Internet versus face-to-face group cognitive-behavioral therapy for fibromyalgia: A randomized control trial

New Study (1)Abstract:

Background:The aim of this study was to explore the effectiveness of Internet-delivered cognitive-behavioral therapy (iCBT) in treating fibromyalgia (FM) compared with an identical protocol using conventional group face-to-face CBT.
Methods:Sixty participants were assigned to either (a) the waiting list group, (b) the CBT group, or (c) the iCBT group. The groups were assessed at baseline, after 10 weeks of treatment, and at 3-, 6-, and 12-month follow-ups. The primary outcome measured was the impact of FM on daily functioning, as measured by the Fibromyalgia Impact Questionnaire (FIQ). The secondary outcomes were psychological distress, depression, and cognitive variables, including self-efficacy, catastrophizing, and coping strategies.
Results: In post-treatment, only the CBT group showed improvement in the primary outcome. The CBT and iCBT groups both demonstrated improvement in psychological distress, depression, catastrophizing, and utilizing relaxation as a coping strategy. The iCBT group showed an improvement in self-efficacy that was not obtained in the CBT group. CBT and iCBT were dissimilar in efficacy at follow-up. The iCBT group members improved their post-treatment scores at their 6- and 12-month follow-ups. At the 12-month follow-up, the iCBT group showed improvement over their primary outcome and catastrophizing post-treatment scores. A similar effect of CBT was expected, but the positive results observed at the post-treatment assessment were not maintained at follow-up.
Conclusions: The results suggest that some factors, such as self-efficacy or catastrophizing, could be enhanced by iCBT. Specific characteristics of iCBT may potentiate the social support needed to improve treatment adherence.

Vallejo M. A., Ortega J., Rivera J., Comeche M.I. & Vallejo-Slocker L.(2015). Internet versus face-to-face group cognitive-behavioral therapy for fibromyalgia: A randomized control trial. J Psychiatr Res. 2015 Sep;68:106-13. doi: 10.1016/j.jpsychires.2015.06.006. Epub 2015 Jun 20.

Using CBT and Smart Phones for the Self-Management of Chronic Pain

In this age of technology, internet interventions are becoming more common in the practice of Cognitive Behavioral Therapy (CBT).  Chronic Widespread Pain (CWP) causes patients to live in constant pain, as well as fear of that pain, which can lead to avoidant behavior and depression.  Kristjansdottir et al (2011) hope to develop an intervention program that will help patients with CWP to self-manage their pain.  Using CBT with a focus on mindfulness and the acceptance of pain, researchers developed a four week intervention that is administered to the patients via Web-enabled smart phones.  In the present study, the researchers look into the feasibility of the intervention.

Six women with CWP were recruited to participate in the intervention.  Each participant first met one-on-one with a therapist where she was asked about her condition, informed of the intervention, and lent a web-enabled phone.  For the next four weeks, the participants received an SMS text message three times a day (morning, evening, and a random time between 11:30 am and 2 pm) reminding the participants to fill out an online diary.  This diary included a set of questions asking about current thoughts and pain awareness.  Within 90 minutes, each participant received online feedback from a therapist, who was supervised by two other professionals of mindfulness meditation and CBT.

Each online diary included questions regarding the usefulness of the previous diary’s feedback.  The effects of the intervention were quantified by use of the Chronic Pain Acceptance Questionnaire (CPAQ) and the Pain Catastrophizing Scale (PSC), given to participants before and after the intervention.  Half-way through the intervention, and after completion, researchers met with participants to ask them about their experiences and opinions.

Kristjansdottir et al found that the participants were responsive to the intervention and saw it as supportive and useful.  Despite minimal technical difficulties, the program was found to be user-friendly and feasible.  Future randomized studies can adapt the program and explore its effects on CWP.

Kristjansdottir, O. B., Fors, E. A., Eide, E., Finset, A., van Dulmen, S., Wigers, S. H., & Eide, H. (2011).  Written online situational feedback via mobile phone to support self-management of chronic widespread pain: A usability study of web-based intervention.  BMC Musculosketital Disorders, 12(51).

Combination of CBT and Exercise May Ease Fibromyalgia

newstudy-graphic-66x60.jpgA new study conducted by researchers at Radboud University Nijmegen Medical Center in the Netherlands tested the effectiveness of Cognitive Behavioral Therapy (CBT) combined with exercise to treat fibromyalgia. This syndrome, that affects about 5 million adults in the U.S., causes widespread aches and pains, specific “tender points”, fatigue, and sleep problems. Though the cause of Fibromyalgia is unknown and it is difficult to treat, research has proven combinations of treatments more effective than a single treatment alone. Types of treatments for this syndrome include painkillers, antidepressants, CBT, and exercise therapy.

The study participants were “high-risk” fibromyalgia patients, those whose symptoms were judged to cause significant distress. First the participants were divided into two groups, based on how they handled their pain–those who avoided activities they feared would increase their pain and those who maintained their usual activities despite their pain. Both groups were then further divided into two randomly assigned groups–one group underwent 16 sessions of CBT-plus-exercise therapy and the other were placed on a wait-list for treatment. The CBT was specifically tailored as follows: For the patients who avoided activities, the CBT focused on dealing with the fear of pain and setting goals for increasing their daily activity. For the patients who maintained their activities, the CBT focused on setting more realistic goals and pacing daily activity to avoid overdoing it. After each CBT session, all of the patients had an exercise session with a physical therapist.

Immediately following the treatment period, and six months later, both the avoidant and the overactive therapy groups were faring better than those on the wait-list. After six months, 2/3 of the patients in the therapy groups had experienced noticeable changes in their daily lives, as compared to 1/3 of the wait-list patients. These improvements were in measures of physical well-being, such as pain, fatigue, and disability. They manifested themselves in the patients’ comparative ease in walking, climbing stairs, and doing household chores. Additionally, 62% of patients in the therapy groups experienced improvements in anxiety or depression symptoms, compared to 33% of patients on the wait-list.

Fibromyalgia – real disease getting real benefit from CBT

People with Fibromyalgia suffer on many levels. They live with a chronic and painful, life-altering, multi-system disease that affects about 2% of the general U.S. population. For many years, they also suffered from widespread skepticism and debate about the disease itself. Was it real? Wasn’t it the same as Chronic Fatigue Syndrome, which the media disparagingly called Yuppie Flu?

Thankfully, the uncertainty officially ended in 1990 when the American College of Rheumatology established criteria for its diagnosis. This was a positive step; however, appropriate treatment would remain unclear.

A good deal of research has emerged since then and a recent review of treatment protocols for Fibromyalgia showed that the best outcomes involved pharmacologic therapies in combination with Cognitive Behavioral Therapy (CBT). Exercise and patient education, part and parcel of a CBT approach, were also important.

Cognitive therapy strategies “help patients understand the effect that thoughts, beliefs, and expectations have on their symptoms.” It was also very important to use the strategies to help patients prioritize time to achieve balance in their daily lives.