Online CBT for fibromyalgia shows promise
Researchers at Karolinska Institutet have developed an online Cognitive Behavioural Therapy (CBT) programme 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, gastro-intestinal 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 programme 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 practise 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.”
The studies included in the thesis were financed with support from the Söderström-König Foundation, Fredrik and Ingrid Thuring Foundation, Region Stockholm and Karolinska Institutet.
Maria Hedman-Lagerlöf will be defending her thesis “Getting close with discomfort: exposure therapy for fibromyalgia” at Karolinska Institutet on 6 December 2019.
Online CBT
Many studies have shown that CBT (Cognitive Behavioural Therapy) is efficacious for many different physiological problems, such as tinnitus, IBS and chronic pain. However, there are too few trained CBT psychologists, especially in Sweden’s remoter areas, which means that most patients have no access to the therapy. One way of solving this is to provide CBT via the Internet, giving the patients access to the same treatment as normal CBT, only via a secure internet platform and a messaging system for maintaining contact with a psychologist throughout the treatment. In recent years, numerous studies have shown that online CBT is just as effective as traditional CBT for many physical and psychological problems.