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.

Fibromyalgia Syndrome in Need of Effective Treatments

“…One study found that patients receiving educational intervention had significantly more improvement than controls and that the beneficial effects continued for 3 to 12 months after the sessions had ended (Goldenberg et al, 2004). A meta-analysis of randomized clinical trials using cognitive behavioral therapy showed it could reduce fear of pain and fear of activity (Bernardy et al, 2010); however, it provided little benefit as single modality except possibly in juvenile FMS (Bennett and Nelson, 2006). Comprehensive reviews of Chinese stress reduction exercise programs, such as tai-chi and qigong, reported improvement of symptoms in FMS patients but with little difference when compared with controls (Mist et al, 2013;Sawynok and Lynch, 2014).…”

Fibromyalgia: psychiatrists should now be picking up the baton

“…A metaanalysis of 13 studies of cognitive-behavioural therapy for fibromyalgia showed that in most studies there were worthwhile improvements in pain-related behaviour, selfefficacy and overall physical function, with particular Fibromyalgia: psychiatrists should now be picking up the baton Leigh A. Neal 1 benefits for juveniles. 10 A meta-analysis of 26 randomised controlled studies of antidepressants in fibromyalgia concluded that amitriptyline, selective serotonin reuptake inhibitors and serotonin and noradrenaline reuptake inhibitors are probably all effective in the treatment of fibromyalgia. 11 In addition, individuals with fibromyalgia report a considerable impact on their quality of life and their perceived disability level seems to be influenced by their mental health condition.…”

Fibromiyalji Sendromunda Uygulanan Tedavi Yöntemleri

“…Başlangıcı 1950'lerde ilk Alber Ellis'in akılcı duygusal terapi terimini ortaya attığı dönemlere dayanmaktadır. Sonrasında Aeron Beck 1960'ların başlarında depresyon tedavisinde bilişsel terapiyi kullanmış, 1970'lerde ise Michael Mahoney ilk kez davranış modifikasyon prensiplerini uygulamıştır ve son olarak Donald Meichenbaum ise stresle başa çıkma ve stres yönetimi için yeni bir yaklaşım geliştirerek adını bilişsel davranışsal modifikasyon koymuştur (62). Akut ağrı sırasında koruyucu rol oynayan davranışsal (kaçınma davranışı), bilişsel (katastrofizm, bedensel duyumlara karşı dikkat artışı) ve fizyolojik (otonom cevabın ve kas gerginliğinin artması) reaksiyonlar ortaya çıkmakta ancak bu reaksiyonlar kronik ağrıda olduğu gibi uzun dönem devam ettiğinde zararlı ve etkisiz hale gelmektedir (59).…”

“…Multidisipliner ve interdisipliner tedavilerin etkinliğini araştırmak için yapılan meta-analizler sonucunda, egzersiz ve eğitim programlarının bir arada uygulanması gerektiği vurgulanmaktadır (59). Yapılan çalışmalar, bu tedavi yaklaşımlarının protokollerinde uygulanan egzersiz programlarının etkinliklerini desteklemektedir ve BDT gibi psikolojik girişimlerle kombine edildiğinde etkinliğin daha da arttığını göstermektedir (3,17,62,70). Günümüze kadar yapılan çalışmalarda, multidisipliner ve interdisipliner tedavilerin etkinlikleri gösterilmiştir, ancak içeriklerinde uygulanan tedavi komponentlerinden hangisinin daha etkili olduğu konusu halen tartışmalıdır (66 …”