Fibromiyalji sendromlu hastalarda gevşeme odaklı bilişsel davranışçı grup psikoterapisinin karma yöntemle değerlendirilmesi

Fibromiyalji sendromunun (FMS) klinik özellikleri nedeniyle multidisipliner tedavilere yönelik vurgu gün geçtikçe artmaktadır. Bu çalışmanın temel amacı, FMS hastalarında gevşeme odaklı bilişsel davranışçı grup psikoterapisinin etkinliğinin sınanmasıdır. Müdahale sonunda hastaların ağrı yönetimlerinin, işlevsel baş etme stratejilerinin, özetkinliklerinin ve psikolojik iyilik hallerinin geliştirilmesi hedeflenmiştir. Ayrıca gevşeme egzersizi, motivasyonel ve tamamlayıcı bir teknik olarak kullanılmıştır.Gereç ve Yöntem: Çalışma, FMS tanısı almış ve grup psikoterapi sürecini yürütebilecek özelliklere sahip 25 kadınla yürütülmüştür. Ancak çalışmanın son testlerinin alındığı sekizinci seansa, 17 kişi katıldığından analizler bu kişilerin verileriyle yapılmıştır.Çalışmanın veri toplama ve analiz sürecinde, hem nicel hem de nitel araştırma yöntemlerini içeren karma yöntem kullanılmıştır. Nitel veriler, seanslarda gözlemciler tarafından tutulan yazılı kayıtlar ve terapistlerin gözlemleri aracılığıyla elde edilmiştir.Nicel verilerin toplanmasında, Sosyodemografik ve Klinik Bilgi Formu, Görsel Analog Skalası, Hasta Sağlık Ölçeği-Somatik Anksiyete ve Depresyon Semptomları, Ağrı Özetkinlik Ölçeği-2 ve Ağrıyla Başetme Envanteri kullanılmıştır. Görüşme içeriklerininnitel analizinde, Tematik Analiz yöntemlerinden faydalanılmıştır. Ölçeklerden elde edilen verilerin analizi ise Wilcoxon İşaretliSıralar Testi ile gerçekleştirilmiştir.Bulgular: Nicel analiz bulguları, müdahale sonrasında sonuç değişkenlerin çoğunluğunda gelişim kaydedilmesine rağmen bugelişimin istatistiksel olarak anlamlı olmadığını göstermektedir. Nitel analiz sonuçlarına göre grup terapi süreci “ağrı ile ilişkilisorunlar”, “duygusal ve sosyal sorunlar” ve “grup terapi sürecine uyum” olarak ele alınmıştır. Katılımcıların temaların alt kodlarında gelişme kaydettikleri görülmüştür.Sonuç: Sonuçlar, müdahalenin etkinliğinin gösterilmesinde nicel ve nitel desenlerin bir arada kullanılmasının önemine işaretetmektedir. Gelecek çalışmalarda, müdahalenin daha geniş örneklemde sınanmasının faydalı olacağı düşünülmektedir.

A mixed method evaluation of cognitive-behavioral group psychotherapy-based relaxation in patients diagnosed with fibromyalgia syndrome

Objectives: The main purpose of this study is to examine the effectiveness of relaxation-oriented cognitive-behavioral group psychotherapy in FMS patients. It was aimed to improve the pain management, functional coping strategies, self-efficacy, and psychological well-being of the patients at the end of the intervention. Furthermore, relaxation exercise was used as a motivational and complementary technique. Methods: The study was conducted with 25 women who were diagnosed with FMS and had the characteristics to carry out the group psychotherapy process. Mixed method including both quantitative and qualitative research methods was used in the data collection and analysis process of the study. Qualitative data were obtained through written records kept by the observers in the sessions and the observations of the therapists. In collecting quantitative data, Sociodemographic and Clinical Information Form, Visual Analog Scale, Patient Health Questionnaire-Somatic Anxiety and Depression Symptoms, Pain Self-efficacy Questionaire-2, and Pain Coping Inventory were used. Thematic Analysis methods were used in the qualitative analysis of the interview contents. The analysis of the data obtained from the scales was carried out with the Wilcoxon Signed-Ranks Test. Results: According to the qualitative analysis results, the group therapy process was considered three themes as “pain related problems,” “emotional and social problems,” and “adherence with the group therapy process.” It was seen that the participants made improvements in the subcodes of the themes. Conclusion: Results indicate the importance of using quantitative and qualitative patterns together in demonstrating the effectiveness of the intervention

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1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008;58(1):26–35.
