The story gets high marks for its evaluation of the evidence and especially for pointing out the limitations of psychotherapy studies that use a waiting list as a control group. The story would have been improved by the inclusion of some truly independent expert sources to comment on the research. Such experts may have emphasized that this "new" therapy may not differ very dramatically from existing psychotherapeutic approaches.
Because of the controversy that has surrounded the diagnosis of fibromyalgia for decades (and which still persists today), researchers have been slow to develop new therapies for treating the condition. The new approach discussed here is especially welcome because it addresses the "mind-body" connection in the development of chronic pain. That is, it acknowledges–as research increasingly suggests– that the source of chronic pain for some patients lies not only in achy muscles and joints but also in the central nervous system. Much more research will be needed to demonstrate whether this new approach is broadly effective for fibromyalgia patients.
Chronic pain takes a huge financial toll in terms of direct medical costs and lost productivity, but the story didn’t cover this angle. It would have been interesting to hear how costs of this psychotherapy compare with those of drug therapy. Also, no word on whether the costs would be covered by insurance or borne out of pocket by patients.
The story reports that 46% of patients receiving affective self-awareness therapy had a 30% or greater reduction in pain severity, which was the study’s primary outcome, compared to zero patients in the control group. This succinct summary, presented in absolute terms and unembellished with patient anecdotes, is enough to merit a satisfactory. But we wish the story had explained whether a 30% reduction in this pain rating scale is a clinically important finding. In addition, it is not clear why the article failed to mention that patients receiving affective self-awareness therapy had improved self-reported functional status. This is an important measure of how patients are able to get along in their daily lives.
We’ll grade this one not applicable because the story didn’t mention any potential harms of psychotherapy – which is understandable since these are generally thought to be small. But there are some theoretical risks which the story could have mentioned.
The story does a relatively thorough job of explaining the study and included key information such as the number of patients, a description of the intervention, and the length of follow-up. It could have done a better job of pointing out strengths of the research, including the fact that the evaluators were blinded to the treatment status of the subjects. Moreover, the story didn’t comment on the the fact that the therapy was provided only in the first month of the study (and was limited to the initial evaluation followed by three two hour group sessions), and yet the positive effect on pain was noted at 6 months–evidence of a durable effect of the treatment.
Importantly, the story drew attention to several limitations such as the small sample size and the fact that the control group was on a wait list and didn’t receive as much attention as the intervention group. The latter point is important, the story points outs, because patients tend to get better when they are seen by health care professionals, regardless of whether any effective treatment is provided. Accordingly, the improvements seen with affective self-awareness therapy might be due in part to the increased number of office visits these patients made rather than any specific effect of the treatment.
Fibromyalgia is a controversial diagnosis that some experts maintain isn’t a real illness. Nevertheless, the disease is recognized by the FDA, insurers, and the American College of Rheumatology, who estimate that 5 million Americans suffer from this condition. This prevalence estimate is accurately cited in the article.
The story included only one expert source, Dr. Howard Schubiner, who in addition to being an author on the paper is also the original developer of affective self-awareness therapy. While these credentials no doubt make him an authority on the treatment and an important interview subject, they also create the appearance that he could be biased in favor of the approach. Another expert perspective would have been useful, for example, to explain why some professionals disagree with Schubiner’s approach to fibromyalgia treatment. Schubiner suggests that his ideas are "controversial," but we never learn what it is that other experts in the field object to.
The story mentions other common approaches to treatment, including painkillers, antidepressants, CBT and exercise therapy. It also provides some discussion of the overlap between CBT and affective self-awareness, both of which focus on recognizing and modifying maladaptive responses to emotions and thoughts. For comparison purposes, we think it would have been interesting to hear how these other therapies have performed in similarly designed studies of fibromyalgia pain. Nevertheless, the story does enough to earn a satisfactory.
The story notes that only a small number of healthcare providers practice affective self-awareness, suggesting that the treatment is not widely available.
The story earns a satisfactory for not over-selling the novelty of the therapy. Cognitive-Behavioral therapy (CBT), an established psychotherapy treatment, deals with the recognition of emotions and their relationship to cognition, function and maladaptive responses. Affective self-awareness seems to deal with similar issues, so It is not clear how novel this treatment really is. The story adequately describes this, and is not overly assertive
It’s clear that the story interviewed the author of the study, so it’s apparent that it was not lifted entirely from a news release.