According to a study conducted by researchers at the Karolinska Institutet, there appears to be no significant difference between exposure-based cognitive behavioral therapy (CBT) and traditional CBT in the treatment of fibromyalgia. Both treatment modalities led to significant relief of symptoms in people affected by the disease. The study, published in the journal PAIN, is one of the most comprehensive comparisons of different treatment options for fibromyalgia.
Currently, about 200,000 people in Sweden live with fibromyalgia, a long-term pain syndrome that causes widespread pain, fatigue, and stiffness in the body for the patients. There is no cure for fibromyalgia. Existing medications often have insufficient effects, increasing the necessity for more effective treatment methods. Cognitive behavioral therapy (CBT) has shown some effects, but there is a lack of trained CBT practitioners. There is also a lack of knowledge about which form of cognitive behavioral therapy is most effective.
The study compared two different forms of internet-delivered cognitive behavioral therapy in terms of how effectively they reduce the symptoms and functional impacts of fibromyalgia.
In short, exposure-based cognitive behavioral therapy involves the participant systematically and repeatedly approaching situations, activities, and stimuli that the patient has previously avoided due to experiences of pain, psychological discomfort, or symptoms such as fatigue and cognitive problems.
With traditional cognitive behavioral therapy, the participant is presented with various strategies to work on during the treatment, such as relaxation, activity planning, physical exercise, or strategies for coping with negative thoughts and improving sleep.
The study found that traditional cognitive behavioral therapy was generally equivalent to the newer exposure-based form of treatment.
„This result was surprising, as our hypothesis based on previous studies was that the new exposure-based form would be more effective. Our study shows that the traditional form can yield an equally good result and thus contribute to the discussion in practice.“
– Maria Hedman-Lagerlöf, licensed psychologist and researcher at the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet
274 fibromyalgia participants were involved in the randomized study, randomly assigned to receive treatment with traditional or exposure-based cognitive behavioral therapy. The treatments were conducted entirely online, and all participants had regular contact with their therapist.
Participants answered questions about their mood and symptoms before, during, and after the treatment. After the 10-week treatment, 60 percent of those who received exposure-based cognitive behavioral therapy, and 59 percent of those who received traditional cognitive behavioral therapy, reported that the treatment had helped them.
„The fact that both treatments were associated with a significant reduction in participants‘ symptoms and functional impairments, and that the effects persisted for 12 months after the end of the treatment, indicates that the internet can be of great clinical benefit as a treatment format for people with fibromyalgia,“ says Maria Hedman-Lagerlöf. „These are good news because it means that more people have access to treatment.“
According to the researchers, the study is the second largest to compare different psychological treatment options for fibromyalgia.
„Our study is also one of the first to compare with another active, established psychological treatment,“ says Maria Hedman-Lagerlöf.
The study was a collaboration between the Karolinska Institutet and Uppsala University. It was funded by the Tercentenary Foundation of the Bank of Sweden, and none of the researchers reported any conflicts of interest.
Hedman-Lagerlöf, M., et al. (2022). Effect of exposure-based vs. traditional cognitive behavioral therapy in fibromyalgia: a single-blinded, randomized, controlled trial at two sites. PAIN. doi.org/10.1097/j.pain.0000000000003128.