{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T08:57:13Z","timestamp":1780477033467,"version":"3.54.1"},"reference-count":61,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2020,8,27]],"date-time":"2020-08-27T00:00:00Z","timestamp":1598486400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["grant number PI17\/00858"],"award-info":[{"award-number":["grant number PI17\/00858"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Although fatigue usually goes unnoticed, it is a symptom that poses great challenges to patients with fibromyalgia and is a strong limitation. The aim of this study is to identify and describe the variables involved in fatigue in nine different situations of the Goal Pursuit Questionnaire (GPQ) that may occur in the daily lives of women with fibromyalgia, according to an ABC (Antecedents\u2013Behaviors\u2013Consequences) model. This study followed a qualitative descriptive research method and a deductive\u2013inductive hybrid approach based on a phenomenological paradigm. Twenty-six women with fibromyalgia participated in focus group discussions between February and March of 2018. Thematic content analysis was carried out from transcribed verbatim interviews. We identified nine major themes that emerged from the participants\u2019 conversations: self-imposed duties, muscle fatigue, overwhelming feeling of tiredness, difficulty thinking, difficulty concentrating, negative emotions, lifestyle changes, affected everyday activities, and lack of motivation for daily activities and social interactions. We conclude that the ABC model allowed certain elements to emerge regarding the fatigue experience, highlighting its importance as a symptom in fibromyalgia. This additional analysis of the ABC model showed that fatigue can be described through the 4 U\u2019s Rule, which is integrated by these four adjectives: (1) Unpredictable, (2) Uncontrollable, (3) Unseen, and (4) Unintelligible. Identifying these characteristics can contribute to a better understanding of fibromyalgia in addition to better treatment for these patients.<\/jats:p>","DOI":"10.3390\/ijerph17176224","type":"journal-article","created":{"date-parts":[[2020,8,27]],"date-time":"2020-08-27T08:05:18Z","timestamp":1598515518000},"page":"6224","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["The 4 U\u2019s Rule of Fibromyalgia: A Proposed Model for Fatigue in a Sample of Women with Fibromyalgia: A Qualitative Study"],"prefix":"10.3390","volume":"17","author":[{"given":"Lilian","family":"Velasco-Furlong","sequence":"first","affiliation":[{"name":"Department of Psychology of Universidad Rey Juan Carlos, Avenida Atenas s\/n, 28922 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Guti\u00e9rrez-Hermoso","sequence":"additional","affiliation":[{"name":"Department of Psychology of Universidad Rey Juan Carlos, Avenida Atenas s\/n, 28922 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Mateos-Pintado","sequence":"additional","affiliation":[{"name":"Department of Psychology of Universidad Rey Juan Carlos, Avenida Atenas s\/n, 28922 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Garvi-de","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Psychology of Universidad Rey Juan Carlos, Avenida Atenas s\/n, 28922 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Blanco-Rico","sequence":"additional","affiliation":[{"name":"Department of Psychology of Universidad Rey Juan Carlos, Avenida Atenas s\/n, 28922 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"Sanrom\u00e1n-Canelada","sequence":"additional","affiliation":[{"name":"Department of Psychology of Universidad Rey Juan Carlos, Avenida Atenas s\/n, 28922 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sof\u00eda","family":"L\u00f3pez-Roig","sequence":"additional","affiliation":[{"name":"Department of Behavioural Sciences and Health of Universidad Miguel Hern\u00e1ndez, Avinguda de la Universitat d\u2019Elx s\/n, 03202 Elche, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda \u00c1ngeles","family":"Pastor-Mira","sequence":"additional","affiliation":[{"name":"Department of Behavioural Sciences and Health of Universidad Miguel Hern\u00e1ndez, Avinguda de la Universitat d\u2019Elx s\/n, 03202 Elche, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6307-5921","authenticated-orcid":false,"given":"Cecilia","family":"Pe\u00f1acoba-Puente","sequence":"additional","affiliation":[{"name":"Department of Psychology of Universidad Rey Juan Carlos, Avenida Atenas s\/n, 28922 Alcorc\u00f3n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1002\/art.1780330203","article-title":"The American College of Rheumatology 1990 criteria for the classification of fibromyalgia","volume":"33","author":"Wolfe","year":"1990","journal-title":"Arthritis Rheum."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/acr.20140","article-title":"The American College of Rheumatology Preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity","volume":"62","author":"Wolfe","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.semarthrit.2016.08.012","article-title":"2016 Revisions to the 2010\/2011 fibromyalgia diagnostic criteria","volume":"46","author":"Wolfe","year":"2016","journal-title":"Semin. 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