Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Chris Koronakos

Second Advisor

Dr. R. Wayne Fuqua

Third Advisor

Dr. Malcolm Robertson

Fourth Advisor

Dr. Morton Wagenfeld


Fibromyalgia is a noninflammatory rheumatic disorder characterized by musculoskeletal pain, nonrestorative sleep, and mood disturbance. Emotional stress is frequently reported as a factor that exacerbates symptoms. This study was designed to assess the impact of stress management training on perceived stress and fibromyalgia symptoms. Four female subjects with fibromyalgia participated on an individual basis in a 10 week stress management training program, which was administered in the fixed sequence of training in self-monitoring, relaxation, cognitive behavioral skills, and assertion. The effects of the training on self-report measures of perceived stress, pain, functional disability, sleep disruption, daytime fatigue, and depression were assessed using a multiple baseline across subjects design. It was hypothesized that stress management training would produce clinically significant improvements across these variables.

Two subjects displayed notable decreases on measures of stress, pain, and depression. The other two subjects displayed no sustained decreases on these measures. None of the four subjects displayed sustained reductions on measures of physical disability, sleep disruption, or fatigue. These findings offer qualified support for the efficacy of this stress management training program in decreasing stress, pain, and depression for some fibromyalgia patients.

The question remains as to whether specifically targeting stress was the key to the positive changes observed in the two subjects who responded to treatment, because one of these subjects displayed decreases in depression before her stress level decreased. The wide range of techniques used in the training program may have directly impacted pain and depression, rather than pain and depression decreasing as a secondary response to diminished stress. Subject characteristics were examined in an attempt to explain the differences in response patterns between the responders and nonresponders. Implications for treatment strategies were discussed in light of the qualified support of the hypothesis.

Access Setting

Dissertation-Open Access