Cognitive Behavioral Therapy for Fibromyalgia

Cognitive-behavioral therapy (CBT) is a frequently recommended treatment for fibromyalgia (FMS). It's also one of the better-researched non-drug treatments for this condition.

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.

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 this research 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, consistently follow your treatment regimen, and pace yourself more effectively.

Studies show CBT improved multiple symptoms of FMS, including:

• Insomnia
• Alertness
• Sleep quality
• Daily function
• Exercise tolerance
• Emotional distress
• Depression
• 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 shown that it's effective when done over the phone or via the Internet.

CBT for FMS usually involves three phases:

1. 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.
2. 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.
3. 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. That makes phone and web-based programs especially important.

Insurance companies may deny coverage unless you also have a diagnosed psychological illness, such as depression or anxiety, so if you're not diagnosed with any of those but believe you do have them, talk to your healthcare provider about a diagnosis.

If you're interested in CBT, your healthcare provider may be able to refer you to a qualified practitioner.