Cognitive behavioral therapy for fibromyalgia

Abstract

Cognitive behavioral therapy (CBT) techniques offer short-term, goal-oriented psychotherapy. In this respect, it differs from classical psychoanalysis in emphasizing changes in thought patterns and behaviors rather than providing 'deep insight'. Importantly, the beneficial effects of CBT can be achieved in 10–20 sessions, compared with the many years required for classical psychoanalysis. Although CBT is often done on a one-to-one basis, it also lends itself to a group therapeutic setting. CBT was initially used in the treatment of mood disorders, but its use has subsequently been expanded to include various other medical conditions, including chronic pain states. Over the past 18 years, several chronic pain treatment programs have used CBT techniques in the management of fibromyalgia. In this review, the results from 13 programs using CBT, alone or in combination with other treatment modalities, are analyzed. In most studies, CBT provided worthwhile improvements in pain-related behavior, self-efficacy, coping strategies and overall physical function. Sustained improvements in pain were most evident when individualized CBT was used to treat patients with juvenile fibromyalgia. The current data indicate that CBT, as a single treatment modality, does not offer any distinct advantage over well-planned group programs of education or exercise, or both. Its role in the management of fibromyalgia patients needs further research.

Key Points

  • Cognitive behavioral therapy (CBT) has a long track record in the treatment of mood disorders

  • CBT also has a role in the treatment of a variety of chronic medical conditions, including chronic pain syndromes

  • The rationale for use of CBT in the management of patients with fibromyalgia is based, in part, on the physiological links between chronic pain and depression

  • In general, CBT does not seem to provide sustained pain relief in fibromyalgia patients

  • The published literature indicates that the primary utility of CBT in the management of patients with fibromyalgia lies in improving aspects of the syndrome other than pain, including self-efficacy, dysfunctional thought patterns and physical function

  • Current evidence suggests that CBT should be considered as an adjunctive therapy in the management of fibromyalgia patients, particularly those who present with an emotionally distressed and/or dysfunctional profile, although CBT could also be useful for other patient subgroups

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Figure 1: Cartoon showing the major neural pathways in pain processing.

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Correspondence to Robert Bennett.

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Bennett, R., Nelson, D. Cognitive behavioral therapy for fibromyalgia. Nat Rev Rheumatol 2, 416–424 (2006) doi:10.1038/ncprheum0245

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