Tailored cognitive-behavioral therapy for fibromyalgia: Two case studies

• Published in: Patient education and counseling 2008-05, Vol.71 (2), p.308-314
• Main Authors: van Koulil, S, van Lankveld, W, Kraaimaat, F.W, van Helmond, T, Vedder, A, van Hoorn, H, Cats, H, van Riel, P.L.C.M, Evers, A.W.M
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adaptation, Psychological; Adult; Attitude to Health; Avoidance behaviour; Avoidance Learning; Cognitive behaviour therapy; Cognitive Therapy - organization & administration; Cognitive-behavioral therapy; Fatigue - etiology; Fear; Feasibility Studies; Female; Fibromyalgia; Fibromyalgia - complications; Fibromyalgia - diagnosis; Fibromyalgia - prevention & control; Fibromyalgia - psychology; Follow-Up Studies; Group therapy; Health Behavior; Humans; Internal Medicine; Middle Aged; Needs Assessment; Nursing; Pain; Pain avoidance; Pain Measurement; Pain persistence; Patient care; Patient Care Planning - organization & administration; Patient Care Team - organization & administration; Self Care - methods; Self Care - psychology; Stress, Psychological - etiology; Tailored therapy; Treatment Outcome
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2007.11.025

Abstract Objective To illustrate a multidisciplinary group treatment for patients with fibromyalgia (FM) tailored to the patient's cognitive-behavioral pattern. Method In a case-study design the tailored treatment approaches of two FM patients were described. One patient characterized by avoidance behavior (pain-avoidance pattern) participated in a group treatment aimed at changing pain-avoidance mechanisms and one patient characterized by continuing with activities in spite of pain (pain-persistence pattern) participated in a group treatment aimed at changing pain-persistence mechanisms. Assessments were made at baseline, post-treatment and at 6-months follow-up. Results Comparison of the pretest, post-test and follow-up scores on pain, functional disability, fatigue and psychological distress showed clinically significant improvements for both patients. Conclusion The heterogeneity of patients regarding pain-related cognitive-behavioral mechanisms has been proposed to underlie varying treatment outcomes in FM patients. These results demonstrate that a group treatment tailored to pain-avoidance and pain-persistence patterns is feasible and can result in clinically significant changes for FM patients. Practice implications FM offers a great challenge for clinicians due to the lack of effective treatment options. These case studies suggests that tailored CBT and exercise training directed at specific patient patterns can contribute to the improvement of the care of FM patients.