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Psychological and behavioural therapies in fibromyalgia and related syndromes

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Abstract

Psychological and behavioural therapies are being applied to patients with fibromyalgia (FM) with increasing frequency. The rationale for including psychological therapies is not for the treatment of co-morbid mood disorders, but rather to manage the many non-psychiatric psychological and social factors that comprise pain perception and its maintenance. This chapter reviews the involvement of mental health professionals under both the biomedical and biopsychosocial models of illness and describes cognitive behavioural therapy (CBT), a commonly used form of psychological therapy in the management of chronic pain conditions. The empirical literature supports the use of CBT with FM in producing modest outcomes across multiple domains, including pain, fatigue, physical functioning and mood. Greatest benefits appear to occur when CBT is used adjunctively with exercise. While the benefits are not curative or universally obtained by all patients, the benefits are sufficiently large to encourage future refinement of CBT for this population of patients.

Section snippets

A clash of models for understanding unexplained pain

Patients suffering from fibromyalgia (FM) experience a variety of physical symptoms (e.g. pain, fatigue, tenderness and sleep disturbance), decrements in physical functioning and disruptions in psychological functioning (e.g. memory problems, diminished mental clarity, mood disturbances and lack of well-being). The aetiology of FM is still unknown1 and treatment approaches are based largely upon pharmacological management of symptoms. Treating FM by this approach benefits less than 50% of

Psychosocial factors and fibromyalgia

Two individuals can experience identical pain-evoking events yet experience and respond to the pain in markedly different ways. This fascinating observation underlies why the work on the appraisal process9 is so often considered relevant when trying to understanding psychological processes that help to determine the perception of pain. This theory posits that once a nociceptive event occurs, individuals make an appraisal of the event. Primary appraisal determines whether the nociceptive event

Origins and rationale for use in FM

Cognitive behavioural therapy (CBT) has its origins within the traditional psychotherapy literature and is considered an efficacious treatment for depression and anxiety.39 Each application of CBT (e.g. for depression or anxiety) uses a different set of specific skills, but each of the skills shares a common scientific foundation based on learning and cognitive principles.40 The techniques used to change behaviour are based on principles of classical and operant conditioning (e.g. extinction,

Evidence supporting the use of CBT in fibromyalgia

Due to differences in nomenclature, many more studies than those claiming to have used CBT have taught skills to patients with FM that are based upon principles of behavioural and cognitive change. Referred to here as CBT-supported skills, the next section briefly reviews 17 clinical studies fitting this classification. It should be noted that, based on its theoretical tie to the biopsychosocial model, CBT as applied to medical conditions tends not to be used as a stand-alone intervention but

Summary

The biopsychosocial model provides a useful framework in which to conceptualize how FM can be maintained or treated over time. In this model, there is no predominance of biological or psychological factors but rather a dynamic interplay of the mind and body. Cognitive factors such as appraisals drive affective and behavioural responses to illness and help to determine whether adaptation to illness is consistent or opposed to long-term health. Methods of changing behaviour and thinking patterns

Acknowledgements

Preparation of this manuscript was supported in part by Department of Army Grant DAMD17-00-2-0018.

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