Online cognitive behavioral therapy for fibromyalgia shows promise

Researchers at Karolinska Institutet have developed an online cognitive behavioral therapy (CBT) program for the difficult-to-treat pain syndrome fibromyalgia. In her doctoral thesis, Maria Hedman-Lagerlöf shows that patients who receive the treatment experience fewer symptoms and enjoy better quality of life.

"Many doctors feel frustrated and at a loss when meeting a patient with fibromyalgia as there is currently no effective treatment, but now things might be looking up," says licensed psychologist Maria Hedman-Lagerlöf, doctoral student at the Department of Clinical Neuroscience, Karolinska Institutet.

Some 200,000 people in Sweden live with fibromyalgia, a chronic pain syndrome that often causes considerable suffering in the form of diffuse muscle and joint pain, fatigue and stiffness. Many sufferers also develop insomnia, memory and concentration difficulties, gastrointestinal problems, headaches, depression and anxiety. The cause of fibromyalgia is uncertain.

Less occupied with pain signals

For her thesis, Maria Hedman-Lagerlöf assayed an online CBT program for the condition that she has developed with her colleagues at Karolinska Institutet. The therapy is designed to counteract the brain's learned over-awareness of the body. The patients are encouraged to do things that they avoid doing on account of their fibromyalgia and to practice holding onto their experience of pain and discomfort without becoming distracted.

"The brain gradually learns that these unpleasant signals aren't dangerous and so stops interpreting them as important," explains Hedman-Lagerlöf. "When you become less occupied with the pain signals you don't feel as impeded by them, which tends to mitigate the pain and other symptoms."

In one of the constituent studies, people with fibromyalgia were randomly assigned either to a course of online CBT or to a waiting list. After ten weeks' treatment, the study group had markedly fewer symptoms and felt less obstructed by their condition than the control group. They also experienced improved functionality and quality of life, with less fatigue, anxiety and depression.

Cost-effective treatment

A health-economy analysis showed that the treatment is cost-effective, which is partly to do with it being online. Apart from the reduction in symptoms and discomfort, the participants also spent less time in healthcare, with the savings to society this entails.

"The next step is to compare our therapy with a different kind of psychological treatment," says Maria Hedman-Lagerlöf. "If it proves more effective it wouldn't take long for it to be implemented by the health services, where it can benefit the lives of many patients."