Psychoeducation for Fibromyalgia Syndrome: A Systematic Review of Emotional, Clinical and Functional Related-Outcomes
2. Materials and Methods
2.1. Search Strategy
2.2. Eligibility Criteria
2.3. Data Extraction and Quality Assessment
2.4. Data Synthesis
3.1. Literature Search and Study Characteristics
|First Author (Publication Year), Study Name, Country||Objectives||Study Design/Procedure||Sample Size|
[Mean ± Age (SD)]
|FMS Diagnostic Criteria||Instruments and Variables||Results|
|Antunes et al. (2022). Amigos de Fibro (Fibro Friends): Validation of an Educational Program to Promote Health in Fibromyalgia. Brazil. .||To validate a multidisciplinary educational health promotion program for individuals with FMS.||Delphi technique.|
Phases: (1) Development of Amigos de Fibro; (2) Content validation of Amigos de Fibro; (3) Adjusting the Amigos de Fibro; (4) Final assessment of Amigos de Fibro; and (5) Final version of Amigos de Fibro.
|N = 23 health professionals (expert judges). 10 males (43.5%) and 13 females (56.5%). Aged between 31 and 40 years old (39.2%).|
N = 45 individuals with FMS (target audience). 4 males (9%) and 41 females (91%). Aged between 31 and 40 years old (38%).
|2016 ACR, revised version.||Groups of professionals and individuals with FMS listed their demands through the focus group.|
Evaluation of Amigos de Fibro, built with the information and results obtained from the first round, regarding the objectives, proposed themes and initiatives, relevance, writing style, and structure of the program (with specialists and individuals with FMS).
Final evaluation of the material after the corrections are made, based on the judges’ suggestions.
|Content validity index (CVI) ≤ 0.78 and coefficient kappa ≤ 0.61. |
All 25 items evaluated in both groups presented considerable minimum CVI by CVI and the kappa coefficient.
Global CVI of Amigos de Fibro, by the specialist judges, was 0.90; and 0.95 by the target audience judges.
The kappa coefficient of the expert judges was 0.90 and that of the target audience judges was 0.85.
Amigos de Fibro was considered with adequate content validity and internal consistency.
|Pérez-Aranda et al. (2021). Do humor styles predict clinical response to the MINDSET (MINDfulneSs & EducaTion) program? A pilot study in patients with fibromyalgia. Spain. .||To explore the role of humor styles in predicting clinical changes after the multicomponent intervention (MINDSET) that combines mindfulness and psychoeducation for FMS patients.||Pilot Study. *|
Procedure: MINDSET intervention: 4 psychoeducation sessions about FMS, based on a previously validated program, and 4 sessions of mindfulness training, based on the Mindfulness-Based Stress Reduction curriculum.
Psychoeducation Sessions: 2 h, twice per week, run by health psychologists in a group setting of 8–10 patients.
Intervention added on to the patient’s usual care (i.e., medication). No additional active treatments.
|N = 35 FMS patients. |
N = 34 (97.1%) FMS female patients [54.97 ± 8.65].
|FMS patients: affiliative humor and positive/negative ratio humor styles had a unique predictive effect on self-reported clinical changes. Association between humor styles with functional impact and mindfulness facets. Some humor styles may imply a better disposition in patients to learn and implement the concepts and resources that the intervention offered.|
|Melin et al. (2018). Psychoeducation against depression, anxiety, alexithymia, and fibromyalgia: a pilot study in primary care for patients on sick leave. Sweden. .||(1) To try the feasibility of ASSA in a Swedish primary care setting; (2) to explore associations between symptoms of depression, anxiety, alexithymia, and MUPS.||Pilot Study. * ¤|
Procedure: ASSA began with 8 group sessions—‘the Affect School’, which were followed directly by 10 individual sessions—‘the Script Analysis’. All 27 respondents one-week post-intervention terminated ASSA within 20 weeks from the start. Script Analysis sessions were performed with one instructor, either the physiotherapist, the GP, or one social counselor. Affect School comprised 8 weekly, 2-h sessions, of a 5–7 participant group, led by the same instructors (one psychotherapist, one physiotherapist, and one GP) during all sessions.
Psychoeducation Sessions: 8 weekly 2-h sessions with a 5–7 participant group led by two instructors followed by 10 individual hour-long sessions.
