggest that the OBQ-E may be a suitable instrument for assessing OB in the Spanish population; hence, it is a promising tool for epidemiological research that will significantly contribute to the understanding of OB as a health-related factor. Nevertheless, further investigation is also warranted to explore the potentiality of this instrument for clinical purposes.

Assessing Self-Efficacy for Physical Activity and Walking Exercise in Women with Fibromyalgia.

BACKGROUND: Exercise and physical activity are an evidence-based practice for chronic pain. Health professionals need instruments to assess self-efficacy for this practice taking into account the specific barriers of patients with these health problems. PURPOSE: To develop and test the psychometric properties of a new self-efficacy scale for physical activity and walking exercise in patients with fibromyalgia. DESIGN: A cross-sectional and prospective study was conducted in a Spanish Fibromyalgia Unit. Two hundred and eleven new patients signed the informed consent and participated in the study. All of them were women, referred to by either Primary or Specialized Health Care. In addition to the new scale, they filled out several self-reported and validated instruments to collect the data present in this study. RESULTS: Exploratory factor analysis showed a three-factor model (GFI = .99; RMSR = .06) that explained 74.2% of the total variance. They assessed how confident patients felt about walking quickly in both 30- and 60-minute sessions, (Factor I: 10 items; α = .97), to perform daily physical activities (Factor II: 10 items; α = .93) and to undertake moderate physical activity (Factor III: 5 items; α = .95). The total score of the scale and the three-factor scores showed good criterion validity and adequate validity based on the relationships with other constructs. CONCLUSIONS: The scale showed adequate psychometric properties and can be a useful tool to help health professionals monitor patients' self-efficacy perception and customize both physical activity and walking exercise intervention goals and their implementation.

Contextualizing goal preferences in fear-avoidance models. Looking at fatigue as a disabling symptom in fibromyalgia patients.

The fear-avoidance model provides an explanation for the development of chronic pain, including the role of perception (i.e. pain catastrophism) as an explanatory variable. Recent research has shown that the relationship between pain catastrophism and avoidance is influenced in turn by different psychological and contextual variables, highlighting the affective-motivational ones. From this perspective, the Goal Pursuit Questionnaire (GPQ) was developed to measure the preference for hedonic goals (mood-management or pain-avoidance goals) over achievement goals in musculoskeletal pain patients. Recently, the Spanish version of the GPQ in fibromyalgia patients has been validated. Our aim has been to adapt the Spanish version of GPQ from pain to fatigue symptoms and to validate this new questionnaire (GPQ-F) in fibromyalgia. Despite the recognition of fibromyalgia as a complex disorder and the need for a differential study of its symptoms, fatigue, despite its high prevalence and limiting nature, remains the forgotten symptom. We conducted a cross-sectional study with 231 women with fibromyalgia. Previously, we adapted the Spanish GPQ for fatigue symptoms with three sub-studies (group structured interview, self-administration questionnaire and thinking-aloud; n = 15-27 patients). We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Exploratory factor analysis showed two factors: 'Fatigue-avoidance goal' and 'Mood-management goal' (39.3% and 13.9% of explained variance, respectively). The activity avoidance pattern fully mediated the relation between both catastrophizing and fatigue-avoidance goals with fatigue. The study shows initial findings about the usefulness of the GPQ-F as a tool to analyze goal preferences related to fatigue in fibromyalgia. The results supported the mediational role of activity avoidance patterns in the relationship between preference for fatigue-avoidance goals and fatigue.

Positive and Negative Emotional Eating Are Not the Same-The Spanish Version of the Positive-Negative Emotional Eating Scale (PNEES).

The literature points to the importance of distinguishing between positive and negative emotional eating in relation to overeating and binge eating. The aim of this study was to evaluate the Spanish version of the Positive-Negative Emotional Eating Scale (PNEES) in a Spanish community sample. The sample consisted of 628 participants. The mean age was 27.5 (SD = 12.7) and 70.1% of them were women. The participants completed the PNEES, and measures of anxiety and depression (HADS), and eating disorder-related scales (TFEQ-R18, BULIT-R, and EAT-26) that were selected to examine convergent validity. A confirmatory factor analysis was conducted, replicating the original two-factor solution, consisting of Negative Emotional Eating (PNEES-N) and Positive Emotional Eating (PNEES-P). The results showed an acceptable fit of the model (CFI = 0.986; TLI = 0.984, RMSEA = 0.055). Internal consistency ranged from ω = 0.92 to ω = 0.96 for both subscales and the total score. PNEES-P correlations with other variables were lower with respect to the PNEES-N, showing that they are different constructs. A mediation analysis was conducted, in which PNEES-P significantly predicted binge eating and PNEES-N was a partially mediator variable. The results showed that the adaptation process was successful.

