Competitive and caregiving mentality as a comprehensive framework for Fibromyalgia

Abstract

A investigação tem demonstrado que a fibromialgia e a depressão se encontram fortemente correlacionadas. No entanto, os mecanismos psicossociais envolvidos nessa associação são ainda pouco conhecidos. Os estudos sobre o papel da vergonha na fibromialgia são escassos, mas a vergonha externa tem mostrado ser um forte indicador de depressão. A hipótese de partida deste estudo é que a natureza invisível e as limitações impostas pelos sintomas da fibromialgia podem dar origem nestes doentes a uma perceção de existir de forma negativa na mente dos outros, elevando o risco de desenvolverem sintomas depressivos. Considerando que a autocompaixão é um antídoto bem estabelecido para a vergonha e parece ser um fator relevante na depressão e na dor crónica em geral, procurou-se investigar se o impacto dos sintomas de fibromialgia e da vergonha sobre os sintomas depressivos seria mediado pela autocompaixão. Para testar essas hipóteses, testou-se um modelo de mediação serial numa amostra de 142 mulheres com fibromialgia. Verificou-se que a vergonha e a autocompaixão mediam a ligação entre os sintomas de fibromialgia e de depressão, explicando 54% da variância nos sintomas depressivos. Estes resultados parecem indicar que a vergonha externa e a autocompaixão são mecanismos relevantes na fibromialgia e que o seu papel deve ser melhor investigado. Os resultados também facultam evidências preliminares sobre o potencial benefício de integrar a autocompaixão na prática clínica com pessoas com fibromialgia.

Fibromyalgia is a chronic and highly disabling condition that entails a significant individual and socio-economic burden (Häuser et al., 2015; Wolfe et al., 2011; Schaefer et al., 2016). Characterized by a set of somatic, cognitive, and affective symptoms such as widespread pain, fatigue, non-refreshed sleep, cognitive difficulties, and emotional distress (Wolfe et al., 2011), fibromyalgia remains a rather challenging condition for both patients and clinicians. This is fueled not only by the limited understanding of fibromyalgia’s nature (Wolfe et al., 2014) but also by the lack of effective treatments for the condition (Pinto et al., 2020). Extensive research demonstrates that fibromyalgia and depression are strongly correlated. However, the psychological and psychosocial mechanisms involved in this association are still poorly understood. Studies on the role of shame in fibromyalgia are scarce but external shame has been shown to be a strong predictor of depression. We hypothesize that the invisible nature and limitations imposed by fibromyalgia symptoms may give rise to a perception of existing negatively in the mind of others, increasing the risk of developing depressive symptoms. Considering that self-compassion is a well-established antidote for shame and seems to be a relevant player in chronic pain in general, we sought to investigate whether the impact of fibromyalgia symptoms and of shame on depressive symptoms would be mediated by self-compassion. To test these hypotheses, we run a serial mediation model in a sample of 142 women with fibromyalgia. Shame and self-compassion were found to mediate the link between fibromyalgia symptoms and depression, accounting for 54% of the variance in depressive symptoms. These findings seem to indicate that external shame and self-compassion are relevant mechanisms in fibromyalgia and that their role should be further investigated. The results also provide preliminary evidence on the potential benefit of integrating self-compassion in clinical work with people with fibromyalgia.