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Fibromyalgia sufferers were once told their pain was all in their head. But in recent years, the medical community has found evidence that fibromyalgia is in fact a physiological disorder. However, that doesn’t mean that talk therapy has no place in treatment of fibromyalgia. In fact, cognitive behavioral therapy or CBT, has been found to be useful in addressing insomnia and some of the side effects of fibromyalgia symptoms.

According to Dr. Dorothy McCoy from PsychNetUK:

In a recent study, CBT offered an alternative approach that demonstrated clinically significant improvement within six weeks (Edlinger, 2001). In another study, on chronic fatigue syndrome, the researchers compared standard treatment with cognitive therapy and standard treatment without cognitive therapy. “Seventy-three percent of the cognitive group were spending less time in bed and functioning normally after a year” (WebMD Health). Only 27% of the other group experienced the same gains. Flemming (1997) suggests amplifying standard treatments’ efficacy by including bodywork and relaxation. According to the eminent wellness physician, Dr. Andrew Weil, guided imagery tapes are useful in reducing pain and speeding the healing process. Patients are relieved to discover they have a legitimate medical disorder and the pain is not imaginary.

In a study on low back pain, researchers found that relaxation response training was effective in reducing pain severity. Twenty-eight of the patients also had fibromyalgia. Many of the study subjects reported reduced pain and a reduction in other symptoms, as well as “improved function and general health” (Millea, 2001). One panel of experts concluded that relaxation techniques were helpful in managing chronic pain. Furthermore, the techniques were valuable in managing the stress inherent in living with a chronic pain disorder. Yet anther study suggests that patients who believe they have little control over their symptoms report more severe and chronic fatigue. CBT is helping patients to change their inaccurate, self-defeating beliefs and regain a sense of control over their lives. A belief in one’s ability to manage one’s disorder frequently becomes a self-fulfilling prophecy.

According to the University of Maryland Medical Center website:

Studies show that fibromyalgia patients feel better when they deal with the consequences of their disorder on their lives. Cognitive-behavioral therapy (CBT) enhances a patient’s belief in their own abilities and helps them develop methods for dealing with stressful situations. CBT, also called cognitive therapy, is known to be an effective method for dealing with chronic pain from arthritic conditions. Evidence also suggests that cognitive-behavioral therapy can help some patients with fibromyalgia.

Although the effects of CBT and other non-medication treatments for fibromyalgia do not always last over the long-term, they may help certain groups of people, particularly those with a high level of psychological stress.

CBT may be particularly useful for addressing insomnia, one of the hallmark symptoms of fibromyalgia. In studies, patients who received CBT for insomnia woke up 50% less often at night, and had fewer symptoms of insomnia and improved mood.

The Goals of CBT. The primary goals of CBT are to change any unclear or mistaken ideas and self-defeating behaviors. Using specific tasks and self-observation, patients learn to think of pain as something other than a negative factor that controls their life. Over time, the idea that they are helpless goes away and they learn that they can manage the pain.

Cognitive therapy is particularly helpful for defining and setting limits, which is extremely important for these patients. Many fibromyalgia patients live their lives in extremes. They first become heroes or martyrs, pushing themselves too far until they collapse. This collapse reverses the way they view themselves, and they then think of themselves as complete failures, unable to cope with the simplest task. One important aim of cognitive therapy is to help such patients discover a middle route. Patients learn to prioritize their responsibilities and drop some of the less important tasks or delegate them to others. Learning these coping skills can eventually lead to a more manageable life. Patients learn to view themselves and others with a more flexible attitude.

The Procedure. Cognitive therapy usually does not last long. It typically consists of 6 – 20 one-hour sessions. Patients also receive homework, which usually includes keeping a diary and trying tasks they have avoided in the past because of negative attitudes.

A typical cognitive therapy program may involve the following measures:

  • Keep a Diary. Patients are usually asked to keep a diary, a key part of cognitive therapy. The diary serves as a general guide for setting limits and planning activities. Patients use the diary to track any stress factors, such as a job or a relationship that may be improving or worsening the pain.
  • Confront Negative or Discouraging Thoughts. Patients are taught to challenge and reverse negative beliefs. For example, “I’m not good enough to control this disease, so I’m a total failure” becomes the coping statement, “Where is the evidence that I can control this disease?”
  • Set Limits. Limits are designed to keep both mental and physical stress within manageable levels, so that patients do not become discouraged by getting in over their heads. For example, tasks are broken down into incremental steps, and patients focus on one step at a time.
  • Seek out Pleasurable Activities. Patients list a number of enjoyable low-energy activities that they can conveniently schedule.
  • Prioritize. Patients learn to drop some of the less critical tasks or delegate them to others.

Patients should learn to accept that relapses occur, and that over-coping and accomplishing too much too soon can often cause a relapse. Patients should respect these relapses and back off. They should not consider them a sign of failure.

Research also shows that patient education can be effective in treating fibromyalgia, especially when combined with CBT, exercise, and other therapies. Educational programs can take the form of group discussions, lectures, or printed materials, although there isn’t any clear evidence on which type of education works best.

Support Organizations and Group Therapy

Cognitive therapy may be expensive and not covered by insurance. Other effective approaches that are free or less costly include support groups or group psychotherapy. In one study, educational discussion groups were as effective, or even more so, than a cognitive therapy program. Such results are not typical in all centers. Therapeutic success varies widely depending on the skill of the therapist.

Resources

References

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