Abstract
Background
Several recent reviews have evaluated evidence on the efficacy of Mindfulness-Based Stress Reduction (MBSR) among fibromyalgia sufferers, and concluded that more research should test effects on both psychological and physiological functioning.
Purpose
We conducted a randomized prospective trial of MBSR among female fibromyalgia patients.
Methods
Effects on perceived stress, pain, sleep quality, fatigue, symptom severity, and salivary cortisol were tested in treatment (n = 51) versus wait-list control participants (n = 40) using data at baseline, post-program, and 2-month follow-up.
Results
Analyses revealed that MBSR significantly reduced perceived stress, sleep disturbance, and symptom severity, with gains maintained at follow-up. Greater home practice at follow-up was associated with reduced symptom severity. MBSR did not significantly alter pain, physical functioning, or cortisol profiles.
Conclusion
MBSR ameliorated some of the major symptoms of fibromyalgia and reduced subjective illness burden. Further exploration of MBSR effects on physiological stress responses is warranted. These results support use of MBSR as a complementary treatment for women with fibromyalgia (ISRCTN: 34628811).
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References
Wolfe F, Clauw DJ, Fitzcharles M-A, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010; 62(5): 600-610. doi:10.1002/acr.20140.
Bennett RM, Jones J, Turk DC, Russell IJ, Matallana L. An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet Disord. 2007; 8(1): 27. doi:10.1186/1471-2474-8-27.
Rutledge DN, Jones K, Jones CJ. Predicting high physical function in people with fibromyalgia. J Nurs Scholarsh. 2007; 39(4): 319-324. doi:10.1111/j.1547-5069.2007.00187.x.
Shillam CR, Dupree Jones K, Miller L. Fibromyalgia symptoms, physical function, and comorbidity in middle-aged and older adults. Nurs. Res. 2011;1: doi:10.1097/NNR.0b013e31822bbdfa.
Crofford LJ. Violence, stress, and somatic syndromes. Trauma Violence Abuse. 2007; 8(3): 299-313. doi:10.1177/1524838007303196.
Van Houdenhove BV, Egle U, Luyten P. The role of life stress in fibromyalgia. Curr Rheumatol Rep. 2005; 7(5): 365-370. doi:10.1007/s11926-005-0021-z.
Mease P. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures, and treatment. J Rheumatol. 2005; 75: 6-21.
McCain GA, Tilbe KS. Diurnal hormone variation in fibromyalgia syndrome: a comparison with rheumatoid arthritis. J Rheumatol Suppl. 1989; 19: 154-157.
Weissbecker I, Salmon P, Studts JL, Floyd AR, Dedert EA, Sephton SE. Mindfulness-based stress reduction and sense of coherence among women with fibromyalgia. J Clin Psychol Med Settings. 2002; 9(4): 297-307. doi:10.1023/A:1020786917988.
McLean SA, Williams DA, Harris RE, et al. Momentary relationship between cortisol secretion and symptoms in patients with fibromyalgia. Arthritis Rheum. 2005; 52(11): 3660-3669. doi:10.1002/art.21372.
Korszun A. Sleep and circadian rhythm disorders in fibromyalgia. Curr Rheumatol Rep. 2000; 2(2): 124-130. doi:10.1007/s11926-000-0052-4.
Hellhammer DH, Wüst S, Kudielka BM. Salivary cortisol as a biomarker in stress research. Psychoneuroendocrinology. 2009; 34(2): 163-171. doi:10.1016/j.psyneuen.2008.10.026.
Wilhelm I, Born J, Kudielka BM, Schlotz W, Wüst S. Is the cortisol awakening rise a response to awakening? Psychoneuroendocrinology. 2007; 32(4): 358-366. doi:10.1016/j.psyneuen.2007.01.008.
Pruessner JC, Hellhammer DH, Kirschbaum C. Burnout, perceived stress, and cortisol responses to awakening. Psychosom Med. 1999; 61(2): 197-204.
