Clicca qui per scaricare

Il trattamento psicoterapeutico nella Sindrome Fibromialgica: le applicazioni della terapia dinamica breve in un setting ospedaliero italiano
Titolo Rivista: PSICOLOGIA DELLA SALUTE 
Autori/Curatori: Annunziata Romeo, Valentina Tesio, Benedetta Vicino, Fabrizio Colonna, Enrico Fusaro, Daniela Converso, Lorys Castelli 
Anno di pubblicazione:  2019 Fascicolo: Lingua: Italiano 
Numero pagine:  19 P. 119-137 Dimensione file:  300 KB
DOI:  10.3280/PDS2019-001007
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più:  clicca qui   qui 


La Fibromialgia (FM) è una Sindrome Funzionale Somatica caratterizzata da dolore cronico, fatica, disturbi del sonno e deficit cognitivi. Lo scopo del presente lavoro è quello di esporre l’applicazione della terapia dinamica breve alla FM. Nello specifico, ispirandosi al modello della Terapia Dinamica Interpersonale Breve basato sulla mentalizzazione, l’attaccamento e la regolazione dello stress, viene descritta la sua applicazione, su pazienti affette da FM in un setting ospedaliero italiano. Il presente articolo, partendo dalle premesse teoriche, descrive la sua applicazione clinica evidenziando la possibilità e l’utilità del trat-tamento psicologico per le difficoltà interpersonali delle pazienti con FM.


Keywords: Fibromialgia, depressione, psicoterapia, attaccamento, mentalizzazione.

