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showed a significant increase in pain behaviours immediately after and at the 6- and 12-month follow-ups. OBT patients reduced their pain behaviours immediately after the treatment, an effect that was maintained for a period of at least 12 months. CBT patients showed a significant reduction in pain behaviours only 12 months after treatment. Overall, observed pain behaviours showed a very large ES) for OBT (1.59) in contrast to a moderate ES for CBT (0.57). Significant-other behaviours The ANOVA revealed a significant group × time interaction (F(3, 121) = 7.65, P < 0.001) with significant group differences between OBT and AP (P < 0.02) but not between CBT and AP or between CBT and OBT. The OBT displayed a statistically significant decrease of solicitous spouse behaviour immediately after the treatment as well as at the two follow-ups. The AP group showed a statistically significant increase of solicitous behaviour at the follow-ups. The CBT did not show any significant changes over time The CBT patients showed lower solicitous spouse behaviour immediately after the treatment comparison with the AP patients. However, this effect was not maintained. The OBT group showed fewer solicitous spouse behaviours than the AP patients at the 12-month follow-up. There were no significant differences between CBT and OBT. Only the OBT experienced a significant reduction of solicitous significant-other behaviours over time. The ES for reduced solicitous spouse behaviour (Table 3) after OBT increased over the time. Adjusted ESs The adjusted ESs were still moderate to high but substantially lower than the uncorrected ESs (Table 3). The OBT showed greater effects in the reduction of physical impairment (ES = 1.07) and pain behaviour (ES = 1.48), whereas the CBT showed the greatest increase in coping (ES = 1.70) and reduction in affective distress (ES = 0.61). Discussion Both the CBT and OBT groups reported significant improvements in physical functioning, pain, and emotional distress 1 year after treatment, in comparison with the AP group. The latter actually demonstrated significant deterioration after treatment. Even though no statistically significant differences were identified favoring CBT or OBT overall, the within-calculations for each group over time revealed that the CBT did not demonstrate as pronounced a set of treatment effects in functional limitations, whereas the OBT revealed somewhat less of a treatment effect in affective distress. A clear superiority was found for the active psychological interventions in comparison with the AP group. In fact, the results were increased at the 6-month and 12-month follow-ups, and notably, the demonstrated beneficial effects were achieved without the inclusion of an additional structured physical therapy program or additional antidepressant medication. These results have important implications because physical therapy and antidepressant medication are often recommended as important components of treatment for FMS [18]. Future studies should directly compare these very different treatment approaches and also perform responder analyses to clarify the characteristics of patients who require different treatments to achieve beneficial effects. Interestingly, no significant differences on the cognitive variables were observed between the CBT and OBT groups. One explanation that seems plausible is that, although the CBT treatment directly focused on cognitive variables, it is possible that the behavioural changes and symptom improvements achieved by the patients treated by OBT produced changes in active coping and catastrophising without targeting those directly. Thus, observation of one's behaviour and experiences of increased activities may produce changes in a patient's beliefs about their plight. The most significant changes for CBT were found with respect to pain and cognitive and affective variables. Positive cognitions were successively increased, and patients learned to improve their use of coping strategies to decrease catastrophic thinking with the consequence of reduced affective distress. These results are consistent with previous research [15, 16] and indicate that the treatment successfully targeted improvements in cognitive

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