The Mystery of Fibromyalgia and How Cognitive-Behavioral Therapy Can Help

Fibromyalgia syndrome (FMS) is the medical terminology used to represent a complex clinical disorder of symptoms characterized by soft tissue pain, stiffness, and altered deep pain threshold with psychological fallout. It can mimic or accompany symptoms of joint injury, but it is not an arthritic or neurological condition. The disorder affects between 3 to 6 million people – or as many as one in 50 Americans. About 80 and 90 percent of those diagnosed with fibromyalgia are women.

There is usually an emotional overlay of depression and anxiety that affects the sufferer. There are numerous reasons why this is true. Many within the medical community have discounted fibromyalgia as a bona fide disease. Patients have been told that they are over-dramatizing their pain and that the stiffness or soreness has been psychologically induced. Others have been told that the condition was fabricated for attention or perceived by health providers as feigned helplessness. These assertions from medical experts make patients with FMS feel ignored, mistrusted, alone and without support. Patients often turn to self-blame, which fuels the pain cycle.

The pain and symptoms of fibromyalgia are real and have a definite physical basis.
There is no known cause for fibromyalgia. Some researchers have speculated that physical trauma or viral influences have triggered FMS syndrome in many patients. There are no known abnormalities in the muscle tissue of fibromyalgia patients that would account for the disease.

Current research has focused on regions of the FMS patient’s brain and the susceptibility of certain brain locations to pain sensitivity. The brain receives a pain signal from the muscles and stays in a state of alert. For unknown reasons, the brain fails to let go of the pain signal and sets up a chronic pattern or pain syndrome. The brain stays in a constant feedback loop, consisting of a system of amplified pain signals.

Recent brain scan research studies have shed new light on this disorder. Results published in the May 2008 edition of the Journal of American College of Rheumatology shows that neuroscientists have been able to conduct scanning technology to areas of the brain affected by fibromyalgia. Mild pressure on trigger points of the patient has produced measurable brain response in processing the sensation of pain. The elevated response of pain in FMS patient’s brain scans was significantly different from those in the control group of the study. This is one of several studies that validate the reality of fibromyalgia as a disorder affecting the brain's response to muscular and neuropathic pain. Hopefully, future studies will lead to new treatment options.

Currently, treatment options consist of the use of a multidisciplinary approach. Medication management, physical therapy, meditation, exercise, alternative therapies, and cognitive-behavioral therapy are useful. CBT is a valuable therapeutic treatment option for those suffering from pain syndromes. One of the byproducts of pain can be the escalation of anxiety and depression. Likewise, anxiety and depression can intensify the impact of pain and make it more debilitating.

Cognitive-behavioral therapy’s goal is to teach the FMS patient to embrace pain rather than fight it. Cognitive distortions, such as magnification and “catastrophizing” need to be addressed so that patients learn to de-escalate fueling the pain process. How one thinks about his pain affects its impact. One can learn to rationally respond to pain by saying:
"Although this problem is difficult, I can learn to manage it."
"What's the use of getting all upset about my pain, it won't help anyway."
"If I relax and walk into my pain, maybe all this will feel less troublesome."
"I'm not alone in this. I have the support of my family and friends."
"I'm not helpless, I have many strategies I can try to minimize the effect of my pain. Just keep moving!"

Cognitive-behavioral therapy can assist the fibromyalgia patient to identify stressful triggers that exacerbate pain. This may involve examining family struggles, exploring inner-conflict, and working with core, self-defeating assumptions that affect thinking and behavior. Teaching the patient mindfulness meditation as a way of relaxing the sympathetic nervous system is beneficial.

Through the use of CBT, a therapist can provide the fibromyalgia patient with structured homework assignments that will help pain sufferers to experiment with new behaviors such as increased involvement and activities. Motivating the client to set realistic goals for everyday functioning can be helpful. Encouraging a multidisciplinary approach involving exercise, physical therapy, rehabilitation and pain management are essential.

Fibromyalgia patients fear that their disorder will cause them to lose the ability to function at work and at home. Teaching patients to focus on what they can do rather than their limitations is important. There is a tendency for fibromyalgia patients to distort reality by focusing on negative perceptions to the exclusion of the positive. Helping the patient and family to accept physical limitations is a necessary component to successful treatment.