Follow-up: 18 months.
|N = 36 patients. 29 female patients (81%). Median age 39, range 27–60 years. (N FMS patients: 2 [6%]).||Not specified.||TAS-20.|
EuroQol ‘health barometer’ (100 mm—VAS).
|Patients: one-week post-intervention median test score changes were significantly favorable for 9 of 11 measures (depression, anxiety, alexithymia, MUPS, general health, self-affirmation, self-love, self-blame, and self-hate); at 18 months post-intervention the results remained significantly favorable for 15 respondents for 7 of 11 measures (depression, alexithymia, MUPS, general health, self-affirmation, self-love, and self-hate).|
|Feliu-Soler et al. (2016). Cost-utility and biological underpinnings of Mindfulness-Based Stress Reduction (MBSR) versus a psychoeducational program (FibroQoL) for fibromyalgia: a 12-month randomized controlled trial (EUDAIMON study). Spain .||(1) To examine the effectiveness and cost-utility for FMS patients of MBSR as an add-on to treatment as usual (TAU) versus TAU + the psychoeducational program FibroQoL, and versus TAU only; (2) to examine pre-post differences in brain structure and function, as well as levels of specific inflammatory markers in the three study arms; and (3) to analyze the role of some psychological variables as mediators of 12-month clinical outcomes.||12-month randomized controlled trial. * ¤|
Procedure: Protocol in progress.
Psychoeducation Sessions (FibroQoL): 8, 2-h sessions.
Three treatment arms: (1) TAU + MBSR; (2) TAU + FibroQoL; (3) TAU.
Control Group: TAU (pharmacologic treatment + counselling about aerobic exercise adjusted to patients’ physical limitations).
Active control group: TAU + FibroQoL. FibroQoL: a psycho-educational program for FMS patients based on a consensus document drawn up by the Health Department of Catalonia.
Planned follow-up: 12 months.
|N = 180 FMS female patients. |
N = 60 FMS female patients per group.
|1990 ACR.||Sociodemographic-clinical questionnaire.|
Structured Clinical Interview for DSM Axis I Disorders (SCID-I).
Screening measures: MMSE.
Log of out-session for MBSR and psychotherapeutic practices.
Adverse events of the interventions.
Brain structure: VBM.
Inflammatory markers: Blood samples.
|Protocol in progress.|
|Bourgault et al. (2015). Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial. Canada .||To evaluate, quantitatively and qualitatively, the efficacy of the PASSAGE Program—a multicomponent interdisciplinary group intervention for the self-management of FMS.||A mixed-methods randomized controlled trial. * ¤|
Intervention (INT) vs. waitlist (WL).
Qualitative group interviews with a subset of patients were also conducted.
Procedure: Intervention: PASSAGE Program (a structured multicomponent interdisciplinary group intervention aimed at reducing FMS symptoms and maintaining optimal function through the use of self-management strategies and patient education). 9 group sessions with 8 participants lasting 2.5 h each. Each session involved 3 major components: (1) psycho-educational tools; (2) CBT-related techniques; and (3) patient-tailored exercise activities.
Follow-up: 3 months.
|N = 28 INT Group. 26 females (92.9%). [49.98 ± 9.23].|
N = 28 WL Group. 26 females (92.9%). [46.74 ± 11.42].
|1990 ACR.||Primary outcomes:|
Change in pain intensity (0–10).
Pain coping strategies.
Health-related quality of life.
Perceived pain relief.
|FMS patients: the intervention had a statistically significant impact on the three PGIC measures. At the end of the PASSAGE Program, the percentages of patients who reported pain relief and perceived overall improvement on their pain levels, functioning, and quality of life were significantly higher in the INT Group than in the WL Group. The same differences were observed 3 months post-intervention. |
The results of the qualitative analysis were in line with the quantitative findings regarding the efficacy of the intervention. The improvement, however, was not reflected in the primary and secondary outcomes.
|Dowd et al. (2015). Comparison of an Online Mindfulness-based Cognitive Therapy Intervention With Online Pain Management Psychoeducation: A Randomized Controlled Study. Ireland, the UK, North America, and other countries .||To test the effectiveness of a computerized mindfulness-based cognitive therapy intervention (MIA) compared to computerized pain management psychoeducation (PE) in a randomized study.||A randomized controlled study. * ¤|
Procedure: Participants in each condition received 12 sessions of treatment, twice per week for 6 weeks. MIA intervention was based on established mindfulness meditation and emotional regulation programs shown to be effective for chronic pain.