Kunz-Ebrecht SR, Kirschbaum C, Marmot M, Steptoe A. Differences in cortisol awakening response on work days and weekends in women and men from the Whitehall II cohort. Psychoneuroendocrinology. 2004; 29(4): 516-528. doi:10.1016/S0306-4530(03)00072-6.
Hellhammer J, Fries E, Schweisthal OW, Schlotz W, Stone AA, Hagemann D. Several daily measurements are necessary to reliably assess the cortisol rise after awakening: state- and trait components. Psychoneuroendocrinology. 2007; 32(1): 80-86. doi:10.1016/j.psyneuen.2006.10.005.
Riva R, Mork PJ, Westgaard RH, Rø M, Lundberg U. Fibromyalgia syndrome is associated with hypocortisolism. Int J Behav Med. 2010; 17(3): 223-233. doi:10.1007/s12529-010-9097-6.
Riva R, Mork PJ, Westgaard RH, Lundberg U. Comparison of the cortisol awakening response in women with shoulder and neck pain and women with fibromyalgia. Psychoneuroendocrinology. 2012; 37(2): 299-306. doi:10.1016/j.psyneuen.2011.06.014.
Curtis K, Osadchuk A, Katz J. An eight-week yoga intervention is associated with improvements in pain, psychological functioning and mindfulness, and changes in cortisol levels in women with fibromyalgia. J Pain Res. 2011; 4: 189-201. doi:10.2147/JPR.S22761.
Carlson LE, Speca M, Faris P, Patel KD. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun. 2007; 21(8): 1038-1049. doi:10.1016/j.bbi.2007.04.002.
Carlson LE, Garland SN. Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med. 2005; 12(4): 278-285. doi:10.1207/s15327558ijbm1204_9.
Crofford LJ, Appleton BE. The treatment of fibromyalgia: a review of clinical trials. Curr Rheumatol Rep. 2000; 2(2): 101-103. doi:10.1007/s11926-000-0048-0.
Crofford LJ. Pain management in fibromyalgia. Curr Opin Rheumatol. 2008; 20(3): 246-250. doi:10.1097/BOR.0b013e3282fb0268.
Glombiewski JA, Sawyer AT, Gutermann J, Koenig K, Rief W, Hofmann SG. Psychological treatments for fibromyalgia: a meta-analysis. PAIN. 2010; 151(2): 280-295. doi:10.1016/j.pain.2010.06.011.
Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004; 292(19): 2388-2395. doi:10.1001/jama.292.19.2388.
Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol Sci Pract. 2003; 10(2): 144-156.
Keng S-L, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of empirical studies. Clin Psychol Rev. 2011; 31(6): 1041-1056. doi:10.1016/j.cpr.2011.04.006.
Shapiro SL. The integration of mindfulness and psychology. J Clin Psychol. 2009; 65(6): 555-560. doi:10.1002/jclp.20602.
Bohlmeijer E, Prenger R, Taal E, Cuijpers P. The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: a meta-analysis. J Psychosom Res. 2010; 68(6): 539-544. doi:10.1016/j.jpsychores.2009.10.005.
Matousek RH, Dobkin PL, Pruessner J. Cortisol as a marker for improvement in mindfulness-based stress reduction. Complement Ther Clin Pract. 2010; 16(1): 13-19. doi:10.1016/j.ctcp.2009.06.004.
Sephton SE, Salmon P, Weissbecker I, et al. Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial. Arthritis Care Res. 2007; 57(1): 77-85. doi:10.1002/art.22478.
Grossman P, Tiefenthaler-Gilmer U, Raysz A, Kesper U. Mindfulness training as an intervention for fibromyalgia: evidence of postintervention and 3-year follow-up benefits in well-being. Psychother Psychosom. 2007; 76(4): 226-233.
Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. PAIN. 2011; 152(2): 361-369. doi:10.1016/j.pain.2010.10.043.
Lush E, Salmon P, Floyd A, Studts JL, Weissbecker I, Sephton SE. Mindfulness meditation for symptom reduction in fibromyalgia: psychophysiological correlates. J Clin Psychol Med Settings. 2009; 16(2): 200-207. doi:10.1007/s10880-009-9153-z.