Fibromyalgia patients can easily get enmeshed in a cycle of pain and associated emotional symptoms. It is the goal of cognitive-behavioral therapy to assist the patient in coming to terms with his disorder and making plans to manage it. This is accomplished through acceptance and teaching the patient positive ways of thinking about his condition and multiple ways of treating it.





James P. Krehbiel, Ed.S., LPC, CCBT is an author, freelance writer and nationally certified cognitive-behavioral therapist practicing in Scottsdale, Arizona. His book, Stepping Out of the Bubble is available at www.booklocker.com.

Are You Anxious About Your Anxiousness?

Excessive anxiety is troublesome. For many, it can be an immobilizing experience. Anxiousness can be associated with social avoidance and withdrawal, can be a factor in relationship difficulties, can create painful symptoms, and trigger a need to rehash issues related to our past and future. Anxiety triggers the "fight or flight" response, ramping up our sympathetic nervous system.
The most successful treatment approach to dealing with anxiety is through the application of Cognitive therapy since anxiety is a reaction to our thinking, beliefs and underlying assumptions about life. It is usually not our primary anxiousness that creates our distress. It is our secondary thoughts and feelings - the "anxiety about our anxiety" that intensifies our symptoms.
Almost everyone experiences anxiety, but not everyone catastrophizes about it. Let's say you are taking a midterm exam in college. There are several ways you might respond when you open the test booklet and note that there are numerous questions that you are not prepared to answer. First, you might respond by saying, "wow, none of these answers look familiar. I don't remember studying for us- I'm going to flunk this test. If I fail it, there goes my grade for the semester. Wait until my parents find out, they will kill me!" Or and alternative, rational response might be, "Gee, I don't understand these first three questions - that's okay, I'll just take some deep breaths, relax and work on the questions that I am familiar with. Then I'll go back and tackle the ones I couldn't answer before."
An individual’s manner of self-talk determines the level of anxiety. When we "awfulize" about anxiety, it tends to intensify it. When we respond rationally to our anxiety, that diminishes its effect. Rationally responding to anxious thoughts is critical to minimizing its effect.
Many people tend to believe that their panic or general anxiety "appear out of the blue." They may feel confused and perplexed by the sudden emergence of their feelings. Cognitive therapists view anxious feelings as a byproduct of faulty thinking. There is no mystery to it. Teaching others to respond rationally to self-defeating talk is the primary goal of therapy.
Individuals who experience panic attacks are usually troubled by symptoms such as racing heart, sweating, fear of dying, hyperventilating and a need to escape social situations. Helping individuals to manage panic attacks takes understanding and patience. Assisting people to realize that their panic is time-limited is important. Since panic tends to take on a life of its own, it is important to address the secondary symptoms or the "panic over the panic." When people panic, they tend to magnify their symptoms through self-defeating thinking, perpetuating the attack. Teaching people to relax into their panic is necessary.
The following are some guidelines for those who experience anxiety and panic:
1. Anxiety is time-limited. It is comforting to know that it always diminishes in its impact over time.
2. Don't fight with your anxiety. It only makes things worse. Lean into your anxiety, embrace it, and it will subside.
3. Schedule a "worry time." Go into a quiet room, relax and try to expose yourself to your anxieties. Try to bring on your symptoms and you will find that it is difficult to do.
4. If you have a tendency to panic, create an exit strategy. Plan a way to remove yourself from anxious situations to bring relief.
5. Refocus your attention away from your anxiety. For example, when people experience panic attacks that involve a racing heart, I might encourage them to do jumping jacks to demonstrate that there is nothing physically causing their symptoms. This strategy actually lightens the situation and their symptoms.
6. If you are anxious, chunk things down into smaller parts. People tend to feel overwhelmed when they look at the entire picture. Rather than clean the entire house, pick a few specific tasks such as shredding a few unnecessary documents.
7. Stay in the present. Don't rehash your history or anticipate your future. Worrying about your future or history serves no useful purpose. You can't control it anyway.

Cognitive therapy emphasizes replacing self-defeating thinking with more rational ways are responding to stressors. Identifying goals of therapy, approaching them in a practical manner, and providing homework assignments are significant ingredients to addressing anxiety.