  1. Kratz A.L., Davis M.C. and Zautra A.J. (2012). Attachment predicts daily catastrophizing and social coping in women with pain. Health Psychology, 31: 278-285.
  2. Abbas A.A., Kisely S.R and Kroenke K. (2009). Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials. Psychotherapy and Psychosomatics, 78: 265-74., 10.1159/00022824DOI: 10.1159/00022824
  3. Abbas A.A., Kisely S.R., Town J.M., Leichsenring F., Driessen E., De Maat S., Gerber A., Dekker J., Rabung S., Rusalovska S. and Crowe E. (2014). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev, (7):CD004687., 10.1002/14651858.CD00468DOI: 10.1002/14651858.CD00468
  4. Kenberg O.F. (1985). Mondo interno e realtà esterna. Torino: Bollati Boringhieri.
  5. Abeles A.M., Pillinger M.H., Solitar B.M. and Abeles M. (2007). Narrative review: the pathophysiology of fibromyalgia. Annals of Internal Medicine, 146(10): 726-734., 10.7326/0003-4819-146-10-200705150-0000DOI: 10.7326/0003-4819-146-10-200705150-0000
  6. Ablin J.N., Buskila D., Van Houdenhove B., Luyten P., Atzeni F. and Sarzi-Puttini P. (2012). Is fibromyalgia a discrete entity? Autoimmunity Reviews, 11: 585-588.
  7. Afari N., Ahumada S.M., Wright L.J., Mostoufi S., Golnari G., Reis V. and Cuneo J.G. (2014). Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosomatic Medicine, 76(1): 2. , 10.1097/PSY.000000000000001DOI: 10.1097/PSY.000000000000001
  8. Aguglia A., Salvi V., Maina G., Rossetto I. and Aguglia E. (2011). Fibromyalgia syndrome and depressive symptoms: Comorbidity and clinical correlates. Journal of Affective Disorders, 128: 262-266. 
  9. Anderberg U.M., Marteinsdottir I., Theorell T. and Von Knorring L. (2000). The impact of life events in female patients with fibromyalgia and in female healthy controls. European Psychiatry, 15(5): 295-301., 10.1016/S0924-9338(00)00397-DOI: 10.1016/S0924-9338(00)00397-
  10. Aslakson E., Vollmer-Conna U., ReevesW. and White P. (2009). Replication of an empirical approach to delineate the heterogeneity of chronic unexplained fatigue. Population Health Metrics, 7: 17. , 10.1186/1478-7954-7-1DOI: 10.1186/1478-7954-7-1
  11. Bartholomew K. and Horowitz L.M. (1991). Attachment styles among young adults: a test of a four-category model. Journal of Personality and Social Psychology, 61(2): 226.
  12. Bernardy K., Füber N., Köllner V. and Häuser W. (2010). Efficacy of cognitive–behavioral therapies in fibromyalgia syndrome — a systematic review and meta-analysis of randomized controlled trials. Journal of Rheumatology, 37: 1991-2005.
  13. Bernardy K., Klose K., Bush A.J., Choy E.H.S. and Hauser W. (2013). Cognitive behavioural therapies for fibromyalgia. Cochrane of Systematic Review, 9: CD009796. 
  14. Bertolotti M., Roccia E., Zucchetti G., Peirolo C., Geuna T., Bellini S. e Converso D. (2017). Valutare il rischio bio-psico-sociale in oncoematologia pediatrica. Riflessioni sull’applicazione del Percorso Diagnostico Terapeutico Assistenziale (PDTA) della Regione Piemonte in psicologia oncologica: risultati preliminari. [Evaluation of bio-psycho-social risk in pediatric oncology. Application of the Diagnostic Asisstance Therapeutic Pathway in psychoncology: preliminary results]. Psicologia della Salute, 1: 147-158., 10.3280/PDS2017-001008DOI: 10.3280/PDS2017-001008
  15. Branco J.C., Bannwarth B., Failde I., Abello Carbonell J., Blotman F., Spaeth M., Saraiva F., Nacci F., Thomas E., Caubère J.P., Le Lay K., Taieb C. and Matucci-Cerinic M. (2010). Prevalence of Fibromyalgia: A Survey in Five European Countries. Seminars in Arthritis and Rheumatism, 39(6): 448-453.
  16. Borrell-Carrió F., Suchman A.L. and Epstein R.M. (2004). The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. The Annals of Family Medicine, 2(6): 576-582.
  17. Buskila D., Sarzi-Puttini P. and Ablin J.N. (2007). The genetics of fibromyalgia syndrome. Pharmacogenomics, 8: 67-74., 10.2217/14622416.8.1.6DOI: 10.2217/14622416.8.1.6
  18. Castelli L. and Tesio V. (2016). Commentary: Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients. Frontiers in Psychology, 7: 740.
  19. Castelli L., Tesio V., Colonna F., Molinaro S., Leombruni P., Bruzzone M., Fusaro E., Sarzi-Puttini P. and Torta R. (2012). Alexithymia and psychological distress in fibromyalgia: prevalence and relation with quality of life. Clinical and Experimental Rheumatology, 30(6 Suppl 74): 70-7.
  20. Converso D. (2015). La sfida della cronicità: quale organizzazione delle cure è necessaria? [The challenge of chronic illness: what care organization is needed?]. Salute e Società, 3: 72-88., 10.3280/SES2015-00300DOI: 10.3280/SES2015-00300
  21. Di Tella M. and Castelli L. (2013). Alexithymia and fibromyalgia: clinical evidence. Frontiers in Psychology, 4: 909. 
  22. Di Tella M. and Castelli L. (2016). Alexithymia in Chronic Pain Disorders. Current Rheumatology Reports, 18(7): 1-9.