Psychoeducation Sessions: based on many of the common elements found within pain management programs. The PE program was presented in a series of twice-weekly emails containing written information about chronic pain self-management.
Follow-up: 6 months.
|N = 124 chronic pain patients. 112 females (90.3%) and 12 males). [44.53 ± 12.25].|
N MIA group = 62 participants (N FMS patients: 15).
N PE group = 62 participants. (N FMS patients: 18).
|Not specified.||Primary Outcomes:|
Pain interference (BPI).
Psychological Distress (HADS).
Pain Intensity: 2 NRS from BPI.
Pain Right Now.
|FMS patients: both groups showed improvements in pain interference, pain acceptance, and catastrophizing from pre-treatment to post-treatment and at follow-up. Reduced average pain intensity from baseline to post-treatment for both groups, but not at follow-up. Increases in subjective well-being, were more pronounced in the MIA than in the PE group. |
MIA group: greater reduction in pain ‘right now’, and increases in their ability to manage emotions, manage stress and enjoy pleasant events on completion of the intervention.
|Luciano et al. (2013). Cost-Utility of a Psychoeducational Intervention in Fibromyalgia Patients Compared With Usual Care. An Economic Evaluation Alongside a 12-Month Randomized Controlled Trial. Spain. .||(1) To determine the effectiveness of adding psychoeducational treatment implemented in general practice to usual care for patients with fibromyalgia; (2) to analyze the cost-utility of the intervention from health care and societal perspectives.||12-month randomized controlled trial. * ¤|
Procedure: See Luciano et al., 2011.
|See Luciano et al., 2011.||1990 ACR.||See Luciano et al., 2011.||FMS patients who received psychoeducation: greater improvement on global functional status, physical functioning, pain, morning fatigue, stiffness, and depression. It was confirmed the long-term clinical effectiveness of a psychoeducational treatment program for FMS implemented at the primary care level and the cost-utility from a healthcare and societal perspective.|
|Luciano et al. (2011). Effectiveness of a Psychoeducational Treatment Program Implemented in General Practice for Fibromyalgia Patients. A Randomized Controlled Trial. Spain. .||To examine whether a psychoeducational intervention implemented in primary care is more effective than usual care for improving the functional status of patients with FMS.||Randomized Controlled Trial. * ¤|
Procedure: The treatment program is based on a consensus document developed by an expert panel in 2005 and published in 2006 by the Catalan Health Department.
Psychoeducation Sessions: 9, 2-h sessions (5 sessions of education and 4 sessions of autogenic relaxation), delivered over a 2-month period (1-afternoon session per week), run by GP and rheumatologist, with a maximum of 18 patients per group. Six separate intervention groups were performed.
Intervention group: Usual care from their GP + psychoeducational program.
Control group: Usual care from their GP.
Usual care from their GP: pharmacologic treatment + counselling about aerobic exercise adjusted to patients’ physical limitations.
Follow-up: 12 months.
|N = 211 participants.|
N = 105 intervention group. FMS female patients (97.2%) [55.17 ± 8.58].
N = 106 control group. FMS female patients (98.1%) [55.42 ± 8.63].
|1990 ACR.||Sociodemographic Questionnaire.|
Chronic Medical Conditions Checklist.
Marlowe-Crowne Social Desirability Scale.
|FMS patients who received psychoeducation: a 2-month psychoeducational intervention improves the functional status to a greater extent than usual care, at least in the short-term. The social desirability bias did not explain the reported outcomes. Trait anxiety was associated with response to treatment.|
|Mannerkorpi et al. (2009). Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses. Sweden .||To evaluate the effects of pool exercise in patients with fibromyalgia and chronic widespread pain and to determine characteristics influencing the effects of treatment.||Randomized controlled trial. * ¤ |
Procedure: 20-session exercise programme combined with a standardized 6-session education programme based on self-efficacy principles with an active control group, which undertook the same education programme.
Psychoeducation Sessions: The education programme, which was designed to introduce strategies to cope with FMS symptoms, consisted of 6 1-h sessions, conducted once a week for 6 weeks. The programme was led by a physiotherapist. The pedagogical approach was based on the active participation of the patients through discussions and practical exercises. The control group received the same education programme.
Exercise programme: comprised 20 sessions of 45-min pool exercise once a week for 20 weeks in temperate (33 °C) water, supervised by a physiotherapist. The exercise was planned to permit individual progress, aiming to improve overall function and to motivate regular physical activity.