2. Mas AJ, Carmona L, Valverde M, Ribas B, the EPISER Study Group. Prevalence and impact of fibromyalgia on function and quality of life in individuals from the general population: Results from a nationwide study in Spain. Clin and Exp Rheum 2008;26:519–26.
3. Walitt B, Katz RS, Bergman MJ, Wolfe F. Three-Quarters of Persons in the US Population Reporting a Clinical Diagnosis of Fibromyalgia Do Not Satisfy Fibromyalgia Criteria: The 2012 National Health Interview Survey. PLoS One 2016;11(6):e0157235.
4. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016;46(3):319–29.
5. Traynor LM, Thiessen CN, Traynor AP. Pharmacotherapy of fibromyalgia. Am J Health Syst Pharm 2011;68(14):1307– 19.
6. Bernardy K, Füber N, Köllner V, Häuser W. Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome - a systematic review and metaanalysis of randomized controlled trials. J Rheumatol 2010;37(10):1991–2005.
7. Glombiewski JA, Sawyer AT, Gutermann J, Koenig K, Rief W, Hofmann SG. Psychological treatments for fibromyalgia: a meta-analysis. Pain 2010;151(2):280–95.
8. Lami MJ, Martínez MP, Sánchez AI, Miró E, Diener FN, Prados G, et al. Gender Differences in Patients with Fibromyalgia Undergoing Cognitive-Behavioral Therapy for Insomnia: Preliminary Data. Pain Pract 2016;16(2):E23–34.
9. Temeloğlu Şen E, Hocaoğlu A, Sertel Berk Ö. Group Psychotherapy With Fibromyalgia Patients: A Systematic Review. Arch Rheumatol 2019;34(4):476–91.
10. Turkyilmaz AK, Kurt EE, Karkucak M, Capkin E. Sociodemographic characteristics, clinical signs and quality of life in patients with fibromyalgia. Eurasian J Med 2012;44(2):88–93.
11. Thieme K, Turk DC, Flor H. Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables. Psychosom Med 2004;66(6):837– 44.
12. Iacob E, Donaldson G, Neikrug A, Nakamura Y, Okifuji A. Self report ecological momentary assessment in patients with fibromyalgia to examine temporal relationships between pain with mood, fatigue, and sleep. The J of Pain 2016;17(4):121.
13. Sahar K, Thomas SA, Clark SP. Adjustment to Fibromyalgia: The Role of Domain-Specific Self-Efficacy and Acceptance. Aust J of Psy 2016;68(1):29–37.
14. Thorn BE, Kuhajda MC. Group cognitive therapy for chronic pain. J Clin Psychol 2006;62(11):1355–66.
15. James LD, Thorn BE, Williams DA. Goal specification in cognitive-behavioral therapy for chronic headache pain. Beh Ther 1993;24:305–20.
16. Keefe FJ, Beaupre PM, Gil KM, Rumble ME, Aspnes A. Group therapy for patients with chronic pain. In: Gatchel RJ, Turk DC, editors. Psychological approaches to pain management: A practitioner’s handbook. 2nd ed. New York: Guilford Press; 2002.
17. Morris MJ, Rowe BF, Stauf JL. The Effectiveness of Cognitive Behavioral Therapy on Management of Symptoms in Rheumatoid Arthritis Patients. Cedarville: The Research and Scholarship Symposium Poster Presentation; 2017.
18. Anderson FJ, Winkler AE. An integrated model of group psychotherapy for patients with fibromyalgia. Int J Group Psychother 2007;57(4):451–74.
19. Sherman AC, Mosier J, Leszcz M, Burlingame GM, Ulman KH, Cleary T, et al. Group interventions for patients with cancer and HIV disease: Part I: Effects on psychosocial and functional outcomes at different phases of illness. Int J Group Psychother 2004;54(1):29–82.
20. Cramer H, Lauche R, Langhorst J, Dobos G, Paul A. Characteristics of patients with internal diseases who use relaxation techniques as a coping strategy. Complement Ther Med 2013;21(5):481–6.
