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  • New research has found that cognitive behavioral therapy may help people with fibromyalgia.
  • The researchers were able to identify differences between fMRI scans between participants as well as a significant reduction using survey-style tools.
  • Experts are hopeful that these finding can help support patients and clients while reducing bias and barriers to care.

For those in chronic pain, mental health supports are both vital and lack availability. A new study, published September 20 in Arthritis & Rheumatology, has found that the use of cognitive behavioral therapy (CBT) can be especially helpful for those living with fibromyalgia.

The research—conducted by a team from Harvard, Norway, and Pittsburgh—included 114 participants and found that CBT was better at helping to reduce catastrophic thinking related to the disease.

This was compared to people using educational materials alone.

Understanding catastrophizing, according to Dr. Chandler Chang (PhD), clinical psychologist and founder at Therapy Lab, is key to supporting people with a chronic illness like fibromyalgia.

“Let’s say you have fibromyalgia and you start thinking, ‘The rest of my life is going to be like this, my life is ruined, everything is going to suck after this.’ Those are examples of catastrophic thoughts that you might have,” Chang said.

The researchers used tools such as Brief Pain Inventory (BPI), BPI Pain Severity, the Fibromyalgia Impact Questionnaire-Revised (FIQR), and the Pain Catastrophizing Scale (PCS), to assess participants alongside the scans. Once the participants participated in the imaging, they were either given eight weeks of CBT or educational materials about fibromyalgia and chronic pain.

Those who received the CBT were provided weekly sessions across eight weeks.

The researchers used the Pain Catastrophizing Scale (PCS), a tool that is scored out of 52, to see how CBT could impact people with the condition.

They found that those who received CBT therapy saw an average reduction of 8.7 points on the scale while those receiving educational materials saw a much lower drop of 4.6.

The team also used an fMRI scan and were able to see the impact of catastrophizing thoughts in the brain patterns. After the CBT, they could see evidence that changes in brain patterns coincided with people who benefited from CBT.

Kelsey Bates (LPC), founder at Women’s CBT, says that catastrophizing is a particularly impactful element of both fibromyalgia and CBT treatment but that providing mental health support for those with chronic illness, in her practice, requires the use of trauma-informed tools.

“Reframing our thoughts is important. But we also need space to acknowledge the grief that might happen when people are going through a chronic illness or dealing with chronic pain,” Bates said. “There’s a level of acceptance that we have to figure out.”

Dr. Jeff Krauss, Chief Medical Officer at Hinge Health and Staff Physician at the VA of Palo Alto, says that this study could help reduce stigma and lead to better patient outcomes.

“One of the problems with chronic pain is that it’s very hard to see it. People used to get, and still do get, accused of faking their pain, because doctors will look and see that there’s nothing wrong with their back, or there’s nothing wrong with their knee… It’s really exciting that we can start to see it in the brain, and know that these feelings that people have are very real, even though it might not be correlated with tissue damage.”

Bates says that while “pain doesn’t discriminate” she also regularly sees clients who feel left behind by the medical system when it comes to the mental health side of chronic illness and chronic pain.

“I meet folks and they’ve felt really gaslit by medical providers, especially with fibromyalgia in particular, that they have heard the phrases like you just need therapy, you just need to relax, just manage your stress,” Bates said.

One of the stated limitations of the study was that, while fibromyalgia does disproportionately affect women, and all the participants were female, more work can and should be done to include both men and non-binary people in future research.

As for what comes next, Krauss says that while these results are encouraging they are still part of a larger picture that has many barriers to treatment for those experiencing these symptoms.

“I think until we have the ability at scale to do this very expensive imaging, and to find those interventions that can actually change the way the brain processes pain through some sort of pharmacologic intervention or something, through a drug, then we’re really left with a lot of these very foundational lifestyle changes that are so effective and necessary for treating chronic pain.”

Bates, meanwhile, says that her hope is that research like this can add to a more integrated approach when it comes to CBT, one that prioritizes trauma-informed care as well as other modalities like Dialectical Behavioral Therapy (DBT) and acceptance and commitment therapy (ACT).

“My personal outlook is that chronic illness and chronic pain is considered medical trauma…So I think it’s our clinical duty to provide a safe, warm therapeutic space that’s conducive to holding space for all of those things.”

A new study, published this week in Arthritis & Rheumatology, has found that the use of CBT can be especially helpful for those living with fibromyalgia.