Fibromyalgia and Cognitive Behavioral Therapy

By Dr Ananya Mandal, MD

Fibromyalgia has a worldwide presence affecting nearly 1 in 20 people globally. In the United States nearly 2–10% of the general population of all ages are affected by this condition.

Although men may be affected by this condition, women are seen to be seven times more likely to develop fibromyalgia. While in females the prevalence of the condition is 3.4%, among men it is 0.5%.

Most patients complain of a wide spread pain that affects nearly whole of the body. This pain maybe felt throughout the body but is particular in certain areas like the back or neck.

Other associated symptoms include headaches, sleep problems, depression and anxiety, irritable bowel syndrome etc.

Psychotherapy

Psychotherapy was originally developed in the mid to late 20th century. There is a deeper understanding today regarding cognitive factors in psychology and behavior modification in particular.

What is cognitive behaviour therapy (CBT)?

Contemporary Cognitive Behaviour therapy (CBT) is based on the cognitive theory of emotional responses. The principle behind this therapy is that pathological negative emotions may be the result of dysfunctional thinking that is in turn shaped by the patient’s belief system.

The cognitive therapists educate the patients to understand the fact that distorted beliefs can negatively affect the symptoms and can be changed and improved by educational and behavioral interventions.

The process of cognitive behavior therapy is thus biphasic:-

  • identification and modification of the dysfunctional thought patterns

  • engagement of the patient in behavioral interventions that break the vicious cycle between the thoughts and the symptoms

CBT for widespread pain conditions

In widespread pain conditions, cognitive behavioral therapy emphasizes the view that behavioral, cognitive, sensory or physical aspects are all important components in understanding the pain. The theory emphasizes the influence of the individual’s beliefs on the pain experience.

In patients with pain syndromes, cognitive behavior therapy typically helps to increase patient’s sense of personal control over their pain and helps reduce the dysfunctional thought patterns.

Dysfunctional thought patterns include “catastrophizing” or exaggerating the significance of a negative event about the pain and its effects.

CBT for fibromyalgia

In fibromyalgia the key features of cognitive behavioral therapy include:-

  • Educating the patient about the pain

  • Identifying dysfunctional thought patterns

  • Setting realistic goals for achieving functional freedom such as work-like activities, social activities, involvement with family and friends etc.

  • Relaxation training with progressive muscle relaxation and controlled diaphragmatic breathing

  • Behavioral pacing to allow for optimum activities with no over use or underuse of muscles

  • Training in communication skills to improve assertiveness and release of tension

  • Prevention of relapse and flare ups and managing flare ups

  • Acquiring as well as maintenance of the skills

Reviewed by , BA Hons (Cantab)

Further Reading

Last Updated: Jul 31, 2013

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