Activity Patterns and Functioning. A Contextual-Functional Approach to Pain Catastrophizing in Women with Fibromyalgia.

BACKGROUND: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective-motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. METHODS: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire-Revised) in 491 women with fibromyalgia. RESULTS: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = -0.09, t = -2.24, p = 0.02, [-0.18, -0.01]), pain persistence (B = -0.10, t = -2.04, p = 0.04, [-0.19, -0.004]) and functioning. CONCLUSION: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns.

Is Thought Management a Resource for Functioning in Women with Fibromyalgia Irrespective of Pain Levels?

OBJECTIVE: This study aimed to examine the relationship between cognitive factors (cognitive fusion and catastrophizing) and functional limitation experienced by patients with fibromyalgia across different levels of pain severity (i.e., moderation). METHODS: The sample comprised 226 women with fibromyalgia. Their mean age was 56.91 years (standard deviation = 8.94; range = 30 to 78 years). RESULTS: Pain severity, cognitive fusion, and all components of catastrophizing (i.e., rumination, magnification, and helplessness) contributed to greater fibromyalgia impact on functioning in the multivariate analyses (all P < 0.001). A moderation effect was also found in the relationship between cognitive fusion and fibromyalgia impact on functioning (B = -0.12, t = -2.42, P = 0.016, 95% confidence interval: -0.22 to -0.02) and between magnification and fibromyalgia impact (B = -0.37, t = -2.21, P = 0.028, 95% confidence interval: -0.69 to -0.04). This moderation was not observed for rumination and helplessness. CONCLUSIONS: The results suggest that in interventions to improve functioning in people with fibromyalgia, some maladaptive forms of thought management (i.e., cognitive fusion and magnification) preferably should be challenged at milder levels of pain severity. According to our findings, cognitive fusion and magnification might have less room to impact functioning at higher levels of pain severity; therefore, rumination and helplessness, which had comparable associations with functioning irrespective of pain levels, would be preferable targets in psychological interventions in patients with fibromyalgia experiencing more severe pain levels.

Are Pacing Patterns Really Based on Value Goals? Exploring the Contextual Role of Pain Acceptance and Pain Catastrophizing in Women with Fibromyalgia.

Pain catastrophizing and pain acceptance have been associated with functioning in fibromyalgia. In relation to activity patterns, pacing has been defined as a helpful pattern to regulate activities in the context of value-based goals, but results regarding whether it is adaptive or not are controversial. This study analyzes the moderating role of pain acceptance between pain catastrophizing and pacing in 231 women with fibromyalgia. Moderation analyses were conducted with model 1 from the PROCESS Macro version 3.4. The results showed a clear moderating effect of pain acceptance. At low levels of pain acceptance, catastrophizing and pacing patterns maintained significant and positive associations. However, at high levels of pain acceptance, pacing was independent of catastrophizing. Far from considering pacing patterns as functional or dysfunctional per se, our results suggest that women with low pain acceptance carry out pacing influenced by catastrophizing independently of their goal pursuit, while patients who accept their pain may use pacing as a regulatory mechanism according to their goals.

Promoting unsupervised walking in women with fibromyalgia: a randomized controlled trial.

The objective of this study is to test the efficacy of a group motivational plus implementation intentions intervention in promoting adherence to an unsupervised walking program recommended for fibromyalgia, compared to an implementation intentions condition and to an active control condition. A triple-blind, randomized, longitudinal study with measures at baseline, short (seven weeks post-intervention), mid (12 weeks) and long-term (36 weeks) is performed. Data are analyzed using multilevel longitudinal growth curve two-level modelling. Participants are 157 women with fibromyalgia. In the short-term, adherence to the minimum and to the standard walking program (primary outcome measures) is explained by time (both p <.001), motivational plus implementation intentions intervention (both p <.001) and by their interaction (both p <.001). Regarding the secondary outcomes, only physical function is explained by time (p <.001), motivational plus implementation intentions intervention (p <.05) and by their interaction (p <.05). Motivational plus implementation intentions intervention achieve the promotion of walking as an exercise in the short-term; furthermore, physical function of the women in this condition is better than in the other two intervention groups, which is a relevant outcome from a rehabilitation point of view. However, more studies are needed to maintain the exercise at mid and long-term.

Why do some people with severe chronic pain adhere to walking prescriptions whilst others won't? A cross-sectional study exploring clinical and psychosocial predictors in women with fibromyalgia.

