Cognitive-Behavioral Therapy For Fibromyalgia: Can CBT Help?

Fibromyalgia can be a challenging condition that may significantly impact one's quality of life. Those with fibromyalgia often experience mental and emotional distress alongside their chronic pain, and flare-ups can make it challenging to function in daily life. Due to a lack of public awareness about fibromyalgia, those with chronic pain may find it difficult to communicate with others about their condition.

Psychiatric interventions like cognitive-behavioral therapy (CBT) have shown promise in helping individuals with fibromyalgia manage their pain and associated psychological factors. CBT is a short-term form of psychotherapy aimed at helping individuals manage their mental health through restructuring thoughts and behavioral patterns. Understanding the impacts of this therapy on fibromyalgia treatment may help you decide whether CBT is suitable for your goals. 

Understanding fibromyalgia in psychology 

Fibromyalgia is a complex condition that involves physical and psychological components. It is characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, and other symptoms. Fibromyalgia often begins after a physical trauma such as surgery or an accident, and researchers believe it to be the result of the neurological system's interpretation of pain signals.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

In addition to fibromyalgia's physical components, there are several psychological factors associated with fibromyalgia. These factors may play a significant role in the experience of pain, mental health, and overall functioning. These may include:

• Impaired cognitive functioning called "brain fog"
• Pain catastrophizing
• Inhibited self-efficacy
• Anxiety
• Depression

These psychological factors can lead to a negative feedback loop, wherein a person's mental health challenges aggravate their physical symptoms. Additionally, chronic pain can make it difficult to enjoy hobbies and social activities, significantly impacting well-being. Chronic medical conditions like fibromyalgia may also cause relationship strain due to disruptions in communication, intimacy, and overall relationship dynamics. 

Cognitive behavioral therapy for fibromyalgia (CBT)

Cognitive behavioral therapy (CBT) is a structured, goal-oriented therapeutic approach widely used to address various psychological conditions. It focuses on the connection between thoughts, emotions, and behaviors to identify and modify unhelpful thoughts and behaviors. Often, cognitive-behavioral therapy promotes positive changes in emotions and functioning. 

Unlike other forms of psychotherapy, CBT may be a short-term intervention. It involves weekly sessions that take place over 12 to 20 weeks. CBT can be administered by a mental health professional like a licensed professional counselor (LPC) or licensed clinical social worker (LCSW). 

Cognitive-behavioral therapy treatment may address the psychological factors associated with fibromyalgia management, including pain catastrophizing, inhibited self-efficacy, and symptoms of anxiety and depression, as follows. 

Pain catastrophizing

Cognitive-behavioral therapy (CBT) can be particularly effective in addressing pain catastrophizing, a common psychological factor in fibromyalgia. Pain catastrophizing refers to exaggerated, negative thoughts and beliefs about pain and its consequences. 

Cognitive-behavioral therapy for fibromyalgia helps individuals identify and challenge pain-related thoughts. By modifying these maladaptive thought patterns, CBT can assist clients in developing more adaptive ways of interpreting and coping with pain and health challenges. This process might also reduce pain catastrophizing and its negative impact on pain perception and emotional well-being.

Self-efficacy

Self-efficacy can influence how individuals perceive and manage their pain. CBT can effectively heighten an individual's belief in their ability to complete tasks or achieve goals despite their fibromyalgia pain successfully. Through cognitive-behavioral therapy for fibromyalgia, they can overcome negative thoughts and beliefs that may undermine their self-efficacy, including self-doubt or fear of failure.

Anxiety and depression

Individuals living with chronic pain may experience concurrent mental health conditions like anxiety and depression. Cognitive-behavioral therapy (CBT) may help these individuals manage anxiety and depression by addressing maladaptive thought patterns and offering coping strategies and self-care techniques. This process can lead to improved mental health outcomes in individuals with fibromyalgia.

Coping strategies and behavioral interventions

Cognitive-behavioral therapy (CBT) offers coping strategies and behavioral interventions that may help fibromyalgia patients improve their quality of life. For example, therapists may teach their clients problem-solving skills to manage flare-ups, cope with fatigue, and adjust to lifestyle changes. They may also use targeted interventions to address fibromyalgia's physical and psychological aspects, including the following. 

Graded exposure

Graded exposure is a behavioral intervention used in CBT for fibromyalgia that involves gradually and systematically exposing clients to activities or situations that may incite pain or discomfort. The goal of graded exposure is to help individuals develop increased tolerance. This approach might offer the opportunity to gradually overcome fear or avoidance of certain activities, build confidence in one's ability to manage pain, and improve overall functioning and quality of life.

Activity pacing

Activity pacing involves setting realistic goals for activity levels and balancing rest and activity. This skill can help individuals avoid overexertion or prolonged inactivity, which may worsen fibromyalgia symptoms. Activity pacing can help individuals develop an awareness of their physical limitations, learn to manage their energy levels, and avoid cycles of increased activity followed by crashes. 

Relaxation strategies

Relaxation strategies aim to help individuals manage stress, reduce muscle tension, and promote relaxation, which may alleviate pain and improve overall well-being. Examples of relaxation strategies used in CBT for fibromyalgia may include deep breathing exercises, progressive muscle relaxation, guided imagery, and mindfulness techniques. By improving stress response, fibromyalgia patients may benefit from reduced muscle tension, which may mitigate symptoms.

Communication skills and assertiveness training

Communication is one aspect of living with chronic illnesses like fibromyalgia syndrome. Individuals may be asked to advocate for themselves in healthcare environments and communicate their needs, desires, and boundaries to others. Assertiveness training can teach individuals how to effectively assert themselves to receive appropriate care and consideration. In cognitive-behavioral therapy for fibromyalgia, a therapist may also help fibromyalgia patients learn how to navigate social or professional situations that may be affected by their medical condition. 

Evidence for the efficacy of CBT in fibromyalgia

CBT has been proven effective in several randomized controlled trials. One systematic review found a significant effect on self-efficacy pain post-treatment and at follow-up. It also found that CBT was associated with fewer physician visits.

A randomized study examining coping skills training for juvenile patients found improved functioning and ability to cope with pain. Another randomized clinical trial found that CBT led to significant improvements in pain coping, catastrophizing, and efficacy sustained over time in adolescents with juvenile fibromyalgia.

A 2018 controlled trial studied the effect of CBT on fibromyalgia patients experiencing insomnia alongside their chronic pain and those experiencing only chronic pain. It found significant improvements at post-treatment in fibromyalgia impact and self-efficacy for coping with pain and at follow-up with pain intensity. 

In the study, the group experiencing both insomnia and pain reported improvements at follow-up in pain intensity. In contrast, those with primarily pain reported improvements post-treatment in pain catastrophizing and pain acceptance.

Finding CBT treatment for fibromyalgia

Those living with fibromyalgia and other forms of chronic pain may benefit from psychological treatment with a licensed therapist. To find a therapist, you may search online for a mental health professional near you. Alternatively, you might consider online therapy through a virtual therapy platform like BetterHelp. 

Online therapy can be sought from the comfort of your home, which may be beneficial if your chronic pain makes it challenging to get to appointments. Internet-based therapy may also be more convenient if a busy work schedule interferes with your ability to attend sessions during business hours.

Online CBT has been proven as effective as in-person CBT. One 12-week randomized controlled trial found that internet-based CBT could be beneficial in treating mild to moderate depression and anxiety in individuals with fibromyalgia. Additionally, one review found compelling information that showed internet-delivered CBT was as effective as in-person treatment while being more cost-effective and convenient.