Table 2.

Brief description of the psychotherapeutic interventions and the results on physical pain.

Original research
[22] Psychotherapeutic Intervention. Dance movement psychotherapy (DMP). Ten weekly individual sessions. If needed, the program can be extended for up to 20 sessions. Each session begins with the therapist directing introductory warm-up exploring body connectivity, followed by the process of producing spontaneous/improvised movements. The session ends verbally discussing the possible meanings of the previously performed movements.
Groups. One group of 16 women
Outcome. After 10 weeks of intervention, the pain level reduced but not at a significant level
[23] Psychotherapeutic Intervention. Promotion of positive emotions through the use of a virtual reality environment. In groups of 6, participants were placed in front of a screen during 20 minutes, receiving simultaneously images, melodies, and narratives promoting relaxation, motivation, and positive emotions. Participants also received one session of psychoeducation about fibromyalgia and about the activity management component of the virtual reality device.
Groups. One group of 40 women
Outcome. There was a decrement from pretest to posttest on pain intensity, but it was not statistically significant
[24] Psychotherapeutic Intervention. Cognitive behavioral therapy for insomnia. The intervention was provided in groups of 5 to 7 participants, including only men or women. Participants received a protocol-based manual including psychoeducational information, exercises, and topics that would be discussed in the sessions and homework. There were 9 weekly sessions, lasting 90 minutes each.
Groups. One group of 28 participants, 15 women and 13 men
Outcome. Pain intensity reduced significantly through time (immediately after the intervention and three months later), with no interaction with sex
[25] Psychotherapeutic Intervention. Psychoeducation. The program included 5 sessions providing information about symptoms, course, comorbidities, potential causes, psychosocial factors, available treatments, benefits of regular exercise, and common barriers to behavioral change. There were also 4 sessions for autogenic training, a relaxation technique in which the person teaches the body to respond to commands to relax and control breathing, blood pressure, heart beat, and body temperature. Educational and autogenic training sessions were intercalated during 9 weeks, for 2-hour sessions, for a group of a maximum of 18.
Groups. Intervention group received usual care plus psychoeducation. Control group received only usual care (i.e., adjusted pharmacology and counseling about aerobic exercise). Each group included 108 participants.
Outcome. No difference between groups at baseline. At 12-month follow-up, patients who received psychoeducation reduced their score on pain, the control group increased its score, and differences were significant between groups.
[26] Psychotherapeutic Intervention. Intervention Emotion Awareness and Expression Therapy. This therapy aims at reducing amplification of central nervous system pain and sensory processes due to stress or conflicts, followed by emotional avoidance, by awareness, experiencing, and expression of more adaptive emotions. For each treatment option, patients met with therapist in groups of approximately 6, for eight 90-minute weekly sessions.
Groups. One group received emotional awareness and expression therapy (n = 79), a second group received cognitive behavioral therapy (n = 75), and a third group received fibromyalgia education (n = 76)
Outcome. Emotional awareness and expression therapy did not differ from education on pain severity. Compared to cognitive behavioral therapy, it did not differ significantly on pain severity, but it did have a higher percentage of patients achieving 50% pain reduction.
[27] Psychotherapeutic Intervention. Guided Imagery. Participants listened to three separate tracks of audio-recorded guided imagery scripts, instructed to use the tracks in 2-week increments and in consecutive order for the first 6 weeks; then to use the tracks in any order for follow-up weeks 7 through 10.
Groups. Control group receiving usual care and intervention group receiving usual care plus guided imagery. Each group with 36 participants.
Outcome. The intervention group showed significant decrease in pain severity from baseline to 6 weeks. From baseline to 10 weeks, the intervention group significantly reduced pain severity in comparison with the control group.
[28] Psychotherapeutic Intervention. Group problem-solving therapy. Three sessions at one-week intervals, and a fourth session at a one month interval after the third session.
Groups. Control group receiving cervical infiltration with botulinum toxin, the intervention group receiving group problem-solving therapy, and a third group receiving both therapies. Each group included 22 participants.
Outcome. No significant differences in pain before and after intervention, neither in total sample, nor in any of the three groups
[29] Psychotherapeutic Intervention. In the first session, the therapist guides the patient with an imagery exercise lasting 15 minutes. This is recorded in a CD and given to the patient with the instructions to listen to it at home at least 4 days during the first week and every day during the second week. The following week, the patient attends another session to practice relaxation, also recorded in a CD with the same previous instructions. In the following 4 weeks, the patient chooses any of the two CDs to listen as many days but only once daily.
Groups. Guided imagery group and a control group. Each group with 30 participants.
Outcome. At week 4, the intervention group reported statistically significantly lower levels of pain than the control group and a statistically significant effect on pain as measured by the daily VAS diary. At week 8, no significant differences were found for pain.
[30] Psychotherapeutic Intervention. Guided Imagery. Participants received three group sessions including guided imagery relaxation exercises, as well as group discussions and instructions on the use of the provided CDs. Participants were requested to do one exercise per day at least 4 times a week, during 8 weeks.
Groups. Guided imagery group (n = 28) and control group (n = 27)
Outcome. At week 4, the intervention group showed a significant reduction in pain at 5 out of 8 sensitive points. At week 8, these significant differences continued in 4 sensitive points. The control group showed no statistically significant differences in pain at sensitive points. No specific values on pain items from the FIQ are reported.
[31] Psychotherapeutic Intervention. Group Music and Imagery. During 12 weeks, participants attended two-hour weekly sessions in groups of 8. Sessions included relaxation, music listening, and spontaneous imagery.
Groups. Intervention group (n = 33) and control group (n = 26) condition
Outcome. Intervention group significantly decreased pain perception, up to three months after intervention
[32] Psychotherapeutic Intervention. Guided Imagery. A first group session included group discussion and theoretical background of guided imagery and received a CD with three guided imagery exercises to use at least one daily for the following four weeks. Then, in the second group session, the therapist led group discussion. Each session lasted 1.5 hour.
Groups. Intervention group (n = 32) and control group (n = 33)
Outcome. No effects on pain intensity of guided imagery could be established
Study protocol
[33] Psychotherapeutic Intervention. Behavioral Activation. Ten group sessions with 5 to 8 participants, over two months. Sessions focus on increasing activities associated with pleasure and reducing those that maintain or increase depression.
Groups. The control group will receive usual care for fibromyalgia with comorbid depression; the intervention group will receive in addition, behavioral activation therapy. Each group will include 45 participants.
[34] Psychotherapeutic Intervention. Personal Construct Therapy and Cognitive Behavioral Therapy. In each therapeutic condition, participants will attend up to eighteen 1-hr weekly sessions. After the end of treatment and during the following 3–5 months, participants will attend up to three 1-hr booster sessions.
Groups. One group will receive personal construct therapy and another group will receive cognitive behavioral therapy. Each group will include 45 participants.