21. Meeus M, Nijs J, Vanderheiden T, Baert I, Descheemaeker F, Struyf F. The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review. Clin Rehabil 2015;29(3):221–33.
22. Onieva-Zafra MD, Parra-Fernández ML, Fernandez-Martinez E. Benefits of a home treatment program using guided ımagery relaxation based on audio recordings for people with fibromyalgia. Holist Nurs Pract 2019;33(2):111–20.
23. Benson H, Klipper MZ. The Relaxation Response. New York, NY: HorperTorch; 1976.
24. Jacobson E. Progressive relaxation: A physiological and clinical investigation of muscular states and their significance in psychology and medical practice. USA: University of Chicago Press; 1938.
25. Ost LG. Applied relaxation: description of a coping technique and review of controlled studies. Behav Res Ther 1987;25(5):397–409.
26. Sertel-Berk HÖ. Klinik kavramlar ve yorumlar: Psikolojik bakış açısıyla kronik ağrı. Agri 2002;14(2):45–7.
27. Bernik M, Sampaio TP, Gandarela L. Fibromyalgia comorbid with anxiety disorders and depression: combined medical and psychological treatment. Curr Pain Headache Rep 2013;17(9):358.
28. Castelli L, Tesio V, Colonna F, Molinaro S, Leombruni P, Bruzzone M, et al. Alexithymia and psychological distress in fibromyalgia: prevalence and relation with quality of life. Clin and Exp Rheum 2012;30(6):70–7.
29. Gormsen L, Rosenberg R, Bach FW, Jensen TS. Depression, anxiety, health-related quality of life and pain in patients with chronic fibromyalgia and neuropathic pain. Eur J Pain 2010;14(2):127.e1–8.
30. American Psychological Association. Publication manual of the American Psychological Association. 6th ed. Washington, DC: APA; 2010.
31. Wolfe F, Walitt BT, Katz RS, Häuser W. Symptoms, the nature of fibromyalgia, and diagnostic and statistical manual 5 (DSM-5) defined mental illness in patients with rheumatoid arthritis and fibromyalgia. PLoS One 2014;9(2):e88740.
32. Nicholas MK. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain 2007;11(2):153–63.
33. Beal CC, Stuifbergen AK, Brown A. Predictors of a health promoting lifestyle in women with fibromyalgia syndrome. Psychol Health Med 2009;14(3):343–53.
34. Eccleston C, Crombez G, Aldrich S, Stannard C. Worry and chronic pain patients: a description and analysis of individual differences. Eur J Pain 2001;5(3):309–18.
35. Jackson T, Wang Y, Wang Y, Fan H. Self-efficacy and chronic pain outcomes: a meta-analytic review. J Pain 2014;15(8):800–14.
36. Verkaik R, Busch M, Koeneman T, van den Berg R, Spreeuwenberg P, Francke AL. Guided imagery in people with fibromyalgia: a randomized controlled trial of effects on pain, functional status and self-efficacy. J Health Psychol 2014;19(5):678–88.
37. Riddle DL, Jensen MP, Ang D, Slover J, Perera R, Dumenci L. Do Pain Coping and Pain Beliefs Associate With Outcome Measures Before Knee Arthroplasty in Patients Who Catastrophize About Pain? A Cross-sectional Analysis From a Randomized Clinical Trial. Clin Orthop Relat Res 2018;476(4):778–86. , 38. Tan G, Teo I, Anderson KO, Jensen MP. Adaptive versus maladaptive coping and beliefs and their relation to chronic pain adjustment. Clin J Pain 2011;27(9):769–74.
39. O’Cathain A, Murphy E, Nicholl J. Why, and how, mixed methods research is undertaken in health services research in England: a mixed methods study. BMC Health Serv Res 2007;7:85.
40. Glesne C. Nitel Araştırmaya Giriş. Ankara: Anı Yayıncılık; 2012.
41. Creswell JW. Research Design: Qualitative, Quantitative, and Mixed Method Approaches. Thousand Oaks: Sage Publications; 2003.
42. Creswell JW ve Plano-Clark VL. Designing and Conducting Mixed Methods Research. 2nd Ed. Los Angeles: Sage Publications; 2011.
