Subgroups of FMS--Symptoms, Beliefs & Tailored Treatment

描述：纤维肌痛综合征（FMS）对患者的生活产生不利影响，他们是医疗保健的高利用率。运动计划对FMS患者有明显的益处。尽管如此，这些项目的流失率是相当大的，而且FMS患者未能将自我指导的锻炼纳入他们的生活方式，从而损害了长期的益处。本申请的基本前提是，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对活动将导致更大疲劳或疼痛的恐惧的回避。预期和实际的身体活动的恐惧可能会导致FMS患者的残疾，以及他们对身体活动和其他自我管理计划的高磨损率和不遵守率。活动恐惧的两个“组成部分”可以有效地区分开来--对身体活动造成的威胁的适应不良信念，以及当个体实际经历可能加剧其疼痛或疲劳的活动时的情绪唤起。这一分析表明，针对适应不良的信念和过度的情绪唤起的治疗应该帮助FMS患者克服他们的活动回避，从而提高他们的功能水平。本申请是R 01 AR 44724“FMS亚组：症状、信念和定制治疗”的延续。“这项应用的中心目标是通过以下方式扩展以前的工作：1）测量参与者对运动的恐惧，2）评估旨在通过减少他们的恐惧和避免体力活动来减少FMS患者残疾的治疗的有效性。治疗将针对减少恐惧唤醒（暴露疗法[ET]）、减少适应不良思维（认知重建和技能培训[CR+ST]）或两者[组合[COMB]）。假设与注意力控制（AC）治疗相比，所有3种治疗方案都是有效的，但是3种方案的相对有效性取决于患者的恐惧水平（即，恐惧程度和治疗之间存在相互作用）。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的信念和应对策略为大多数FMS患者提供一些好处，ET是一种更有针对性的方法，特别适用于具有高度恐惧的FMS患者。COMB治疗可能产生最佳的总体结局，因为它结合了与所有参与者相关的CR+ST和与高度恐惧参与者相关的ET。

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.