Fibromyalgia - Behavioral Therapy

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The Procedure. Cognitive therapy usually 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 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 doing 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.

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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 that one type of education works best.

Treatment of Fibromyalgia in Children

Medications such as pregabalin and milnacipran are recommended for adults, but they have not been well tested in children. Analgesics and NSAIDs are not very effective in children. Psychological therapies may help control pain in children, although there is no evidence that they improve disability or mood. Experts say the treatment of fibromyalgia in children should begin with non-drug therapies, including exercise and cognitive behavioral therapy.

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.

Review Date: 12/27/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).