  23. Di Tella M., Castelli L., Colonna F., Fusaro E., Torta R., Ardito R.B. and Adenzato M. (2015). Theory of mind and emotional functioning in fibromyalgia syndrome: an investigation of the relationship between social cognition and executive function. PLoSOne, 16: 10(1). 
  24. Driessen E., Cuijpers P., de Maat S.C.M., Abbass A.A., de Jonghe F. and Dekker J.J.M. (2010). The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis update. Clinical Psychology Review, 30: 25-36.
  25. Engel G.L. (1980). The clinical application of the biopsychosocial model. Am J Psychiatry, 137(5): 535-544.
  26. Fietta P., Fietta P. and Manganelli P. (2007). Fibromyalgia and psychiatric disorders. ActaBiomedica, 78 (2): 88-95.
  27. Fonagy P. and Luyten P. (2009). A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Development and Psychopathology, 21: 1355-1381., 10.1017/S0954579409990198DOI: 10.1017/S0954579409990198
  28. Gil F.P., Weigl M., Wessels T., Irnich D., Baumüller E. and Winkelmann A. (2008). Parental bonding and alexithymia in adults with fibromyalgia. Psychosomatics, 49(2): 115-122.
  29. Gilardi S., Guglielmetti C., Casati S. e Monti P. (2014). Promuovere l’engagement dei pazienti con malattie croniche: un percorso di ricerca collaborativa [Promoting engagement in chronic illness patients: a collaborative research pathway]. Psicologia della Salute, 3: 58-79., 10.3280/PDS2014-003004.DOI: 10.3280/PDS2014-003004.
  30. Glombiewski J.A., Sawyer A.T., Gutermann J., Koenig K., Rief W. and Hofmann S.G. (2010). Psychological treatments for fibromyalgia: A meta-analysis. Pain, 151: 280-295.
  31. Geenen R., van Ooijen-van der Linden L., Lumley M.A., Bijlsma J.W. and van Middendorp H. (2012). The match–mismatch model of emotion processing styles and emotion regulation strategies in fibromyalgia. Journal of Psychosomatic Research, 72(1): 45-50.
  32. Goldenberg D.L., Burckhardt C. and Crofford L. (2004). Management of fibromyalgia syndrome. Jama, 292(19): 2388-2395.
  33. Häuser W., Bernardy K., Arnold B., Offenbacher M. and Schiltenwolf M. (2009). Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Rheumatism, 61: 216-24.
  34. Häuser W., Kosseva M., Üceyler N., Klose P. and Sommer C. (2011). Emotional, physical, and sexual abuse in fibromyalgia syndrome. A systematic review with meta-analysis. Arthritis Care and Research, 63: 808-20.
  35. Haviland M.G., Morton K., Oda K. and Fraser E.G. (2010). Traumatic experiences, major life stressors, and self-reporting a physician given fibromyalgia diagnosis. Psychiatry Research, 177: 335-41. 
  36. Heim C., Nater U.M., Maloney E., Boneva R., Jones J.F. and Reeves W.C. (2009). Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction. Archives of General Psychiatry, 66: 72-80.
  37. Hyphantis T., Guthrie E., Tomenson B. and Creed F. (2009). Psychodynamic interpersonal therapy and improvement in interpersonal difficulties in people with severe irritable bowel syndrome. Pain, 145: 196-203.
  38. Lemma A., Target M. and Fonagy P. (2011). The development of a brief psychodynamic intervention (Dynamic Interpersonal Therapy) and its application to depression: A pilot study. Psychiatry: Interpersonal and Biological Processes, 74: 41-48.
  39. Lemma A., Target M. e Fonagy P. (2012). Terapia Dinamica Interpersonale Breve. Una guida clinica [Brief Dynamic Interpersonal Therapy. A clinical guide]. Milano: Raffaello Cortina.
  40. Leombruni P., Miniotti M., Colonna F., Sica C., Castelli. L, Bruzzone M., Parisi S., Fusaro E., Sarzi-Puttini P., Atzeni F. and Torta R.G. (2015). A randomized controlled trial comparing duloxetine and acetyl L-carnitine in fibromyalgic patients: preliminary data. Clinical and Experimental Rheumatology, 33: S82-5.
  41. Leombruni P., Zizzi F., Miniotti M., Colonna F., Castelli L., Fusaro E. and Torta R. (2016). Harm Avoidance and Self-Directedness Characterize Fibromyalgic Patients and the Symptom Severity. Frontiers in Psychology, 7: 579.
  42. Low L.A. and Schweinhardt P. (2012). Early life adversity as a risk factor for fibromyalgia in later life. Pain Research and Treatment, 140832., 10.1155/2012/140832DOI: 10.1155/2012/140832
  43. Luyten P., Kempke S., Van Wambeke P., Claes S.J., Blatt S.J. and Van Houdenhove B. (2011). Self-critical perfectionism, stress generation and stress sensitivity in patients with chronic fatigue syndrome: Relationship with severity of depression. Psychiatry: Interpersonal and Biological Processes, 74(1): 21-30.
  44. Luyten P., Van Houdenhove B., Lemma A., Target M. and Fonagy P. (2012). A mentalization-based approach to the understanding and treatment of functional somatic disorders. Psychoanalytic Psychotherapy, 26(2): 121-140., 10.1080/02668734.2012.67806DOI: 10.1080/02668734.2012.67806
  45. Luyten P., Van Houdenhove B., Lemma A., Target M. and Fonagy, P. (2013). Vulnerability for Functional Somatic Disorders: A contemporary Psychodynamic Approach. Journal of Psychoterapy Integration, 23(3): 250-262.
