Introduction:

Fibromyalgia syndrome (FMS) is a widespread chronic pain syndrome with many associated symptoms. It is frequently related to a traumatic event (1), strong and of short duration, or slight but protracted over time. A multidisciplinary therapeutic approach is recommended by international guidelines. The transformative experience (TE) allows for a profound and immediate change that differs from linear and gradual psychological change; this helps create novel responses to the same initial thoughts and actions, thereby breaking the maladaptive emotional/behavioral loop elicited by chronic stress and trauma (2), creating a sort of “virtuous” cycle, adaptive rather than maladaptive and long-lasting. In this study, TE was specifically elicited through transformative art (TA), an intrinsically transdisciplinary tool, in different ways in the three arms of the study.

The objective was the validation of the efficacy (in terms of quality of life and sleep, self-esteem, self-efficacy) of transdisciplinary artistic-transformative pathways in patients with FMS.

Methods:

Prospective observational study lasting 8 months (February-October, 2021), in which the effectiveness of three different TA workshops in patients with FMS was evaluated: in group 1 participants were encouraged to review their autobiography and illness in a humorous sense; in group 2 participants were guided to express their own realities of chronically ill patients in poetry; group 3 was based on the guided narration of works of art according to visual thinking strategies integrated with the principles of narrative medicine. Patients were divided into the three laboratories according to their preference. Tests were administered at baseline and post-workshop. The activities took place entirely online.

Results:

109 FM patients completed the study (n=3 males). No differences were found among the three groups at baseline in terms of clinimetric variables. Data analysis made by a Wlicoxon non-parametric test (WNPT) of the three groups in conjunction showed a statistically significant improvement of the Pittsburgh Sleep Quality Index (PSQI) (p<0.05), Response to Stressful Experiences Scale (RSES) (p<0.05), World Health Organization Five Well-Being Index (WHO-5) (p<0.001) and Global Health scale (GH) (p<0.05). No significant difference was found for The Mindful Attention Awareness Scale (MAAS). A WPNT was performed to compare baseline and final results of the three groups separately. The best performance was seen in Group 1, since patients ameliorated in almost all parameters: PSQI, GH, SAP dimension 1, 2 and 4, WHO-5. MAAS, RSES and SAP dimension 3 resulted nonsignificant, although very close to significance. Sleep and the 3rd dimension of SAP improved in patients of Group 2; whilst self-esteem and WHO-5 did in Group 3.

Conclusion:

Our research shows that art, experienced as TA, leads to significant improvements of the psychophysical condition of FMS patients. TA can be seen as a crucial mediator for overcoming the trauma/stressors, probably through the generation of “pivotal mental states” (PIMS), defined as a “hyper-plastic state aiding rapid and deep learning that can mediate psychological transformation” (3).

References:

1. Miró, E., et al. (2020), JOURNAL OF TRAUMATIC STRESS, 33: 1082-1092

2. Christopher M. (2004), Clinical Psychology Review; 24(1):75-98.

3. Ari, B., and Carhart-Harris, L.R. (2021), Journal of Psychopharmacology 35.4: 319-352.