Kaplan KH, Goldenberg DL, Galvin-Nadeau M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry. 1993; 15(5): 284-289. doi:10.1016/0163-8343(93)90020-O.
Goldenberg DL, Kaplan KH, Nadeau MG, Brodeur C, Smith S, Schmid CH. A controlled study of a stress-reduction, cognitive-behavioral treatment program in fibromyalgia. J Musculoskelet Pain. 1994; 2(2): 53-66. doi:10.1300/J094v02n02_05.
Shapiro SL, Carlson LE, Astin JA, Freedman B. Mechanisms of mindfulness. J Clin Psychol. 2006; 62(3): 373-386. doi:10.1002/jclp.20237.
Salmon P, Sephton S, Weissbecker I, Hoover K, Ulmer C, Studts JL. Mindfulness meditation in clinical practice. Cogn Behav Pract. 2004; 11(4): 434-446. doi:10.1016/S1077-7229(04)80060-9.
Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988; 8(1): 77-100. doi:10.1016/0272-7358(88)90050-5.
Bernstein DP, Fink L. Childhood Trauma Questionnaire: A Retrospective Self-Report: Manual. Harcourt Brace & Company; 1998.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983; 24(4): 385. doi:10.2307/2136404.
Callahan LF, Brooks RH, Summey JA, Pincus T. Quantitative pain assessment for routine care of rheumatoid arthritis patients, using a pain scale based on activities of daily living and a visual analog pain scale. Arthritis Rheum. 1987; 30(6): 630-636. doi:10.1002/art.1780300605.
Douglass A, Bornstein R, Nino-Murcia G, et al. Sleep disorders questionnaire. Sleep. 1994; 17(2): 160-167.
Hann DM, Jacobsen PB, Azzarello LM, et al. Measurement of fatigue in cancer patients: development and validation of the fatigue symptom inventory. Qual Life Res. 1998; 7(4): 301-310. doi:10.1023/A:1024929829627.
Burckhardt CS, Clark SR, Bennett RM, et al. The fibromyalgia impact questionnaire: development and validation. J Rheumatol. 1991; 18(5): 728-33.
Bennett R. The Fibromyalgia Impact Questionnaire (FIQ): a review of its development, current version, operating characteristics and uses. Clin Exp Rheumatol. 2005; 23(5): S154.
Kirschbaum C, Hellhammer DH. Salivary cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology. 1994; 19(4): 313-333. doi:10.1016/0306-4530(94)90013-2.
Pledger GW. Basic statistics: importance of compliance. J Clin Res Pharmacoepidemiol. 1992; 6(2): 77-81.
Friedman LM, Furberg C, DeMets DL. Fundamentals of Clinical Trials. New York, NY: Springer; 2010. Available at: http://link.springer.com/content/pdf/10.1007/978-1-4419-1586-3.pdf. Accessed September 5, 2014.
Lachin JM. Statistical considerations in the intent-to-treat principle. Control Clin Trials. 2000; 21(3): 167-189. doi:10.1016/S0197-2456(00)00046-5.
Lambert MJ, ed. Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change. 5th ed. New York, NY: Wiley; 2004.
Hughes JW, Fresco DM, Myerscough R, van Dulmen HM, Carlson LE, Josephson R. Randomized controlled trial of mindfulness-based stress reduction for prehypertension. Psychosom Med. 2013; 75(8): 721-728. doi:10.1097/PSY.0b013e3182a3e4e5.
Salmon P, Sephton S, Dreeben, S. Mindfulness-based stress reduction. In: Herbert JD, Forman E, eds. Acceptance and mindfulness in cognitive behavioral therapy. NJ: Wiley; 2011.
Kraemer H, Wilson G, Fairburn CG, Agras W. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry. 2002; 59(10): 877-883. doi:10.1001/archpsyc.59.10.877.
