Attachment-Based Compassion Therapy for Ameliorating Fibromyalgia: Mediating Role of Mindfulness and Self-Compassion

Abstract

Objectives

The aim of this study was to evaluate the efficacy of Attachment-Based Compassion Therapy (ABCT)—a standardised programme that includes practices to improve compassionate awareness with the aim of addressing maladaptive attachment—for improving mindfulness and self-compassion in fibromyalgia (FM) patients, and to determine whether gains in mindfulness and self-compassion mediate improvements in FM functional status together with comorbid anxiety and depression.

Methods

The study comprised a randomised controlled trial of individuals undergoing ABCT, with a Relaxation condition as an active control group. Baseline, post-test, and 3-month follow-up assessments were included. Participants (n = 42) were FM patients randomly assigned to ABCT or relaxation. Outcomes were functional status (FIQ), anxiety (HADS-A), depression (HADS-D), mindfulness (FFMQ), and self-compassion (SCS). Differences between groups were estimated using mixed-effects regression models, and mediation analyses were conducted using path analyses.

Results

Compared with the Relaxation condition, the ABCT group was more effective for improving mindfulness and self-compassion, as it observed through changes in the FFMQ and SCS subscales. Effect sizes were in the moderately large to large range (Cohen’s d between 0.60–2.20). Reductions in FM functional status were not mediated by either mindfulness or self-compassion. However, the self-compassion facet of common humanity was a mediator for reductions in both anxiety (B = − 2.04; bootstrapped 95% CI = − 4.44, − 0.04) and depression (B = − 2.12; bootstrapped 95% CI = − 4.40, − 0.45).

Conclusions

The improvement of common humanity via ABCT might be an active component for the reduction of comorbid anxiety and depression in FM patients.

Trial registration

NCT02454244

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Data Availability

In accordance with the International Committee of Medical Journal Editors (ICMJE), all of the individual anonymised and completely de-identified participant data are available with no end date and for any analytical purpose that is related to achieve aims in the present study upon reasonable request to researchers (i) who provide a methodologically sound proposal and (ii) whose proposed use of the data has been approved by an independent ethical review committee. The database is encrypted and password protected and is available at the Open Science Framework (osf.io/mzrx5). Passwords will be provided by the corresponding author to interested researchers that meet the aforementioned criteria.

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Funding

The project has received funding from the DGA group (B17-17R) and the Network for Prevention and Health Promotion in primary Care (RD12/0007/0005) grant from the Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness, co-financed with European Union ERDF funds. JVL has a “Miguel Servet” contract from the ISCIII (CPII19/00003). The funding source had no influence on the design of the study, data collection, management, analysis and interpretation of the data, or the writing of the report and the decision to submit the report for publication, and they had no authority over any of these activities during the conducting of the trial.

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Contributions

JMM designed the study, developed the data analyses, and wrote and edited the manuscript. WVG collaborated in the writing and editing of the final manuscript. ES collaborated in the writing and editing of the final manuscript. MNG designed and executed the study. VG executed the study. YLH collaborated in editing of the final manuscript. JVL collaborated in the writing of the final manuscript. JGC designed and conducted the study and collaborated in the writing of the final version of the manuscript. All authors approved the final version of the manuscript for submission.

Corresponding author

Correspondence to Mayte Navarro-Gil.

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The authors declare that they have no conflict of interest.

Ethical Approval

The study protocol was approved by the ethical review board of the regional health authority of Aragon (CEICA), Spain (reference number: PI15/0049; 01/04/2015). All procedures performed in this study involving human participants were in accordance with the ethical standards of the regional health authority of Aragon (CEICA), with the 1964 Helsinki Declaration and its later amendments and modifications or comparable ethical standards, and the Declaration of Madrid of the World Psychiatric Association and Uniform Requirements for Manuscripts Submitted to Bio-Medical Journals.

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Informed consent was obtained from all individual participants included in the study.

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Montero-Marin, J., Van Gordon, W., Shonin, E. et al. Attachment-Based Compassion Therapy for Ameliorating Fibromyalgia: Mediating Role of Mindfulness and Self-Compassion. Mindfulness 11, 816–828 (2020). https://doi.org/10.1007/s12671-019-01302-8

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Keywords

  • ABCT
  • Fibromyalgia
  • Anxiety
  • Depression
  • Mindfulness
  • Self-compassion