  46. Luyten P. and Van Houdenhove B. (2013). Common and specific factors in the psychotherapeutic treatment of patients suffering from chronic fatigue and pain. Journal of Psychotherapy Integration, 23(1): 14.
  47. Martellotti S. (2011). Fibromialgia: percorsi di sviluppo e personalità. Mente e Cura, (2): 47-58.
  48. Maunder R.G. and Hunter J.J. (2008). Attachment relationships as determinants of physical health. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 36: 11-32.
  49. Mikulincer M. and Shaver P.R. (2007). Attachment in adulthood: Structure, dynamics and change. New York: Guilford Publications.
  50. Oliveira P. and Costa M.E. (2009). Interrelationships of adult attachment orientations, health status and worrying among fibromyalgia patients. Journal of Health Psychology, 14(8): 1184-1195., 10.1177/135910530934247DOI: 10.1177/135910530934247
  51. Porcelli P. (2009). Medicina Psicosomatica e Psicologia Clinica. Modelli teorici, diagnosi, trattamento [Psychosomatic Medicine and Clinical Psychology. Theoretical models, diagnoses, treatment]. Milano: Raffaello Cortina.
  52. Rajeevan M.S., Smith A.K., Dimulescu I., Unger E.R., Vernon S.D., Heim C. and Reeves W.C. (2007). Glucocorticoid receptor polymorphisms and haplotypes associated with chronic fatigue syndrome. Genes, Brain and Behavior, 6: 167-176.
  53. Rimes K.A. and Chalder T. (2010). The beliefs about emotions scale: Validity, reliability and sensitivity to change. Journal of Psychosomatic Research, 68: 285-292.
  54. Romeo A., Tesio V., Castelnuovo G. and Castelli L. (2017). Attachment Style and Chronic Pain: Toward an Interpersonal Model of Pain. Frontiers in Psychology, 8: 284.
  55. Scheidt C.E., Waller E., Endorf K., Schmidt S., König R., Zeeck A., Joos A. and Lacour M. (2013). Is brief psychodynamic psychotherapy in primary fibromyalgia syndrome with concurrent depression an effective treatment? A randomized controlled trial. General Hospital Psychiatry, 35: 160-167.
  56. Sim J. and Adams N. (2002). Systematic review of randomized controlled trials of non pharmacological interventions for fibromyalgia. Clinical Journal of Pain, 18: 324-36.
  57. Sommer C., Häuser W., Alten R., Petzke F., Späth M., Tölle T., Uçeyler N., Winkelmann A., Winter E. and Bär K.J. (2012). [Drug therapy of fibromyalgia syndrome. Systematic review, meta-analysis and guideline]. Schmerz (Berlin, Germany), 26(3): 297-310.
  58. Stern D.N. (1985). The Interpersonal World of the Infant. A View from Psychoanalysis and Developmental Psychology. New York (Basic Books): Karnac Book.
  59. Steinweg D.L., Dallas A.P. and Rea W.S. (2011). Fibromyalgia: unspeakable suffering, a prevalence study of alexithymia. Psychosomatics, 52(3): 255-262.
  60. Sullivan H.S. (1953). The Interpersonal Theory of Psychiatry. New York: WW Norton & Co.
  61. Taylor R.E., Mann A.H., White N.J. and Goldberg D.P. (2000). Attachment style in patients with unexplained physical complaints. Psychological Medicine, 30(04): 931-941., 10.1017/S003329179900231DOI: 10.1017/S003329179900231
  62. Tesio V., Torta D.M., Colonna F., Leombruni P., Ghiggia A., Fusaro E., Geminiani G.C., Torta R. and Castelli L. (2015). Are Fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence. Arthritis Care and Research (Hoboken), 67(1): 143-50.
  63. Torta R.G., Tesio V., Ieraci V., Castelli L., and Zizzi F.B. (2016). Fibro-fog. Clinical and Experimental Rheumatology, 34 (2 Suppl 96): 6-8.
  64. Van Houdenhove B. and Luyten P. (2007). Fibromyalgia and related syndromes characterized by stress intolerance and pain hypersensitivity: Do we need a new nosology? Current Rheumatology Reviews, 3: 304-308., 10.2174/15733970778240893DOI: 10.2174/15733970778240893
  65. Van Houdenhove B. and Luyten P. (2009). Central sensitivity syndromes: stress system failure may explain the whole picture. Seminars in Arthritis and Rheumatism, 39 (3): 218-219.
  66. Vicino B., Ardito R.B., Romeo A., Torta R. e Castelli L. (2016). La terapia cognitiva in psicosomatica: una proposta di intervento per la sindrome fibromialgica [Cognitive therapy in the psychosomatic setting: a treatment’s proposal for fibromyalgia syndrome]. Quaderni di Psicoterapia Cognitiva, 38., 10.3280/QPC2016-03800DOI: 10.3280/QPC2016-03800
  67. Waller E., Scheidt C.E., Endorf K., Hartmann A. and Zimmermann P. (2016). Unresolved trauma in fibromyalgia: A cross-sectional study. Journal of Health Psychology, 21(11): 2457-2465., 10.1177/135910531558046DOI: 10.1177/135910531558046
  68. Yunus M. (2007). Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes. Seminars in Arthritis and Rheumatism, 36(6): 339-356.

Annunziata Romeo, Valentina Tesio, Benedetta Vicino, Fabrizio Colonna, Enrico Fusaro, Daniela Converso, Lorys Castelli, in "PSICOLOGIA DELLA SALUTE" 1/2019, pp. 119-137, DOI:10.3280/PDS2019-001007

   

FrancoAngeli è membro della Publishers International Linking Association associazione indipendente e no profit per facilitare l'accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche