Psychological Factors Associated with Fibromyalgia and the Areas of Psychological Intervention

Abstract

Fibromyalgia is a musculoskeletal pain syndrome characterized with the presence of sensitive points and widespread chronic pain and restricts one's daily life activities and decreases the quality of life. The etiology of fibromyalgia is unclear, but there are numerous hypotheses regarding the emergence and progression of the disease. Among these, the biopsychosocial model offers a holistic framework in which biological, psychological and social mechanisms play a role in the development of fibromyalgia. Since the etiology of the disease is not yet understood, effective methods for its treatment have not been found, thus, interventions aim to reduce the effect of fibromyalgia and increase psychological and physiological functionality. This article aims to examine the psyhcological intervention areas and methods for fibromyalgia patients. In the literature, it is concluded that pain avoidance beliefs and behaviors, self-efficacy, physical activity, sleep quality, self-compassion, emotional skills, coping strategies, personality, comorbid psychopathology are the factors related with the emergence of the disease, severity of pain, and adherence to treatment in fibromyalgia patients. In this context, Cognitive-Behavioral Therapy (CBT), physical exercises, sleep management Acceptance and Commitment Therapy (ACT), compassion focused psychotherapies, mindfulness based psychotherapies, emotion expression and emotion regulation techniques, and biofeedback are recommended as effective methods which can be included in the treatment plans of fibromyalgia patients. Moreover, considering the psychosocial factors in the assessment processes was essential to establish individualized treatment plans. In addition, the importance of multidisciplinary approaches in the treatment processes of fibromyalgia has been discussed within the framework of the biopsychosocial model.

Keywords

• chronic pain
• fibromyalgia
• multidisciplinary treatments
• psychological intervention

Fibromiyalji ile İlişkili Psikolojik Faktörler ve Psikolojik Müdahale Alanları

Öz

Fibromiyalji, yaygın vücut ağrısı ile ağrının lokalize olduğu duyarlı noktaların varlığı ile tanımlanan, kişinin günlük yaşam aktivitelerini kısıtlayan ve yaşam kalitesini düşüren bir kas iskelet sistemi ağrı sendromudur. Fibromiyaljinin etiyolojisi belirsizdir, ancak hastalığın ortaya çıkması ve ilerleyişi hakkında çok sayıda hipotez vardır. Bunlar arasından biyopsikososyal model, fibromiyaljinin gelişiminde biyolojik, psikolojik ve sosyal mekanizmaların bir arada rol oynadığı bütüncül bir çerçeve sunmaktadır. Hastalığın etiyolojisi henüz anlaşılamadığından, tedavisine yönelik etkili yöntemler bulunamamıştır, bu nedenle müdahale yöntemleri fibromiyaljinin olumsuz etkilerini azaltmayı, psikolojik ve fizyolojik fonksiyonelliği artırmayı hedeflemektedir. Bu makalede fibromiyalji hastalarında psikolojik müdahale alanları ve yöntemlerinin incelenmesi amaçlanmaktadır. Literatür incelendiğinde, ağrı ile ilişkili inançlar ve kaçınma davranışları, öz-yeterlilik, fiziksel aktivite, uyku kalitesi, öz-şefkat, duygusal beceriler, baş etme stratejileri, kişilik, eşlik eden psikopatolojiler gibi faktörlerin hastalığın gelişimini, ağrı şiddetini ve hastaların tedaviye uyumunu etkilediği sonucuna ulaşılmıştır. Bu bağlamda, Bilişsel-Davranışçı Terapi (BDT), fiziksel aktivite ve uyku hijyeni takibi, Kabul ve Kararlılık Terapisi (KKT), şefkat odaklı terapiler, farkındalık temelli terapiler, duygu ifadesi ve düzenlenmesine yönelik teknikler, biyogeribildirim gibi yöntemlerin tedavi planlarında yer alabilecek etkili yöntemler olduğu, ancak hastalığı değerlendirme sürecinde psikososyal etmenler göz önünde bulundurularak bireyselleştirilmiş tedavi planları oluşturulmasının elzem olduğu sonucuna ulaşılmıştır. Buna ek olarak, biyopsikososyal model çerçevesinde fibromiyaljinin tedavi süreçlerinde çok disiplinli çalışmanın önemi tartışılmıştır.

Anahtar Kelimeler

• çok disiplinli tedavi
• fibromiyalji
• psikolojik müdahale
• kronik ağrı

Kaynakça

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