Fibromyalgia - Behavioral Therapy

Behavioral Therapy

Studies continue to show that when fibromyalgia patients deal with the specific conditions of their disorder and their lives, they feel better. Cognitive-behavioral therapy (CBT) enhances a patients' belief in their own abilities and helps them develop methods for dealing with stressful situations. CBT is a known effective method for dealing with chronic pain from arthritic conditions. Some evidence also suggests that cognitive-behavioral therapy can help some patients with fibromyalgia. In one study, 25% of patients achieved long-lasting improvement.

The Goals of CBT. The primary goals of CBT (also called cognitive therapy) are to change any distorted perceptions and self-defeating behavoirs.Using specific tasks and self-observation, patients learn to think of pain as something other than anegative factor that dominates their life. Over time, the idea that they are helpless against the pain goes away and, instead, theylearn that they can manage the pain.

Cognitive therapy is particularly helpful in defining and setting limits -- a behavior that is extremely important for these patients. Many fibromyalgia patients live their lives in extremes. They first become heroes or martyrs, doggedly pushing themselves past the point of endurance until they collapse and withdraw. This inevitable backlash reverses their self-perception, and they then view 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, whereby they can 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 and to less of an absolutist perspective on themselves and others.

The Procedure. Cognitive therapy is usually of short duration, typically 6 to 20 sessions that last 1 hour. Patients are also given homework, which usually includes keeping a diary and attempting tasks that they have avoided because of negative attitudes.

A typical cognitive therapy program may involve the following measures:

• Keep a Diary. The patient is almost always asked to keep a diary, and it is usually a key component of cognitive therapy. The diary serves as a general guide for setting limits and planning activities. The patient uses the diary to track any stress factors, such as a job or a relationship that may be making the pain worse or better.
• Confront Negative or Discouraging Thoughts. Patients are taught to challenge and reverse negative beliefs ("e.g., I'm not good enough to control this disease, so I'm a total failure.") to using coping statements ("Where is the evidence that I can control this disease?").
• Set Limits. Limits are designed to keep both mental and physical stress within a manageable framework so that patients do not get discouraged by forcing themselves into situations in which they are likely to fail. For example, tasks are broken down into incremental steps, and patients focus on one at a time.
• Seek out Pleasurable Activities. List a number of enjoyable low-energy activities that can be conveniently scheduled.
• Prioritize. Patients learn to drop some of the less critical tasks or delegate them to others.
• Accept Relapses. Over-coping and accomplishing too much too soon can often cause a relapse of symptoms. Patients should respect these relapses and back off. They should not consider them a sign of treatment or self-failure.

Support Organizations and Group Therapy

Cognitive therapy may be expensive and not covered by insurance. Alternative and effective approaches that are free or less costly include strong, intelligently managed support groups or group psychotherapy. In one center, educational discussion groups were as effective, or even more so, than a cognitive therapy program. Such results cannot necessarily be applied to all centers, of course. Therapeutic success varies widely depending on the skill of the therapist.