Mindfully Considering Treatment of Fibromyalgia: a Comment on Cash et al.
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INVITED COMMENTARY
Mindfully Considering Treatment of Fibromyalgia: a Comment on Cash et al. Mary Davis, PhD
# The Society of Behavioral Medicine 2014
Research focused on evaluating mindfulness-based approaches to the treatment of the widespread pain and fatigue of fibromyalgia (FM) has been growing steadily over the past several years. That growth has been fueled in part by evidence pointing to the utility of these approaches for FM [1] and other chronic pain conditions [2], as well as for depression, anxiety, and other psychological symptoms that are highly prevalent among individuals with FM (e.g., [3, 4]. In this issue, Cash et al. [5] report that mindfulness-based stress reduction (MBSR) yielded significant effects in some core domains targeted by psychological pain treatments [6], effects that were of similar magnitude to those produced by other psychological treatments for FM [7]. These findings add to the body of work documenting that mindfulness-based treatments provide clinically meaningful benefits to those with FM. What are the key challenges facing clinical scientists trying to optimize the impact of not only MBSR but also other treatments for chronic pain? A central issue is identifying the mechanisms that account for treatment effects, a point that has been made previously [8, 9] but bears repeating. MBSR and other mindfulness-based approaches are likely to operate through a number of mechanisms, some unique and some shared with other treatments. Included among purported psychological mechanisms relevant to mindful interventions are changes in attentional processes, such as decreased vigilance to threat cues [10]; emotional processes, such as increased
M. Davis (*) Department of Psychology, Arizona State University, P.O. Box 1104, Tempe, AZ 85287-1104, USA e-mail: [email protected]
distress tolerance and positive affective reactivity [11]; and cognitive-evaluative processes, such as decreased pain catastrophizing and increased pain acceptance. In their investigation, Cash and colleagues probed whether decreases in perceived stress or depressive symptoms, or level of weekly mindfulness practice, accounted for the benefits of MBSR for women with FM, but did not find evidence of mediation. Their data contribute to efforts to build more refined treatment models that delineate the roles of key mediators for particular outcomes. Identifying the processes through which mindfulnessbased treatments produce change also can help us to identify likely moderators of treatment effects [12]. Individuals with FM constitute a heterogenous group. They vary considerably not only in their levels of pain, fatigue, and physical impairment, but also in the extent to which they experience affective distress and the quality of their social milieu. They vary considerably in their response to treatment as well [13]. Carefully elaborating and testing purported mechanisms of action will help us understand for whom treatments are likely to be useful. Ultimately, we may be able to tailor treatment to address the specific psy
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