Multi-Component Cognitive Behavioral Therapy for Fibromyalgia

Status: Strong Research Support


Cognitive Behavioral Therapy (CBT) for FM can be tailored to target many of the symptom domains associated with FM. CBT emphasizes the learning of adaptive behavioral responses to illness and in so doing, alters thinking styles, experiences, and emotional responses that can maintain or worsen the illness. Given FM is a multifaceted disorder; unimodal treatment (i.e. focusing just on pain) is unlikely to lead to maximum positive outcomes. Thus CBT for FM often includes the following components: (1) education about FM including the nature of the disorder and the role patients can play in its management, (2) Symptom self-management skills targeting pain, fatigue, sleep, cognition, mood, and functional status (e.g. relaxation techniques, graded activation, pleasant activity scheduling, sleep hygiene), and (3) Life style change promoting skills targeting barriers to change, unhelpful thinking styles, and long term maintenance of change (e.g. stress management, goal setting, structured problem solving, reframing, and communication skills). In order to better learn and integrate skills into one’s life style, CBT relies upon self-monitoring, skill rehearsal, and social reinforcement. CBT for fibromyalgia can be administered either individually or in small groups over 6 to 10 sessions.

Key References (in reverse chronological order)

  • Williams, D. A., Cary, M. A., Groner, K. H., Chaplin, W., Glazer, L. J., Rodriguez, A. M. et al. (2002). Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention. J.Rheumatol., 29, 1280-1286.
  • Keel, P. J., Bodoky, C., Gerhard, U., & Muller, W. (1998). Comparison of integrated group therapy and group relaxation training for fibromyalgia. Clinical Journal of Pain, 14, 232-238.
  • Bennett, R. M., Burckhardt, C. S., Clark, S. R., O'Reilly, C. A., Wiens, A. N., & Campbell, S. M. (1996). Group treatment of fibromyalgia: a 6 month outpatient program. Journal of Rheumatology, 23, 521-528.
  • Goldenberg, D. L., Kaplan, K. H., & Nadeau, M. G. (1994). A controlled study of stress-reduction, cognitive-behavioral treatment program in fibromyalgia. Journal of Musculoskeletal Pain, 2, 53-65.

Clinical Resources

  • Williams, D. A. (2003). Psychological and behavioral therapies in fibromyagia and related syndromes. Bailliere's Best Practice and Research (Clinical Rheumatology), 17, 649-665.
  • Williams, D.A., Cary, M. (2003). Self-Management Skills & Techniques for Fibromyalgia. This is an online resource describing self-management skills commonly incorporated into CBT for fibromyalgia.
  • Burckhardt, C., Goldenberg, D., Crofford, L., Gerwin, R., Gowans, S., Jackson, K., et al. (2005). Guideline for the Management of Fibromyalgia Syndrome Pain in Adults and Children. Glenview, IL: American Pain Society.

Training Opportunities

Formal training in CBT for FM is often available through workshops held at the American Pain Society, the International Association for the Study of Pain, and through the American College of Rheumatology. Several centers conducting trials of CBT for FM also provide informal training, predoctoral training, psychological internship rotations, or postdoctoral fellowships in CBT for pain management. For information about training opportunities at these centers contact the following centers:

Laurence A. Bradley, Ph.D.
Division of Rheumatology
178A Shelby Research Building
University of Alabama – Birmingham
Birmingham, AL 35294
Francis J. Keefe, Ph.D.
Director, Pain Management Program
Box 3159
Duke University Medical Center
Durham, NC 27710
Dennis C. Turk, Ph.D.
Dept. Anesthesiology
University of Washington
Box 356540
Seattle, WA 98195
David A. Williams, Ph.D.
Chronic Pain and Fatigue Research Center
Dept. of Internal Medicine/Rheumatology
University of Michigan
24 Frank Lloyd Wright Drive, Lobby M
Ann Arbor, MI 48105