What Is Cognitive Behavioral Therapy?
Although it started as a treatment for what we would now call post-traumatic stress disorder (PTSD), Cognitive Behavioral Therapy (often called CBT) is used today for a wide variety of conditions. It has been tested rigorously in clinical trials, including using Cognitive Behavioral Therapy for fibromyalgia and chronic pain treatment.
CBT was created in the 1940s to help returning World War II veterans re-acclimate to civilian life. Cognitive Behavioral Therapy techniques are grounded in helping people change their relationship to their symptoms – and their thoughts about their symptoms – so they can live a life that’s meaningful to them. It provides unique opportunities to develop skills for managing symptoms, and it teaches you how to change your relationship to those symptoms so they don’t dominate your life or dictate what you do.
Types of Cognitive Behavioral Therapy
Cognitive Behavioral Therapy is an umbrella term for several different types of therapy. Whenever you hear CBT, it could mean a number of different treatments.
Common types of Cognitive Behavioral Therapy include:
- Acceptance and Commitment Therapy
- Dialectical Behavior Therapy
- Mindfulness-Based Stress Reduction
- Exposure Therapy
- Eye Movement Desensitization and Reprocessing
Cognitive Behavioral Therapy can also refer to a combination of these CBT treatments.
How Do Cognitive Behavioral Therapy Techniques Work?
Cognitive Behavioral Therapy focuses on the connections between our thoughts, emotions, physical sensations, and behaviors. All of these things are inextricably linked, but often we notice only one at a time, especially if we experience it in a way that seems overwhelming.
It’s hard to get through the day when you’re tormented by pain. When the experience of pain dominates our thoughts, it can feel like we are powerless or have lost control. We have an immediate reaction to that physical sensation, wanting to soothe it. We have thoughts like “I’m in pain. I need to do X right away.” Some of these immediate reactions can be helpful, while others may not be. There might be more options available than the first one that comes to mind.
The work of Cognitive Behavioral Therapy is aimed at creating more awareness during these distressing experiences. You can learn to pause, observe what choices are available to you in that moment, and respond from that heightened awareness. Rather than being driven by “fixing” pain, your choices can be about moving toward what matters to you.
CBT techniques can help you get through those overwhelming experiences with greater awareness and more flexibility about what action to take.
These techniques can include:
- Mindfulness exercises, a secular form of meditation
- Relaxation and grounding techniques (activating the parasympathetic nervous system, the part of the nervous system that helps downregulate the stress response in the brain)
- Communication tools
- Stress-management techniques
- Identifying and honoring values
Taken together, these techniques are aimed at letting your values guide how you respond, rather than letting pain (or fear of the pain) determine how you react.
Why Use Cognitive Behavioral Therapy for Fibromyalgia?
Research shows that Cognitive Behavioral Therapy is one of the most effective and most durable treatments for fibromyalgia (see the data). In terms of efficacy, it has been shown to reduce severity and frequency of symptoms even better than the current FDA-approved medications for fibromyalgia. It’s also durable: not only is Cognitive Behavioral Therapy effective while people are using the therapy, but its effects tend to last even after people have stopped actively doing CBT. (see the data)
Cognitive Behavioral Therapy is also a low-risk treatment. It has not been shown to have adverse effects or side effects. Because of this, it’s the gold-standard therapy for chronic pain. While medications can be helpful in fibromyalgia treatment, their effects are not the same for everyone, and they can have side effects that are limiting or even debilitating.
For people with fibromyalgia, using Cognitive Behavioral Therapy in fibromyalgia studies has been shown to (see the data):
- Improve physical functioning, including in ways that can help prevent future fibro flares
- Reduce how frequently people experience pain
- Reduce pain intensity
- Reduce symptoms of anxiety and depression
- Increase engagement in valued activities
One of the goals of Cognitive Behavioral Therapy is to help people manage what is within their control and accept what is outside their control. Because of this, CBT has been shown to be especially useful for treating chronic pain, including the symptoms of fibromyalgia. Experiencing chronic pain can lead you to feel afraid of your body: afraid to move it, afraid of what symptoms will arise. It can get to the point where that fear of moving your body restricts what you do. Fibro can begin to seem like a dictator who controls your life.
By increasing awareness about habitual reactions to pain as well as possible new responses, Cognitive Behavioral Therapy helps people with fibromyalgia change their relationship to their symptoms and the thoughts and behaviors that surround them – and suffer less as a result.
1. ncbi.nlm.nih.gov/pmc/articles/PMC6481397/(opens in a new tab)
2. researchgate.net/publication/267200915_Effectiveness_of_cognitive_behavioral_therapy_in_the_treatment_of_fibromyalgia_syndrome_A_meta-analytic_literature_review(opens in a new tab)