Follow-up: 11–12 months after the baseline.
|N = 166: 134 FMS female patients + 32 chronic widespread pain (CWP) female patients.|
N = 81 Exercise—Education Group. [44.60 ± 9.26]. Intervention group.
N = 85 Education Group. [46.50 ± 8.30]. Control Group.
|1990 ACR.||Primary outcomes:|
FIQ total score.
Body functions (6MWT).
Pain (the FIQ Pain).
Fatigue (the FIQ Fatigue).
Health-related quality of life (SF36).
Amount of leisure time physical activity (LTPAI).
Clinical manifestations of stress (SCI).
Multiple dimensions of fatigue (MFI-20).
Experience in physical activity (ITT and PP).
Note: PP is defined as attendance at least 60% of the sessions.
|FMS patients: The exercise-education programme showed significant, but small, improvement on health status in patients with fibromyalgia and chronic widespread pain, compared with education only. Patients with milder symptoms improved most with this treatment.|
|Rook et al. (2007). Group Exercise, Education, and Combination|
Self-management in Women With Fibromyalgia. United States .
|To evaluate and directly compare the effects of 4 common self-management interventions on well-established measures of functional status, symptom severity, and self-efficacy in women with fibromyalgia.||Randomized Controlled Trial. * ¤|
Procedure: Both exercise programs involved approximately 60 min of activity per session. Each session began with a brief warm-up of walking on a treadmill at a comfortable pace and then progressed to a self-determined level of moderate effort for a predetermined amount of time. All participants, regardless of fitness level, began with 5 min of walking and increased a maximum of 2 to 4 min weekly following a predetermined progression. The AE group progressed to a total of 45 min of walking. The ST group reached a maximum of 20 min of treadmill walking followed by 25 min of strength training movements.
Psychoeducation Sessions: The Fibromyalgia Self-Help Course (FSHC) is a 7-session program that teaches individuals with fibromyalgia about the condition and self-management skills. Sessions were 120 min long every 2 weeks. All FSHC instructors were certified by the Arthritis Foundation.
Follow-up: 6 months.
|N = 207 enrolled and randomized FMS female patients. |
N = 138 FMS female patients who completed the intervention.
N = 35 Aerobic and flexibility exercise (AE) Group [48.00 ± 11.00].
N = 35 strength training, aerobic, and flexibility exercise (ST) Group. [50.00 ± 11.00].
N = 27 the Arthritis Foundation’s Fibromyalgia Self-Help Course (FSHC) Group. [51.00 ± 12.00].
N = 38 a combination of ST and FSHC (ST-FSHC) Group. [50.00 ± 11.00].
|1990 ACR.||Primary outcomes:|
Change in physical function from baseline to completion of the intervention (FIQ and SF-36).
Social and emotional function, symptoms (FIQ, the bodily pain and vitality subscales of the SF-36, and BDI).
Self-efficacy (adapted Arthritis Self-Efficacy Scale).
|FMS patients: progressive walking, simple strength training movements, and stretching activities improve functional status, key symptoms, and self-efficacy in women with fibromyalgia actively being treated with medication. The benefits of exercise are enhanced when combined with targeted self-management education. Appropriate exercise and patient education be included in the treatment of fibromyalgia.|
|King et al. (2002). The effects of exercise and education, individually or combined, in women with fibromyalgia. Canada .||To examine the effectiveness of a supervised aerobic exercise program, a self-management education program, and the combination of exercise and education for women with fibromyalgia (FMS).||Randomized controlled trial with repeated measures design. * ¤|
Procedure: The intervention programs were based upon principles of self-management (Bandura’s social cognitive theory). Treatment programs ran simultaneously for 12 weeks. Due to the large number of subjects required, the programs were offered on 5 different occasions over a 2 year period (winter–spring once, fall–winter, and spring–summer twice each).
Education Group: met once a week for one and a half to 2 h per session.
Exercise and education group: combined exercise and education programs. The educational component was the same as for the education-only group. The exercise-only group met twice per week and on the third day met for education and then exercise.
Control group: On the day of the initial assessment, they were given a page of instructions for basic stretches and 5 items related to general coping strategies. They were contacted once or twice throughout the 12-week period to ensure they were filling out their logbook and to answer any questions. Subjects from the control group were offered one of the intervention programs at the end of the follow-up period.
