‘Psychological therapy’ works for Fibromyalgia

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An ‘enigmatic’ disorder this is what Perry Nicassio calls fibromyalgia. I hadn’t thought of it that way, because so many chronic pain problems seem to be equally ‘enigmatic’! It’s a common disorder, affects many more women than men, has a multiplicity of effects on people ranging from fatigue, poor sleep, widespread aching, other pain sensations such as stabbing or needle-like pains that can appear anywhere in the body, often with low mood and loss of function. 

There are few medications that seem to help, and many people never seek treatment for their pain.  If people do look for treatment, they can be faced with skepticism from some health providers, despair from others, and offered a multiplicity of treatments that don’t seem to do an awful lot to change the situation.

Outcome of psychological therapies

Have I painted a bad enough picture? It’s only so the good news looks really good!  And the good news is that in a recent meta-analysis of psychological therapies, there was a consistent finding that both short-term and longer term outcomes improved with this kind of input. 

OK, the effect sizes were small but they were maintained, and the good thing about cognitive behavioural therapy (which was found to be the most effective ‘brand’ of therapy) is that once learned, no-one can take it away again, unlike medications!


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These treatments focus on psychological issues, that doesn’t mean that fibromyalgia is psychological

Any discussion of this topic is going to be controversial. That’s understandable, especially given lingering misunderstanding in the public and the medical community about fibromyalgia being “just” depression or some other psychological problem. The important thing to understand, however, is that while these treatments focus on psychological issues, that doesn’t mean that fibromyalgia, is psychological. Here are some facts to keep in mind.

  • >>Fibromyalgia is a neurological illness and involves neurotransmitters (chemical messengers in the brain) that are also involved in some mental illness.
  • >>Stress is a major exacerbating factor in many, if not most, cases of fibromyalgia. It’s suspected as a causal factor and known to make symptoms worse and cause flare-ups.
  • >>Depression and anxiety are common overlapping conditions in fibromyalgia.
  • >>Studies suggest that childhood trauma may alter the body’s physiological stress response, leading to illness later in life.
  • >>Living with a chronic, debilitating illness is difficult and can lead to a lot of negative emotions, and certain types of therapy may help alleviate those emotions. (This is also true of diseases like cancer, which no one thinks is psychological.)
  • >>Psychological treatments aren’t recommended as stand-alone treatments, but as part of a treatment regimen. They’re not intended as replacements for other approaches.
  • >>The brain is changeable. Thoughts have an impact on brain chemistry, so changing thought patterns can affect physiological changes.

Mainstay treatments for fibromyalgia

The mainstay treatments for fibromyalgia include regular exercise it seems that hydrotherapy is popular, but so is tai chi, Pilates, walking, and really, anything that keeps the whole body moving.  People with fibromyalgia also respond to learning more about their disorder information is power! And to cognitive therapy identifying unhelpful thinking and working with these to check out their helpfulness and accuracy, and then identifying new ways of viewing the situation,

Other therapies commonly used, and studied in this meta-analysis, include biofeedback and relaxation training; sleep restriction and other forms of sleep management (e.g. sleep hygiene, cognitive therapy); activity management such as scheduling, pacing, planning, and graded increases in activity; behavioral strategies such as positive reinforcement for well behavior and contingency management for illness behavior; problem solving and communication strategies.

Emotional Awareness and Expression Therapy

According to lead researcher Mark A. Lumley, PhD, EAET is an amalgam of techniques that many therapists are already familiar with. These techniques include:

  • >>Psychodynamic therapy
  • >>Experiential therapy
  • >>Exposure-based therapy
  • >>Expressive writing
  • >>”Rescripting” therapy

“We have just picked themes or techniques from other, more common approaches and repackaged them, and provided some additional ideas to make it more appropriate for pain conditions,” Lumley said in an interview. What that means is, even though EAET is a new approach, it’s one that could be easily replicated by therapists.

The main purpose of EAET is to help people deal with unresolved emotional issues. In the study, 230 people with fibromyalgia had an eight-week course of treatment one group getting EAET, another getting CBT, and the third receiving education about the condition. The participants were evaluated at the beginning of the study, after treatment concluded, and six months later.

Why Is EAET Needed?

In fibromyalgia, the brain amplifies pain signals and even generates them in response to things that shouldn’t cause pain. The brain’s pain pathways “overlap a lot with pathways that deal with danger signals and threat. If you could change those pathways with respect to a person’s sense of power or fear, reducing fear and increasing their power by resolving some of those emotional constraints, it simultaneously reduces the pain experience.” Lumley said.

He says adaptive anger is an emotion that’s often avoided, even in therapy. Many people have justifiable anger toward people in their lives as well as other emotions regarding relationships. By becoming aware of those emotions and learning to express them in healthy ways, he says it can reverse the “helplessness, fear, and sense of being trapped that so many people feel.”

Multiple studies confirm what many of us know from experience chronic illness is hard on relationships. Common misunderstandings of fibromyalgia and its confusing nature only serve to exacerbate that problem. Relationship problems lead to stress, and stress revs up our symptoms.

For support and Discussion join the group “Living with Fibromyalgia and Chronic Illness”

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Research Reference: Nicassio, P. (2010). Psychological approaches are effective for fibromyalgia: Remaining issues and challenges Pain, 151 (2), 245-246 DOI: 10.1016/j.pain.2010.08.011
Glombiewski, J., Sawyer, A., Gutermann, J., Koenig, K., Rief, W., & Hofmann, S. (2010). Psychological treatments for fibromyalgia: A meta-analysis Pain, 151 (2), 280-295 DOI: 10.1016/j.pain.2010.06.011


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