Fibromyalgia (FM) is a highly disabling condition characterized by widespread chronic pain. Physical exercise, such as walking, has been recommended as the treatment of choice for FM. However, adherence to physical exercise tends to be poor. Pain is one of the main inhibitors to adhere to walking in FM patients. The main objective of this study has been to determine whether there is a clinical and psychosocial profile to help predict individual differences in adherence to walking in a sample of patients with FM with severe pain levels. In this cross-sectional study, the sample was composed of 172 women with FM and severe pain levels (> 7 in an 11-point numerical scale). Women were classified into two groups: (1) those who walked regularly and (2) patients who rarely or never walked. Group differences regarding clinical outcomes (e.g., FM impact, anxiety, depression, cognitive fusion, catastrophizing, affect, and personality), sociodemographic variables, and medical history were analyzed. Patients who walked despite pain significantly reported less impact of FM, anxiety, depression, catastrophizing, cognitive fusion, negative affect, openness to experience, agreeableness, and conscientiousness. The unique predictors of group membership (walking versus no walking) in a binary regression were FM impact and negative affect. The results show that adherence to exercise might be influenced and predicted by the clinical profile of the patient, which suggests that personalized motivational interventions should be addressed to this at-risk subgroup.

Is Perfectionism Always Dysfunctional? Looking into Its Interaction with Activity Patterns in Women with Fibromyalgia.

The intrinsically adaptive or maladaptive nature of certain activity patterns in fibromyalgia (FM) has been put into question. The role of contextual factors related to their influence on functional limitation is required. Perfectionism complicates the ability to cope of these patients. The aim of the study has been to analyze the moderating role of perfectionism between activity patterns and functional limitation. The sample were 228 women with FM. Moderation analyses were conducted with the PROCESS Macro. Activity avoidance and excessive persistence were associated with poorer functionality, regardless of perfectionism. Pain avoidance and task persistence were more strongly associated with FM impact in women with high or moderate levels of perfectionism. In a clinical setting adapting the recommendations given to patients according to their level of perfectionism would be justified. Pain avoidance might be inadvisable at high levels of perfectionism, and task persistence is recommendable especially when perfectionism is high.

The 4 U's Rule of Fibromyalgia: A Proposed Model for Fatigue in a Sample of Women with Fibromyalgia: A Qualitative Study.

Although fatigue usually goes unnoticed, it is a symptom that poses great challenges to patients with fibromyalgia and is a strong limitation. The aim of this study is to identify and describe the variables involved in fatigue in nine different situations of the Goal Pursuit Questionnaire (GPQ) that may occur in the daily lives of women with fibromyalgia, according to an ABC (Antecedents-Behaviors-Consequences) model. This study followed a qualitative descriptive research method and a deductive-inductive hybrid approach based on a phenomenological paradigm. Twenty-six women with fibromyalgia participated in focus group discussions between February and March of 2018. Thematic content analysis was carried out from transcribed verbatim interviews. We identified nine major themes that emerged from the participants' conversations: self-imposed duties, muscle fatigue, overwhelming feeling of tiredness, difficulty thinking, difficulty concentrating, negative emotions, lifestyle changes, affected everyday activities, and lack of motivation for daily activities and social interactions. We conclude that the ABC model allowed certain elements to emerge regarding the fatigue experience, highlighting its importance as a symptom in fibromyalgia. This additional analysis of the ABC model showed that fatigue can be described through the 4 U's Rule, which is integrated by these four adjectives: (1) Unpredictable, (2) Uncontrollable, (3) Unseen, and (4) Unintelligible. Identifying these characteristics can contribute to a better understanding of fibromyalgia in addition to better treatment for these patients.

Predicting walking as exercise in women with fibromyalgia from the perspective of the theory of planned behavior.

Based on the theory of planned behavior, this study examined factors related to the intention to adhere to an unsupervised walking program and the intention-behavior gap in relation to walking adherence in women with fibromyalgia. We also accounted for specific variables: fear of movement, pain intensity, distress and disability. TPB constructs, walking behavior and the above-mentioned variables were assessed in 274 women aged 18 to 70 years old (mean 51.8, range 25.5-69.1 years) at baseline and seven weeks later (n = 219) during 2012. Intention to adhere to a walking program showed medium scores at baseline and was associated with attitude and perceived behavioral control (PBC). Self-reported walking adherence at Time 2 was only predicted by perceived behavioral control. The intention-behavior gap was present in 33% of participants. Logistic regression analysis showed PBC associated with being a successful intender. Women with fibromyalgia were motivated to walk; however, they did not act on their intentions, and PBC appeared as the main explanation. Women who perceived high control in comparison to those who perceived low control, increased their likelihood of adhering to a walking program about three-fold. Women with fibromyalgia should increase their perceived control through different strategies.