Follow-up: 3 months.
|N = 170 FMS female patients.|
N = 46 Exercise Group. [45.2 ± 9.4].
N = 48 Education Group. [44.9 ± 10.0].
N = 37 Exercise & Education Group. [47.4 ± 9.0].
N = 39 Control Group. [47.3 ± 7.3].
SE Coping with symptoms.
Tender Point Count.
Total Survey Site Score.
|FMS patients: subjects receiving the combination of exercise and education and who complied with the treatment protocol improved their perceived ability to cope with other symptoms. A supervised exercise program increased walking distance at post-test, an increase that was maintained at follow-up in the exercise-only group. Results demonstrate the challenges with conducting exercise and education studies in persons with FMS.|
3.2. Psychoeducation and Emotional, Clinical, and Functional Related-Outcomes in Fibromyalgia Syndrome
3.3. Structure of the Fibromyalgia Syndrome Psychoeducation Programs
|Study (Author and Year)||Psychoeducation Program Content|
|Antunes et al. (2022) .|
|Pérez-Aranda et al. (2021) .|
|Melin et al. (2018). Affect School .|
(3) Interest and surprise;
(6) Distaste and dissmell;
(2) How we act in different situations and how we interpret experiences are depending on our scripts;
(3) Scripts are formed by family rules and common cultural rules for how affects should be handled;
(4) Intensity and expressions of emotion are controlled by scripts;
(5) Affects can be completely suppressed and thereby unconscious.
(2) How do you know that you feel…?
(3) Do you feel … in a particular place in your body?
(4) Does it happen often that you feel…?
(5) How do you know that someone else is…?
(6) Can you understand and accept another person’s…?
|Feliu-Soler et al. (2016). FibroQoL. .|
|Bourgault et al. (2015) .|
|Dowd et al. (2015) .|
|Luciano et al. (2011) .|
Luciano et al. (2013) .
|Mannerkorpi et al. (2009) .|
|Rook et al. (2007) .||The Fibromyalgia Self-Help Course (FSHC):
|King et al. (2002) .|
3.4. Risk of Bias
|Study (Author and Year)||Random Sequence Generation (Selection Bias)||Allocation Concealment (Selection Bias)||Blinding of Participants and Personnel (Performance Bias)||Blinding of Outcome Assessment (Detection Bias)||Incomplete Outcome Data (Attrition Bias)||Selective Reporting (Reporting Bias)||Other Bias||General Assessment (Low, Medium, High)|
|Antunes et al. (2022) .||H||L||H||L||L||L||Yes||Medium|
|Pérez-Aranda et al. (2021) .||H||H||H||H||L||L||Yes||Low|
|Melin et al. (2018) .||H||H||H||H||L||L||Yes||Low|
|Feliu-Soler et al. (2016) .||L||L||L||L||L||L||Yes||High|
|Bourgault et al. (2015) .||L||L||L||L||L||L||Yes||High|
|Dowd et al. (2015) .||L||L||H||H||L||L||Yes||Medium|
|Luciano et al. (2013) .||L||L||L||L||L||L||Yes||High|
|Luciano et al. (2011) .||L||L||L||L||L||L||Yes||High|
|Mannerkorpi et al. (2009) .||L||L||L||L||L||L||Yes||High|
|Rook et al. (2007) .||L||L||L||L||L||L||Yes||High|
|King et al. (2002) .||L||L||L||L||L||L||Yes||High|
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
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Galvez-Sánchez, C.M.; Montoro, C.I. Psychoeducation for Fibromyalgia Syndrome: A Systematic Review of Emotional, Clinical and Functional Related-Outcomes. Behav. Sci. 2023, 13, 415. https://doi.org/10.3390/bs13050415
Galvez-Sánchez CM, Montoro CI. Psychoeducation for Fibromyalgia Syndrome: A Systematic Review of Emotional, Clinical and Functional Related-Outcomes. Behavioral Sciences. 2023; 13(5):415. https://doi.org/10.3390/bs13050415Chicago/Turabian Style
Galvez-Sánchez, Carmen M., and Casandra I. Montoro. 2023. "Psychoeducation for Fibromyalgia Syndrome: A Systematic Review of Emotional, Clinical and Functional Related-Outcomes" Behavioral Sciences 13, no. 5: 415. https://doi.org/10.3390/bs13050415