The following is an excerpt from the Mayo Clinic Press book Mayo Clinic Guide to Fibromyalgia by Andy Abril, M.D. and Barbara K. Bruce, Ph.D., L.P.
Your muscles ache. Your joints hurt. Your neck feels stiff. Your thinking often seems muddled. You’re exhausted. You feel lightheaded sometimes. You can’t sleep — or, all you want to do is sleep more.
With fibromyalgia, you may feel all of this and more. It can be easy to get discouraged.
But what you think, how you feel and what you do about fibromyalgia can have a powerful effect on your life — for the better. That’s where cognitive behavioral therapy comes in.
At its core, cognitive behavioral therapy helps you replace negative or inaccurate thoughts with thoughts that are more positive and realistic. You then use your thoughts and feelings to change your behavior. The goal of cognitive behavioral therapy is to help you recognize that fibromyalgia is something you can manage. When you feel confident about your ability to manage your symptoms, your entire life can improve.
Changing your approach to fibromyalgia
What if you could:
- Manage your pain and other symptoms, rather than having them run your life, day in and day out.
- Learn techniques that can help you cope with pain and other symptoms more effectively than you are now.
- Change how you think and feel about your pain and other symptoms so that they don’t affect you as much.
- Feel confident about managing your symptoms.
- Anticipate problems before they happen and solve them before they have a chance to take hold of your life.
- Return to a life that you enjoy.
You can do all of this by changing what you think, feel and do. That’s the basis of cognitive behavioral therapy.
Changing your thoughts, behaviors and feelings
Cognitive behavioral therapy helps you cope with fibromyalgia by changing how you think about it and respond to it. It’s been used to effectively treat a variety of pain syndromes. It also teaches ways to cope with stressful life situations.
Cognitive behavioral therapy teaches you to challenge negative thoughts and adopt more realistic ways of thinking. In turn, you learn to believe in your ability to manage fibromyalgia and change the way you think about your pain — and change how it makes you feel.
Here’s a step-by-step look at how cognitive behavioral therapy works:
- Identify troubling situations or conditions in your life. These are the situations that cause you to feel stressed. Maybe you worry that you won’t be able to work again or that you won’t be as good a friend, spouse or parent.
- Become aware of what you think, how you feel and what you believe about these problems. With this step, you learn to recognize when you’re having negative thoughts.
- Identify thoughts that are negative or inaccurate. Are you really a terrible parent, for example, or are you being too hard on yourself because you feel less able to play with your kids like you did before?
- Replace negative thoughts with thoughts that are more realistic and accurate. Instead of telling yourself, “This pain will never get better,” for example, you may tell yourself, “I can handle this. I have done it before, and I can do it again.”
These four steps help you reshape your thoughts and feelings. The steps are based on the idea that your thoughts can either help you or hurt you. That’s the cognitive part of cognitive behavioral therapy.
You can tell yourself, “I can’t do that” or “That will never work.” Or, you can exchange those thoughts for more realistic and positive ones, such as, “I can do this.”
Cognitive behavioral therapy can help you cope with fibromyalgia in a more realistic way. When you face a challenge or obstacle, taking this approach can help you feel less distressed. The strategies you learn are designed to help you feel encouraged, happy, calm, content and confident about your ability to manage your symptoms and the challenges they bring to your life.
The behavioral part of cognitive behavioral therapy addresses the active part of living with fibromyalgia. It includes setting goals, action planning, engaging with people, attending activities, and stretching and physical movement. Put simply, it means truly living your life and not letting fibromyalgia or its symptoms hold you back.
Behavioral strategies include getting more physical activity and learning to pace yourself so that you’re not doing too much on your good days but are still staying active, even on your bad days. Other behavioral strategies include steps you can take to sleep better and relaxation techniques such as deep breathing or mindfulness meditation to help you relax.
How well does cognitive behavioral therapy work?
Cognitive behavioral therapy has been used for many years to help treat a variety of physical challenges, from losing weight to managing headaches. In 1998, researchers wondered whether cognitive behavioral therapy could help treat fibromyalgia, too. An early study indicated that combining education, meditation and movement therapy could help people with fibromyalgia reduce their pain, function better and improve their mood. These tenets of cognitive behavioral therapy are all used today to treat fibromyalgia.
Since then, hundreds of studies have found that the therapy can treat a range of pain syndromes, including fibromyalgia. Today, it’s the most commonly accepted way to help people cope with pain.
Studies suggest that programs using cognitive behavioral therapy to teach people how to manage pain are effective because cognitive behavioral therapy treats the physical side of pain and addresses how people think and feel about it. Cognitive behavioral therapy supports the idea that healthy behaviors can help with managing symptoms.
It also reinforces the idea of refocusing attention away from pain and other symptoms. Paying attention to something other than pain can make pain feel less intense. When people distract themselves from pain, brain images show less activity in the part of the brain that deals with pain.
This technique has been shown to relieve pain as well as — and in some cases, even better than — pain-relieving medications.
Even simply thinking about pain differently can help. Instead of telling yourself, “This pain is never going to get better,” you may tell yourself, “I can handle this pain.”
Other examples of cognitive behavioral therapy techniques — such as guided imagery, meditation and mindfulness-based stress reduction, which teaches ways to manage and reframe thoughts that are worrisome or negative — can lessen the effect that symptoms have on your life.
In addition to pain, cognitive behavioral therapy can be helpful in treating anxiety and depression, both of which are common with fibromyalgia. Some researchers suggest that cognitive behavioral therapy is so effective for anxiety and depression it should be the treatment of choice.
People of all ages coping with a chronic pain condition can benefit from cognitive behavioral therapy. It’s especially helpful when it’s combined with other types of treatment, such as aerobic exercise, strength training, a healthy diet and medication if needed.
With cognitive behavioral therapy, you’re in the driver’s seat. You can choose not to let pain run your life, and you have the power to deal with your pain in ways that enable you to live life more fully — and enjoy it.
