Symptom Management Tools
tients can unwittingly fall into the
logic that if, as the research shows,
people who apply principles of CBT
do better with symptoms of FM,
then it must be, at least in part, a
psychological and behavioral condition. This flawed thinking mixes apples and oranges – it blurs together
“causation” with “treatment,” an important distinction for a condition
as complex as FM. In actuality, CBT
does not offer a position on causation of any health condition.
A CAVEAT FOR FM
While the principles of CBT are good and
helpful when implemented, there is a caveat. One of the common challenges for
people with FM is that the illness itself
compromises one’s ability to concentrate and tolerate stress. This matters
because CBT asks people to exert some
effort and concentration to change their
thinking or behavior patterns.
Change--even positive change--is a
source of stress, in that it requires ad-
aptation and adjustment in how one
is living one’s life. In other words, even
change for the better poses additional
demands on coping, for a time, at least,
in the lives of people who are already
heavily burdened.
People with FM who want to explore strategies of CBT need to be
careful to approach it with a gentle, non-driven, non-perfectionist
attitude. Otherwise, new patterns
that call for added concentration or
initiative, like following a schedule,
could be more difficult to implement and lead to disappointment.
ELEMENTS OF CBT IN FM
CBT is actually a relatively simple approach to wellness in FM. It focuses
on three key elements: education,
learning of specific skills, and applying them in your daily life situation.
EDUCATION. In terms of
education, it is important to
understand FM’s possible causes
Winter 2014
(e.g., some shock or trauma to the
neurological system), factors that
maintain or exacerbate it (e.g.,
chronic or acute stress, over-activity), and why it is important to
be pro-active about self-care (e.g.,
the neuro-physiological effects of
relaxation practices). This is information that can be learned and
will affect one’s attitudes and willingness to take pro-active steps.
SKILLS. As for skills, there are
learnable cognitive and behavioral skills that will lead to improved
well-being. One of the most important behavioral strategies to learn
for management of pain is the relaxation response. This is a body-wide
physiological state that includes reduced
neurological arousal, reduced tension,
reduced stress hormones in the blood,
and increased quiescence and peace.
Importantly for FM, repeated practice will train the body to adopt
these more healing conditions and
reduce pain and other symptoms
Fibromyalgia & Chronic Pain
Life 27