Subgroups of FMS--Symptoms, Beliefs & Tailored Treatment

描述：纤维肌痛综合征（FMS）不利地影响患者的生活，他们是高利用率的卫生保健。运动项目对FMS患者有明显的益处。然而，这些项目的流失率是相当高的，而且由于FMS患者未能将自我指导的锻炼纳入他们的生活方式，长期的好处也受到了损害。当前应用的一个基本前提是，FMS患者不参与和不坚持锻炼计划通常反映了基于害怕活动会导致更大的疲劳或疼痛的回避。对体力活动的预期和实际恐惧可能会导致FMS患者的残疾，并导致他们在体力活动和其他自我管理项目中表现出的高损耗率和不依从性。活动恐惧的两个“组成部分”可以被有效地区分开来——对身体活动构成的威胁的不适应信念，以及当个人实际经历可能加剧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患者克服活动回避，从而提高他们的功能水平。本应用程序是R01AR 44724“FMS的子组：症状、信念和量身定制的治疗”的延续。本应用程序的中心目标是通过以下方式扩展先前的工作：1)测量参与者对运动的恐惧；2)评估旨在通过减少FMS患者对运动的恐惧和回避来减少其残疾的治疗方法的有效性。治疗的目标要么是减少恐惧唤起（暴露疗法[ET]），要么是减少适应不良的想法（认知重组和技能训练[CR+ST]），要么是两者兼而有之[COMB])。假设与注意力控制（AC）治疗相比，这三种治疗方案都是有效的，但这三种治疗方案的相对有效性取决于患者的恐惧水平（即恐惧水平和治疗之间存在相互作用）。关键的前提是，尽管CR+ST是一种强有力的治疗形式，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，但ET是一种更有针对性的方法，特别适用于高度恐惧的FMS患者。COMB治疗可能产生最好的总体结果，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.