Effects of attachment-based compassion therapy (ABCT) on brain-derived neurotrophic factor and low-grade inflammation among fibromyalgia patients: A randomized controlled trial

Jesus Montero-Marin, Laura Andrés-Rodríguez, Mattie Tops, Juan V Luciano, Mayte Navarro-Gil, Albert Feliu-Soler, Yolanda López-Del-Hoyo, Javier Garcia-Campayo, Jesus Montero-Marin, Laura Andrés-Rodríguez, Mattie Tops, Juan V Luciano, Mayte Navarro-Gil, Albert Feliu-Soler, Yolanda López-Del-Hoyo, Javier Garcia-Campayo

Abstract

Fibromyalgia (FM) is a disabling syndrome characterized by chronic pain associated with fatigue. Its pathogenesis is unknown, but alterations in central sensitization, involving an imbalance of brain-derived neurotrophic factor (BDNF) and inflammatory biomarkers, appear to be implicated. The aim of this study was to evaluate the impact of attachment-based compassion therapy (ABCT) on levels of BDNF, the inflammatory markers TNF-α, IL-6, IL-10, and the C-reactive protein (CRP), analysing whether biomarkers play a mediating/moderating role in improvements in FM functional status. Thirty-four female patients with FM participated in a RCT and were assigned to ABCT or relaxation therapy. Blood extractions were conducted at baseline and post-intervention, with self-report assessments of functional status (FIQ) at baseline, post-intervention and 3-month follow-up. A pro-inflammatory composite was obtained by summing up IL-6, TNF-α and CRP normalized values. Non-parametric tests, analysis of variance and regression models were used to evaluate treatment and mediation/moderation. Compared to relaxation therapy, ABCT showed significant improvements in FIQ and decreases in BDNF, CRP, and pro-inflammatory composite. Changes in BDNF had a mediating role in FIQ. ABCT seems to reduce BDNF and appears to have anti-inflammatory effects in FM patients. Reductions in BDNF could be a mechanism of FM functional status improvement.Clinical Trial Registration: http://ClinicalTrials.gov , identifier NCT02454244. Date: May 27th, 2015.

Conflict of interest statement

Dr J.M.M.’s scientific advisory work has been funded by the ‘Mindfulness and Compassion Foundation’, a not-for-profit Spanish association that offers courses and training in diverse meditative techniques, including ABCT. Dr J.G.C. is the developer of A.B.C.T. and leads the not-for-profit Spanish ‘Mindfulness and Compassion Foundation. He is the author of related books and meditation materials for which he receives royalties. Dr M.N.G. is also a board member of the ‘Mindfulness and Compassion Association’, and conducts groups of meditation. The other authors declare they have no financial/non-financial competing interests as defined by Nature Research, or other interests that might be perceived to influence the interpretation of the article.

Figures

Figure 1
Figure 1
Generic path diagram of a mediation/moderation within-subjects model*. *From the proposal of Judd, Kenny and McClelland (2001) and the development of Montoya and Hayes (2017). The independent variable is the repeated-measures factor (“X”). M1 is the pre-post difference (mediating effect). M2 is the pre-post sum (moderating effect). The FM functional status pre-follow up difference is the dependent variable (Y). “a x b” = indirect effect. c′ = direct effect after adjusting for the mediating effect. d = moderating effect.
Figure 2
Figure 2
Flowchart of the study. *For space reasons, the results of the “Mindfulness + Insula Retraining” arm will be detailed elsewhere.
Figure 3
Figure 3
Effects of ABCT vs. Relaxation on BDNF and inflammatory biomarkers. Note: Graphics are violin plots. The scales are different in different sections to make them legible (ng/ml in BDNF; pg/ml in CRP, IL-6, TNF-α and IL-10; and a natural logarithm normalization sum in the GI composite). Raw data was used in all measures (except for the GI Composite, which was calculated by adding the Z scores for the normalized log transformed IL-6, TNF-α and CRP values) to provide a more informed visualization of the treatment effects. *p < 0.05. **p < 0.01. ***p < 0.001.

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