There do not appear to be profound differences between so-called exposure-based CBT and traditional CBT in the treatment of fibromyalgia, according to a study led by researchers at the Karolinska Institutet. Both forms of treatment produced a significant reduction in symptoms in people affected by the disease. The study is one of the largest to date to compare different treatment options for fibromyalgia and is published in the journal PAIN.
About 200,000 people in Sweden currently live with fibromyalgia, a long-term pain syndrome that causes great suffering to patients due to widespread pain, fatigue and stiffness in the body. There is no cure for fibromyalgia. Existing drugs are often ineffective, increasing the need for more effective treatment methods. Cognitive behavioral therapy (CBT) has shown some effect, but there is a shortage of trained CBT practitioners. There is also a lack of knowledge about which form of CBT is most effective. The study compared two different forms of internet-delivered cognitive behavioral therapy for how well they reduced the symptoms and functional impact of fibromyalgia.
Briefly, exposure-based CBT involves the participant systematically and repeatedly approaching situations, activities, and stimuli that the patient has previously avoided because the experiences are associated with pain, psychological distress, or symptoms such as fatigue and cognitive problems.
In traditional CBT, the participant is presented with several different strategies to work on during treatment, such as relaxation, activity planning, physical exercise, or strategies for managing negative thoughts and improving sleep.
The study showed that traditional CBT was largely equivalent to the newer treatment form of exposure-based CBT.
“This result was surprising because our hypothesis, based on previous research, was that the new exposure-based format would be more effective. Our study shows that the traditional format can provide an equally good result and thus contributes to the debate in the field,” says Maria Hedman-Lagerlöf, a licensed psychologist and researcher at the Center for Psychiatric Research in the Department of Clinical Neuroscience at the Karolinska Institute.
The randomized study involved 274 people with fibromyalgia, who were randomly assigned to be treated with traditional or exposure-based CBT. Treatments were delivered entirely online and all participants had regular contact with their therapist.
Participants answered questions about their mood and symptoms before, during, and after treatment. After 10 weeks of treatment, 60 percent of those who received exposure-based CBT and 59 percent of those who received traditional CBT reported that their treatment had helped them.
“The fact that both treatments were associated with a significant reduction in participants’ symptoms and functional impairment, and that the effects were maintained for 12 months after completion of treatment, suggests that the Internet as a form of treatment may have great clinical benefit for people with fibromyalgia,” says Maria Hedman-Lagerlöf. “This is good news because it allows more people to access treatment.”
The study is the second largest to compare different psychological treatment options for fibromyalgia, according to the researchers.
“Our study is also one of the first to compare it with another active, established psychological treatment,” says Maria Hedman-Lagerlöf.