Offenbaecher M, Glatzeder K, Ackenheil M. Self-reported depression, familial history of depression and fibromyalgia (FM), and psychological distress in patients with FM. Z Für Rheumatol. 1998; 57(2): S94-S96. doi:10.1007/s003930050245.
Thieme K, Turk DC, Flor H. Comorbid depression and anxiety in fibromyalgia syndrome: relationship to somatic and psychosocial variables. Psychosom Med. 2004; 66(6): 837-844.
Teasdale JD, Segal ZV, Mark J, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000; 68(4): 615-623. doi:10.1037/0022-006X.68.4.615.
Astin JA, Berman BM, Bausell B, Lee W-L, Hochberg M, Forys KL. The efficacy of mindfulness meditation plus Qigong movement therapy in the treatment of fibromyalgia: a randomized controlled trial. J Rheumatol. 2003; 30(10): 2257-2262.
Rosenzweig S, Greeson JM, Reibel DK, Green JS, Jasser SA, Beasley D. Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice. J Psychosom Res. 2010; 68(1): 29-36. doi:10.1016/j.jpsychores.2009.03.010.
Singh BB, Berman BM, Hadhazy VA, Creamer P. A pilot study of cognitive behavioral therapy in fibromyalgia. Altern Ther Health Med. 1998; 4(2): 67-70.
Chiesa A, Serretti A. Mindfulness-based stress reduction for stress management in healthy people: a review and meta-analysis. J Altern Complement Med. 2009; 15(5): 593-600. doi:10.1089/acm.2008.0495.
Musial F, Büssing A, Heusser P, Choi K-E, Ostermann T. Mindfulness-based stress reduction for integrative cancer care—a summary of evidence. Forsch Komplementärmedizin Res Complement Med. 2011; 18(4): 192-202. doi:10.1159/000330714.
Hölzel BK, Lazar SW, Gard T, Schuman-Olivier Z, Vago DR, Ott U. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspect Psychol Sci. 2011; 6(6): 537-559. doi:10.1177/1745691611419671.
Ditto B, Eclache M, Goldman N. Short-term autonomic and cardiovascular effects of mindfulness body scan meditation. Ann Behav Med. 2006; 32(3): 227-234. doi:10.1207/s15324796abm3203_9.
Pace TWW, Negi LT, Adame DD, et al. Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology. 2009; 34(1): 87-98. doi:10.1016/j.psyneuen.2008.08.011.
Carlson LE, Speca M, Patel KD, Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003; 65(4): 571-581. doi:10.1097/01.PSY.0000074003.35911.41.
Davidson RJ, Kabat-Zinn J, Schumacher J, et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003; 65(4): 564-570.
Baer RA. Self-focused attention and mechanisms of change in mindfulness-based treatment. Cogn Behav Ther. 2009; 38(sup1): 15-20. doi:10.1080/16506070902980703.
Shapiro SL, Astin JA, Bishop SR, Cordova M. Mindfulness-based stress reduction for health care professionals: results from a randomized trial. Int J Stress Manag. 2005; 12(2): 164-176. doi:10.1037/1072-5245.12.2.164.
Jain S, Shapiro SL, Swanick S, et al. A randomized controlled trial of mindfulness meditation versus relaxation training: effects on distress, positive states of mind, rumination, and distraction. Ann Behav Med. 2007; 33(1): 11-21. doi:10.1207/s15324796abm3301_2.
Teasdale JD. Emotional processing, three modes of mind and the prevention of relapse in depression. Behav Res Ther. 1999; 37(Supplement 1): S53-S77. doi:10.1016/S0005-7967(99)00050-9.
Garland E, Gaylord S, Park J. The role of mindfulness in positive reappraisal. EXPLORE J Sci Heal. 2009; 5(1): 37-44. doi:10.1016/j.explore.2008.10.001.
Alan B, Shapiro SL. Mental balance and well-being: building bridges between Buddhism and western psychology. Am Psychol. 2006; 61(7): 690-701. doi:10.1037/0003-066X.61.7.690.
