Subgroups of FMS--Symptoms, Beliefs & Tailored Treatment

FMS 的亚组——症状、信念

• 批准号: 6983841
• 负责人: DENNIS Charles TURK
• 金额: $ 49.24万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-07-20 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6983841
• 关键词: behavior therapy; behavioral /social science research tag; belief; body movement; chronic pain; clinical research; cognition; cognitive behavior therapy; data collection methodology /evaluation; emotions; fear; fibromyalgia; human subject; human therapy evaluation; medical rehabilitation related tag; musculoskeletal disorder; outcomes research; patient oriented research; physical therapy; psychological adaptation; psychological stressor; social adjustment; social psychology

DESCRIPTION: Fibromyalgia Syndrome (FMS) adversely affects patient lives and they are high utilizers of health care. Exercise programs have demonstrable in benefit for FMS patients. Nevertheless attrition rates from such programs are substantial, and long-term benefits are compromised by the failure of people with FMS to incorporate self-directed exercise into their lifestyles. A basic premise of the current application is that the non-participation and non-adherence to exercise programs demonstrated by FMS patients often reflect avoidance based on fears that activity will result in greater fatigue or pain. Anticipated and actual fear of physical activity may contribute to the disability of FMS sufferers, and to the high rates of attrition and nonadherence that they demonstrate to physical activation and other self-management programs. Two "components" of fear of activity can usefully be distinguished - Maladaptive beliefs about the threat posed by physical activity, and emotional arousal when individuals actually experience activities that threaten to aggravate their pain or fatigue. This analysis suggests that treatments directed towards maladaptive beliefs and excessive emotional arousal should help FMS patients overcome their activity avoidance, and thereby improve their level of function. This application is a continuation of R01AR 44724," Subgroups of FMS: Symptoms, Beliefs, and Tailored Treatments." The central Aims of this application are to extend previous work by: 1) measuring participant fear of movement, and 2) evaluating the effectiveness of treatments designed to reduce disability among FMS sufferers by reducing their fear and avoidance of physical activity by. Treatments will target either reduction of fear arousal (exposure therapy [ET]), reduction of maladaptive thoughts (cognitive restructuring and skills training [CR+ST]), or both [Combined [COMB]). It is posited that all 3 treatment protocols are effective in comparison to an Attention Control (AC) treatment, but that the relative effectiveness of the 3 regimens depends on the fear level of patients (i.e., that there is an interaction between fear level and treatment). The key premise is that whereas CR+ST is a robust form of treatment that can provide some benefit for most FMS patients by addressing maladaptive beliefs and coping strategies, ET is a more targeted approach that is particularly appropriate for FMS patients with high levels of fear. COMB treatment potentially produces the best overall outcome, since it incorporates both CR+ST, which is relevant to all participants, and ET, which is relevant to high fear participants.

描述：纤维肌痛综合征(FMS)对患者的生活有不利影响，他们是医疗保健的高利用率者。锻炼计划已经证明对FMS患者有好处。然而，这类计划的流失率很高，长期利益因FMS患者未能将自我指导的锻炼纳入他们的生活方式而受到影响。目前应用的一个基本前提是，FMS患者表现出的不参与和不坚持锻炼计划通常反映了基于担心活动会导致更大的疲劳或疼痛而进行的回避。对身体活动的预期和实际恐惧可能导致FMS患者的残疾，以及他们在身体激活和其他自我管理计划中表现出的高磨损率和不坚持。可以有效地区分活动恐惧的两个“组成部分”--对体育活动构成的威胁的不适应信念，以及当个人实际经历有可能加剧其疼痛或疲劳的活动时的情绪唤醒。这一分析表明，针对适应不良信念和过度情绪唤醒的治疗应该有助于FMS患者克服他们的活动回避，从而提高他们的功能水平。本应用是R01AR 44724的延续，“FMS的亚群：症状、信念和量身定制的治疗”。该应用程序的中心目标是通过以下方式扩展以前的工作：1)测量参与者对移动的恐惧，以及2)评估旨在通过减少FMS患者的恐惧和避免体力活动来减少他们的残疾的治疗的有效性。治疗的目标要么是减少恐惧唤起(暴露疗法[ET])，要么是减少不适应的想法(认知重组和技能培训[CR+ST])，或者两者兼而有之[结合[梳子]]。与注意控制(AC)治疗相比，所有3种治疗方案都是有效的，但3种治疗方案的相对有效性取决于患者的恐惧程度(即，恐惧程度与治疗之间存在交互作用)。关键的前提是，虽然CR+ST是一种强大的治疗形式，可以通过解决适应不良信念和应对策略为大多数FMS患者提供一些好处，但ET是一种更有针对性的方法，特别适合具有高度恐惧的FMS患者。梳子疗法可能产生最好的整体结果，因为它既包括与所有参与者相关的CR+ST，也包括与高恐惧参与者相关的ET。