Project title

FIBROMYALGIA, REPETITIVE NEGATIVE THINKING AND PSYCHOLOGICAL DISTRESS

Scientific Coordinator's name:

António Macedo and José Pereira da Silva

Scientific Coordinator's e-mail:

amacedo@ci.uc.pt

Principal R&D Unit:

Department of Psychological Medicine, Faculty of Medicine, University of Coimbra

Other R&D Units involved in the project:

Rheumatology Clinic, Coimbra Hospital and University Centre

Project keyword(s)

FIBROMYALGIA, PERSONALITY, METACOGNITION, PSYCHOLOGICAL DISTRESS

Short abstract and comments

Fibromyalgia (FM) is a chronic pain syndrome defined by widespread pain (Wolfe et al, 1990) that overlaps significantly with the Chronic Fatigue Syndrome (CFS) (Van Houdenhove et al, 2010). Generalised pain of at least 3 month’ duration without a better explanation and pain on pressure of at least 11 out of 18 predefined tender points are the requirements for the diagnosis (Wolfe et al, 1990). However FM patients frequently report a variety of other symptoms, such as fatigue, effort intolerance, poor sleep quality, cognitive dysfunction, depression and anxiety, multiple drug intolerance, irritable bowel syndrome and temporomandibular disorder (Smith et al, 2011; Van Houdenhove & Egle, 2004; Wolfe & Hauser 2011). Although the exact etiology and pathogenesis of FM are still unknown, there is overwhelming consensus that this conditions should be considered through an integrative biopsychosocial model (Van Houdenhove & Egle, 2004; Schmidt-Wilcke & Clauw, 2011) in which stress, psychological factors and personality traits (e.g. neuroticism; perfectionism) play a major role. Some studies suggest that psychological distress may play a causal role in the FM syndrome (White et al, 2002; Conversano et al, 2010). Maladaptive perfectionism has been linked with a broad range of psychopathological conditions and health problems (Shafran & Mansell, 2001) including chronic fatigue (Luyten et al, 2011). However, the mechanisms that mediate these associations are not fully understood, and the main cognitive processes and cognitions underlying illness behavior in FM and its negative emotional antecedents and consequences wait for further clarification. Worry and rumination involve self-focused thinking in which individuals tend to negatively appraise their health status and functional capacity. In FM patients, the content of these repetitive negative thoughts may be related with excessive monitorization of pain and other physical signs. Such iterations may result in higher pain intensity, and more pain-related fear–avoidance behaviour, which in turn determines more severe functional limitations. It is possible that FM patients hold positive and negative metacognitive beliefs about the benefits of rumination/worrying which motivate these individuals to persist on these cognitive processes, as coping strategies, despite their contribution to the development and persistence of Psychological Distress (PD). Thus, in the present study special importance will be paid to the role of repetitive negative thinking (RNT) (e.g., worry and rumination) and their underlying mechanisms. Settled in this context, the present study aims to investigate the role of stress, some personality traits and specific cognitive processes, namely RNT in the relationship between personality, psychological distress and pain perception in FM patients and controls. For this purpose three samples will be investigated: (1) a clinical sample of FM patients (2) a clinical control sample of rheumatoid arthritis patients, and (3) a non-clinical control sample of women attending a routine gynecological consultation.

Potential uses/indications

Preliminary we expect to find significant relationships between perfectionism dimensions, repetitive negative thinking, positive and negative meta-cognitions, psychological distress, perception of pain and FM impact in FM patients. We anticipate that this pattern of relations will be different in FM patients vs. AR patients and control subjects. As a main outcome we expect to confirm the hypothesis that certain cognitive characteristics, processes and rules play a role in the relationship between perfectionism, psychological distress and FM. We also predict that these meta-cognitive variables will mediate the relation between perfectionism and pain perception and FM impact in FM subjects. Specifically we expect to prove the importance of meta-cognitions in eliciting/ maintaining negative thinking processes that are responsible for the psychological negative outcomes and thus for the negative impact of FM. Additionally we hope that the results of our project could better inform and support the development and implementation of cognitive-behavioral and metacognitive interventions, in FM patients. Specifically this project could draw the attention for the potential importance of meta-cognitive psychotherapeutic techniques for the treatment of perfectionism, RNT and FM, which could subsequently prevent the development of negative psychological conditions and diminish the FM negative impact.