Hofmann SG, Asmundson GJG. Acceptance and mindfulness-based therapy: new wave or old hat? Clin Psychol Rev. 2008; 28(1): 1-16. doi:10.1016/j.cpr.2007.09.003.
Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York, NY: Springer Publishing Company; 1984.
Narkiewicz K, van de Borne P, Montano N, Hering D, Kara T, Somers VK. Sympathetic neural outflow and chemoreflex sensitivity are related to spontaneous breathing rate in normal men. Hypertens. 2006; 47(1): 51-55. doi:10.1161/01.HYP.0000197613.47649.02.
Lehrer PM, Woolfolk RL, Sime WE. Principles and Practice of Stress Management, Third Edition. New York, NY: Guilford Press; 2007.
Khalsa SB. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian J Physiol Pharmacol. 2004; 48(3): 269-285.
Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001; 1(1): 2.
Yunus MB, Arslan S, Aldag JC. Relationship between fibromyalgia features and smoking. Scand J Rheumatol. 2002; 31(5): 301-305. doi:10.1080/030097402760375214.
Shapiro SL, Oman D, Thoresen CE, Plante TG, Flinders T. Cultivating mindfulness: effects on well-being. J Clin Psychol. 2008; 64(7): 840-862. doi:10.1002/jclp.20491.
Baer RA, Smith GT, Allen KB. Assessment of mindfulness by self-report the Kentucky inventory of mindfulness skills. Assess. 2004; 11(3): 191-206. doi:10.1177/1073191104268029.
Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003; 84(4): 822-848. doi:10.1037/0022-3514.84.4.822.
Chadwick P, Hember M, Symes J, Peters E, Kuipers E, Dagnan D. Responding mindfully to unpleasant thoughts and images: reliability and validity of the Southampton mindfulness questionnaire (SMQ). Br J Clin Psychol. 2008; 47(4): 451-455. doi:10.1348/014466508X314891.
Carmody J, Baer RA, LB Lykins E, Olendzki N. An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program. J Clin Psychol. 2009; 65(6): 613-626. doi:10.1002/jclp.20579.
Kilpatrick LA, et al. Impact of mindfulness-based stress reduction training on intrinsic brain connectivity. Neuroimage 2011;56(1): 290-298.
Salmon P, Lush E, Jablonski M, Sephton SE (2008) Yoga and Mindfulness: Clinical Aspects of an Ancient Mind/Body Practice. Cognitive and Behavioral Practice. doi:10.1016/j.cbpra.2008.07.002.
Sampalli T, Berlasso E, Fox R, Petter M. A controlled study of the effect of a mindfulness-based stress reduction technique in women with multiple chemical sensitivity, chronic fatigue syndrome, and fibromyalgia. J Multidiscip Healthc. 2009; 2: 53-59.
Acknowledgments
This was an investigator-initiated study funded by faculty startup monies awarded to S.E.S by the Department of Psychiatry and Behavioral Sciences at the University of Louisville School of Medicine. A.F. was supported by a grant from the National Cancer Institute. L.A.Z. was supported by a doctoral fellowship from the University of Louisville School of Interdisciplinary and Graduate Studies. S.E.S. was supported by grants from the National Institute on Aging and the National Institute of Mental Health. E.D. was supported by a Career Development Award-2 from the Clinical Science Research and Development Service of the VA Office of Research and Development. The funders played no role in the design, conduct or analysis of the study, nor in the interpretation and reporting of the study findings. The researchers were independent from the funders. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards
Author Elizabeth Cash, Author Paul Salmon, Author Inka Weissbecker, Author Whitney N. Rebholz, Author Rene Bayley-Veloso, Author Lauren Zimmaro, Author Andrea Floyd, Author Eric Dedert, and Author Sandra E. Sephton declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
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Cash, E., Salmon, P., Weissbecker, I. et al. Mindfulness Meditation Alleviates Fibromyalgia Symptoms in Women: Results of a Randomized Clinical Trial. ann. behav. med. 49, 319–330 (2015). https://doi.org/10.1007/s12160-014-9665-0
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DOI: https://doi.org/10.1007/s12160-014-9665-0