How Cognitive Behavioral Therapy for Fibromyalgia Can Help You Cope

Fibromyalgia is a chronic disorder that causes pain and tenderness throughout your body, as well as fatigue, difficulties with thinking and memory (sometimes called “brain fog” or “fibro fog”), and trouble sleeping.

What Is Cognitive Behavioral Therapy?

One of the core principles of CBT is that your interpretation of a situation has a strong influence on your emotional, behavioral, and even physiological responses to that situation. By changing the way you think about your pain, you can effect real changes in how your body responds to it.

In CBT, you and your therapist work as a team, either one-on-one or in a group setting, to identify thoughts and behaviors that are working against you, challenge those thoughts with evidence from your life, and then change them as needed.

In keeping with its practical nature, CBT is also structured and time-limited. A course of CBT for chronic pain usually lasts about 8 to 10 sessions. By the end, you should be equipped with a changed outlook, coping strategies, and relaxation techniques that empower you to improve your relationship with your pain and symptoms from fibromyalgia.

How CBT Can Improve Fibromyalgia Symptoms

CBT Can Change the Way You Feel Fibromyalgia Pain

“We know from research that our experience of pain is largely influenced by our ‘pain beliefs,’” says Natalie Dattilo, PhD, a clinical psychologist, the founder of Priority Wellness, and an instructor at Harvard Medical School in Boston. “CBT teaches you how to examine your thoughts and beliefs about pain and make adjustments to them that are more helpful for managing fibro flares and the associated distress.”

CBT helps you break the vicious cycle in which pain and stress mutually reinforce and worsen each other, Dr. Dattilo adds.

“I remind my patients pain is not ‘in your head,’ but it is ‘in your brain’ — that is, pain is perceived in the brain, not in the physical location where you feel it in your body,” she says. “So calming the brain calms the pain.” That's not to say that the pain isn't "real," but rather that the psychology and physiology of pain intersect.

CBT Can Change Your Thinking

“Cognitive restructuring is a core component of CBT that helps patients recognize and modify thought patterns that contribute to negative thoughts and feelings such as pain catastrophizing and feelings of lack of self-efficacy or helplessness,” says Dawn C. Buse, PhD, a licensed psychologist and a clinical professor of neurology at the Albert Einstein College of Medicine in New York City. “By replacing these maladaptive thoughts with more realistic, functional, and hopeful thoughts, individuals can develop a healthier mindset towards the pain experience and quality of life.”

CBT Can Improve Function and Quality of Life With Fibromyalgia

“By combating avoidance behaviors and encouraging gradual increases in activity levels, CBT helps individuals reclaim their lives and improve their physical and emotional functioning,” Buse says. “This holistic approach can contribute to a better quality of life, despite the ongoing presence of fibromyalgia symptoms.”

CBT Can Help You Cope With the Anxiety and Depression That Can Come With Fibromyalgia

Anxiety and depression often accompany and amplify the negative effects of fibromyalgia. CBT can help with this as well.

“CBT addresses these psychological conditions by teaching coping strategies to manage stress, anxiety, and depressive symptoms,” says Buse. “Through cognitive restructuring, patients learn to challenge and reduce the negative thought patterns that create and exacerbate feelings of anxiety and depression.”

Buse highlights behavioral activation, a key CBT technique that encourages patients to engage in activities that provide a sense of accomplishment and pleasure and counteract the tendency to withdraw which often comes with anxiety, depression, and chronic pain.

“One of the most overlooked aspects of fibromyalgia is the impact it has on relationships and social health,” adds Dattilo. “When pain flares, sometimes our first instinct is to withdraw socially, isolate or disconnect from others. This can actually increase the risk of anxiety and depression and further worsen the pain.”

What CBT for Fibromyalgia Is Like

• Assessment and education: An assessment of your specific symptoms, pain presentation, and emotional responses allows you and your therapist to identify maladaptive thought processes and behaviors. You’ll also be educated about CBT and its role in managing fibromyalgia.
• Cognitive restructuring: You’ll learn to identify, challenge, and replace your negative thought patterns, and to develop healthy coping strategies and improved emotional responses to pain.
• Behavioral activation and skill development: You’ll be encouraged to engage in physical activities and set realistic goals for daily life. Often this includes integrating physical exercise with relaxation techniques, which will help you integrate and apply your new knowledge, insights and coping skills to real-life situations.

Finding the Right CBT Professional

CBT therapists can be psychologists, psychiatrists, or clinical social workers. Look for a therapist who specializes in helping people with health conditions and chronic pain. You can find a qualified CBT therapist using the Find-a-Therapist service at the website for the Association for Behavioral and Cognitive Therapies.

The Takeaway

• CBT can help you take control of your thoughts, feelings, and behaviors around your fibromyalgia and empower you to improve your overall quality of life.
• If you’re struggling with fibromyalgia pain as well as stress, anxiety, and depression, CBT is well worth looking into.
• In combination with the other components of a holistic treatment — which it can help you establish — CBT can put you in the driver’s seat and help you reclaim your life in spite of your fibromyalgia symptoms.