43. Yalom ID. Grup Psikoterapisinin Teori ve Pratiği. (Translation Editor, Tangör A, Karaçam Ö). İstanbul: Nobel Tıp Yayıncılık; 1992.
44. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999;282(18):1737–44.
45. Bryant RA. Memory for Pain and Affect in Chronic Pain Patients. Pain 1993;4(3):347–51.
46. Yazici Güleç M, Güleç H, Simşek G, Turhan M, Aydin Sünbül E. Psychometric properties of the Turkish version of the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms. Compr Psychiatry 2012;53(5):623–9.
47. Nicholas MK, McGuire BE, Asghari A. A 2-item short form of the Pain Self-efficacy Questionnaire: development and psychometric evaluation of PSEQ-2. J Pain 2015;16(2):153– 63.
48. Kraaimaat FW, Evers AW. Pain-coping strategies in chronic pain patients: psychometric characteristics of the pain-coping inventory (PCI). Int J Behav Med 2003;10(4):343–63.
49. Hocaoğlu A, Sertel-Berk HÖ, Ketenci A. Ağrıyla Başetme Envanteri’nin geçerlik ve güvenirlik çalışması. Agri 2019;31:32–41.
50. Young SA. Somatic Symptom and Related Disorders: A Primer for Primary Care Providers. Lisbon: Continuing Medical Education Conference Paper; 2017.
51. Turk DC, Okifuji A, Sinclair JD, Starz TW. Differential responses by psychosocial subgroups of fibromyalgia syndrome patients to an interdisciplinary treatment. Arthritis Care Res 1998;11(5):397–404.
52. Chen YL, Francis AJ. Relaxation and imagery for chronic, nonmalignant pain: effects on pain symptoms, quality of life, and mental health. Pain Manag Nurs 2010;11(3):159– 68.
53. Menzies V, Lyon DE, Elswick RK Jr, McCain NL, Gray DP. Effects of guided imagery on biobehavioral factors in women with fibromyalgia. J Behav Med 2014;37(1):70–80.
54. Suri K, Pandey M. Effect of jacobson progressive muscle relaxation (JPMR) on psychopathological problems in chronic non-malignant pain patients, Ind J of Health and Well 2018;9(4):630–33.
55. Kroska EB. A meta-analysis of fear-avoidance and pain intensity: The paradox of chronic pain. Scand J Pain 2016;13:43–58.
56. Lethem J, Slade PD, Troup JD, Bentley G. Outline of a Fear-Avoidance Model of Exaggerated Pain Perception-I. Beh Res and Ther 1983;21(4):401–8.
57. Simons LE, Kaczynski KJ. The Fear Avoidance model of chronic pain: examination for pediatric application. J Pain 2012;13(9):827–35.
58. Ferreira-Valente MA, Ribeiro JL, Jensen MP, Almeida R. Coping with chronic musculoskeletal pain in Portugal and in the United States: a cross-cultural study. Pain Med 2011;12(10):1470–80.
59. Jensen MP, Turner JA, Romano JM. Changes after multidisciplinary pain treatment in patient pain beliefs and coping are associated with concurrent changes in patient functioning. Pain 2007;131(1-2):38–47.
60. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP. Associations between psychosocial factors and pain intensity, physical functioning, and psychological functioning in patients with chronic pain: a cross-cultural comparison. Clin J Pain 2014;30(8):713–23.
61. Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.
62. Thorn BE. Cognitive therapy for chronic pain: A step-bystep guide. New York: Guilford Press; 2004.
63. Collado A, Gomez E, Coscolla R, Sunyol R, Solé E, Rivera J, et al. Work, family and social environment in patients with Fibromyalgia in Spain: an epidemiological study: EPIFFAC study. BMC Health Serv Res 2014;14:513.
64. Thompson JM, Luedtke CA, Oh TH, Shah ND, Long KH, King S, et al. Direct medical costs in patients with fibromyalgia: Cost of illness and impact of a brief multidisciplinary treatment program. Am J Phys Med Rehabil 2011;90(1):40–6.
65. Verhaak PMF, Kerssen JJ, Dekker J, Sorbi MJ, Berzing JM. Prevalence of Chronic Benign Pain Disorder Among Adults: A Review of the Literature. Pain 1998;77:231–39.