Psychological Interventions in Fibromyalgia: An Updated Systematic Review

Background: There is a growing development of psychological approaches for fibromyalgia. Current scientific community advocates a biopsychosocial approach to pain management programme. Psychological interventions seem to contribute to an overall health improvement; however, the reason of their success is still unclear. The aim of this review is to analyze which direction psychological interventions are taking in fibromyalgia and whether there is any intervention proved to be more effective than others. Method: We conducted an updated search of a previous review, from 2013 to 2019 using web of science (all data base). Overall, according to the inclusion/exclusion criteria 72 original studies were identified. This review encompasses an exhaustive analysis of fundamental characteristics (participants' and interventions' characteristics, control group, target variables, quality of studies and outcome measures) and compares results with the intention of evaluating effectiveness of different interventions. Results: CBT remain as the most common treatment for fibromyalgia, both as a stand-alone treatment or included in a multicomponent program. Other interventions show promising results, such as ACT, mindfulness, relaxation and guided imagery approaches, and educational procedures. Also, encouraging outcomes for specific variables have been found in new emerging approaches. For instance, Emotional Expression Acknowledgment and Exposure (EEAE), Body Basic Awareness Therapy (BBAT), Group Music Imagery, Best Possible Self, Time In, Group Solving Therapy, Forgiveness Education and psychotherapy along with spiritual care. However, there is no evidence of superior techniques. All treatments seem to be beneficial when compared with control groups in at least one variable.  Relaxation and education seem to be transversal elements across several treatments that might act as mediator variables. Conclusions: More studies regarding pain-related psychological variables and emphasising on transversal factors might contribute to unify different perspectives.