Cognitive behavioral therapy (CBT) is a frequently recommended treatment for fibromyalgia (FMS). It's also one of the better-researched non-drug treatments for the illness.
CBT is a psychological treatment, but it's used to treat an array of non-psychological ailments. However, FMS patients sometimes mistakenly believe that the recommendation of CBT means that their illness is considered psychological, or "not real." In truth, a growing body of evidence shows that CBT is effective at helping you learn to manage your illness more effectively, and may even result in physiological changes in your brain.
What is Cognitive Behavioral Therapy?
CBT is typically a short-term therapy that's aimed at changing the way you think about certain things, as well as your behaviors in regard to them. For example, research shows that a lot of people with FMS do something called "catastrophizing," which means they believe things are worse than they are. They may make statements such as, "My pain is awful and it will never get better."
That belief can keep people from seeking out treatments that will help them improve. Therefore, CBT can help them change their belief to something such as, "Even though my pain is bad, I can find ways to make it better."
The change in belief isn't a miracle cure that spontaneously changes the course of the illness, but it can change behaviors for the better, which can lead to more effective treatment and management down the road.
CBT often involves "homework" as well as sessions with the therapist. Sometimes, after the therapy is concluded, patients will be encouraged to have an appointment every few months to help them maintain changes.
CBT for Fibromyalgia
Research shows that CBT can help people with FMS improve, especially when it's combined with other interventions and is tailored to the specific needs of the individual. A 2010 meta-analysis of psychological treatments for fibromyalgia showed that CBT was the most effective.
Several studies have shown that CBT was effective as part of a program involving exercise, stretching, and education of both patient and family. Others have looked at its effect when added to drug treatment, and they, too, have shown that CBT is beneficial.
But reviews of research on CBT for FMS have shown that some CBT practitioners rely more on behavioral interventions, making the treatment variable from one practitioner to the next.
CBT may be used to help you modify activities that cause pain or other symptoms, approach exercise in a way that doesn't lead to a flare, improve your sleep habits, follow your treatment regimen more effectively, and pace yourself more effectively.
Studies show CBT improved multiple symptoms of FMS, including:
- Sleep quality
- Daily function
- Exercise tolerance
- Emotional distress
- Cognitive function, especially attention
- Quality of life
CBT may be especially helpful in people who experience depression and anxiety along with FMS.
In some studies, a significant number of people undergoing CBT have not only improved during treatment, but have been able to maintain the effects at follow-up.
Preliminary research suggests that CBT may actually lead to a physical change in the way the certain pain receptors (called nociceptors) respond to stimuli, which leads to a reduction in the amount of pain you experience. However, more research is needed to confirm these findings.
What is CBT Like?
CBT is sometimes one-on-one therapy, but can also be done in a group setting. Some studies have even show that it's effective when done over the phone or via the Internet.
CBT for FMS usually involves 3 phases:
- Education: This phase involves ensuring the patient knows the facts about the condition rather than inaccurate or conflicting information that is common with FMS. This includes the possible causes, things that help sustain the illness, and how important it is for the patient to be actively involved in the treatment process. This phase can also include specific skills to help you learn how to adapt to life with FMS.
- CBT Skill sets: This phase focuses on giving you skills for reducing pain. These may include relaxation techniques; graded-activation, which helps you gradually increase activity levels while avoiding the "push-crash" cycle that's common in FMS; improving sleep habits; changing thoughts about pain; and dealing with other functional or emotional aspects of living with chronic illness.
- Real-Life Application of Skills: This helps you apply what you've learned in the day-to-day realities you face. It typically involves homework assignments focused on the skills from phase 2, and allows them to be tailored to your specific needs.
Finding a Therapist
Not all communities have therapists trained in CBT, which can make it difficult for some people to get this treatment. Also, insurance companies may deny coverage unless you also have a diagnosed psychological illness, such as depression or anxiety. That makes phone- and web-based programs especially important.
If you're interested in CBT, your doctor may be able to refer you to a qualified practitioner. The resources here, from former About.com Mental Health Guide Leonard Homes, may also help:
Alda M, et al. Arthritis research and therapy. 2011;13(5):R173. Effectiveness of cognitive behavior therapy for the treatment of catstrophisation in patients with fibromyalgia: a randomized controlled trial.
Ang DC, et al. Arthritis care and research. 2010 May;62(5):618-23. Cognitive-behavioral therapy attenuates nociceptive responding in patients with fibromyalgia: a pilot study.
Braz Ade S, et al. Revista brasileira de rehmatologia. 2011 May-Jun;51(3):269-82. Non-pharmacological therapy and complementary and alternative medicine in fibromyalgia.
Friedberg F, Williams DA, Ccollinge W. Journal of pain research. 2012;5:425-35. Lifestyle-oriented non-pharmacological treatments for fibromyalgia: a clinical overview and applications with home-based technologies.
Glombiewski JA, et al. Pain. 2010 Nov;151(2):280-95. Psychological treatments for fibromyalgia: a meta-analysis.
Hassett AL, Gevirtz RN. Rheumatic diseases clinics of North America. 2009 May;35(2):393-407. Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine.
Jensen KB, et al. Pain. 2012 Jul;153(7):1495-503. Cognitive behavioral therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia.
Kollner V, et al. Schmerz. 2012 Jun;26(3):291-6. Article in German. Abstract referenced. Psychotherapy for patients with fibromyalgia syndrome. Systematic review, meta-analysis and guideline.
McBeth J, et al. Archives of internal medicine. 2012 Jan 9;172(1):48-57. Cognitive behavior therapy, exercise, or both for treating chronic widespread pain.
Miro E, et al. Journal of health psychology. 2011 Jul;16(5):770-82. Cognitive-behavioral therapy fo insomnia improves attentional function in fibromyalgia syndrome: a pilot, randomized controlled trial.
Sarzi-Puttini P, Atzeni F, Cazzola M. Annals of the New York Academy of Sciences. 2010 Apr;1193:91-7. Neuroendocrine therapy of fibromyalgia syndrome: an update.
Smith HS, Harris R, Clauw D. Pain physician. 2011 Mar-Apr;14(2):E217-45. Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome.
Vasquez-Rivera S, et al. Comprehensive psychiatry. 2009 Nov-Dec;50(6):517-25. Brief cognitive-behavioral therapy with fibromyalgia patients in routine care.
van Koulil S, et al. Arthritis care and research. 2011 Jun;63(6):800-7. Cognitive-behavioral mechanisms in a pain-avoidance and a pain-persistence treatment for high-risk fibromyalgia patients.
van Koulil S, et al. Arthritis care and research. 2010 Oct;62(10):1377-85. Tailored cognitive-behavioral therapy and exercise training for high-risk patients with fibromyalgia.
Woolfolk Rl, Allen LA, Apter JT. Pain research and treatment. 2012;2012:937873. Affective-cognitive behvoiral therapy for fibromyalgia: a randomized controlled trial.