Cognitive-behavioral therapy and acceptance and commitment therapy for anxiety and depression in patients with fibromyalgia: a systematic review and meta-analysis

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.