Cognitive behavioral therapy delivered online could help people with fibromyalgia better manage their symptoms and ease pain, results of studies for a doctoral thesis conducted in patients found.
The thesis, “Getting close with discomfort : exposure therapy for fibromyalgia,” was authored by Maria Hedman-Lagerlöf at the Karolinska Institutet.
Cognitive behavioral therapy (CBT) is a type of talk therapy, or psychotherapy, that aims to change unhelpful or unpleasant thought patterns, so-called negative thinking. For people with fibromyalgia, this would entail training the brain to focus less on the pain associated with their condition.
“The brain gradually learns that these unpleasant signals aren’t dangerous and so stops interpreting them as important,” Hedman-Lagerlöf said in a press release. “When you become less occupied with the pain signals you don’t feel as impeded by them, which tends to mitigate the pain and other symptoms.”
CBT is traditionally given face-to-face, with patients attending structured sessions with a psychotherapist or therapist. Online sessions could, however, make this type of therapy more accessible and be less cost-prohibitive.
Hedman-Lagerlöf and other researchers first developed an online CBT course tailored for people with fibromyalgia. Then, they put this course through a series of studies.
“Exposure therapy has shown some promise in treating other chronic pain conditions, but has not been evaluated specifically for patients with FM,” the study noted. (Exposure therapy is a type of CBT described in the paper as involving “repeated and sustained contact with stimuli that elicit symptom-related distress.”)
All study participants were from Sweden, and nearly all were female.
In the first study, forty people with fibromyalgia completed a 10-week course, which consisted of five consecutive modules and homework assignments. Each was assigned a therapist.
“The main intervention was exposure to stimuli associated with FM-related distress, such as FM symptoms and avoided situations and activities,” the author explained. This rationale was based on the importance of avoidance behavior in maintaining and exacerbating FM symptoms.
The participants completed the Fibromyalgia Impact Questionnaire (FIQ) — which measured both the severity of symptoms and their impact on patients — before and after the intervention. Average FIQ scores significantly decreased following the intervention, suggesting that it eased symptoms.
In a second study, 140 fibromyalgia patients were randomly assigned to take the online CBT course or be placed on a waitlist. There were significantly greater decreases in FIQ scores — suggesting a greater extent of symptom improvement — for those who took the CBT course.
“Our findings suggest that internet-delivered exposure therapy is an acceptable treatment for patients with FM [fibromyalgia] that is significantly better than no treatment in reducing FM symptoms as well as all secondary outcomes,” Hedman-Lagerlöf wrote in a summary of these findings.
Further analysis suggested this treatment may also be more cost-effective than doing nothing at all, judged by differences in other medical costs.
“Participants who made a reliable improvement (i.e., a reliable decrease on FIQ) from pre- to post-treatment had significantly lower [medical] costs post-treatment,” the study notes. In other words, this kind of online talk therapy may lessen reliance on other pain-control options, like medications.
All in all, these data suggest that online CBT could be beneficial for people with fibromyalgia.
“From a clinical view, the finding that reducing avoidance behavior are key for a successful treatment outcome in exposure therapy might be informative to clinicians. In addition, the fact that the results favor the utility of exposure as a treatment for FM could be motivating for patients,” the study concluded.
“Many doctors feel frustrated and at a loss when meeting a patient with fibromyalgia as there is currently no effective treatment,” Hedman-Lagerlöf said.
“The next step is to compare our therapy with a different kind of psychological treatment,” she added. “If it proves more effective it wouldn’t take long for it to be implemented by the health services, where it can benefit the lives of many patients.”