Efficacy, acceptability and safety of internet-delivered psychological therapies for fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials
Abstract
This systematic review aimed at evaluating the efficacy, acceptability and safety of Internet-based psychological therapies (IPTs) in fibromyalgia syndrome (FMS). Clinicaltrials.gov, Cochrane Library, MEDLINE, PsycINFO and SCOPUS were searched from inception to January 2018. Randomized controlled trials (RCTs) comparing IPTs with controls were analysed. Primary outcomes were ≥50% pain relief, disability, negative mood, acceptability and safety at end of therapy and at 6-month follow up. Effects were summarized by a random effects model using risk differences (RD) or standardized mean differences (SMD) with 95% confidence intervals (CI). Six RCTs using different types of Internet-based cognitive-behavioural therapies [ICBTs] (acceptance-based; exposure-based; traditional) with 493 patients were included. At the end of treatment, ICBTs were superior to controls (waiting list, attention control, treatment as usual) in reducing negative mood (SMD -0.51 [95% CI -0.87 to -0.15]) (moderate quality evidence) and disability (SMD -0.56 [95% CI -1.00 to -0.13]) (moderate quality evidence). There were no statistically significant differences between ICBTs and controls in pain relief of 50% or greater (RD 0.09 [95% CI -0.02 to 0.20] (moderate quality evidence) and acceptability (moderate quality evidence). No data on safety and any outcomes at long-term follow-up compared to controls were found. The data available did not allow statistical comparisons between unguided and guided ICBTs and of ICBTs versus traditional face-to-face therapies. ICBTs provided a clinically relevant benefit over control interventions in reducing negative mood and disability at the end of treatment. SIGNIFICANCE: Internet-delivered cognitive behavioural therapies provided a clinically relevant benefit in reducing negative mood and disability in patients with FMS at the end of treatment if compared to waiting list, treatment as usual and attention controls.
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Internet-delivered cognitive-behavioral therapy and acceptance and commitment therapy achieve significant improvements in quality of life, moderate reductions of distress, and modest reductions of pain-related symptoms in chronic conditions, including fibromyalgia.
“achieving significant improvements in quality of life, moderate reductions of distress, and modest reductions of pain-related symptoms in chronic conditions, including FM (Bernardy et al., 2019; Trindade et al., 2021; White et al., 2020).”
From Online ACT intervention for fibromyalgia: An exploratory study of feasibility and preliminary effectiveness with smartphone-delivered experiential sampling assessment (2022) · cites this paper as Bernardy et al., 2019
Online delivery can make interventions more accessible to patients e.g. in rural areas since logistic barriers such as travel or limited access to trained therapists are eliminated.
“Online delivery can make interventions more accessible to patients e.g. in rural areas since logistic barriers such as travel or limited access to trained therapists are eliminated [44].”
From Mindfulness- And acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses (2019) · cites this paper as [44]
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Jammet, L. F., & Laroche, F. (2021) · In Press eBooks · doi:10.3917/pres.laroc.2021.01.0225
Douleur chronique et thérapies comportementales et cognitives (TCC)
Laroche, F. (2021) · In Press eBooks · doi:10.3917/pres.laroc.2021.01.0097
Neuman, D. L., York, A., Gebre, M., Black, L. L., & Chadwick, A. L. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-45863-7.00099-8
Adler, L., Meyer, B., Betz, L. T., Häuser, W., & Knitza, J. (2026) · doi:10.2196/preprints.107347
- Authors
- Bernardy, K., Klose, P., Welsch, P., & Häuser, W.
- Affiliations
- BG University Hospital Bergmannsheil Bochum (DE)
- Kliniken Essen-Mitte (DE)
- Klinikum Saarbrücken (DE)
- Corresponding author
- Häuser, W.
- ORCID
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2018-08-06
- Volume
- 23
- Issue
- 1
- Pages
- 3-14
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W2869100357
- Cited by
- 50
- References
- 45
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 15 · 2022: 7 · 2021: 9 · 2020: 7 · 2019: 4 · 2018: 2
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-07-15)
- Open access
- closed
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- fibromyalgia, internet-based cognitive behavioral therapy, analgesia, disability, negative mood, treatment acceptability, treatment safety, acceptance-based therapy, exposure therapy
- MeSH terms
- Affect, Fibromyalgia, Humans, Patient Acceptance of Health Care, Waiting Lists, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Internet, Pain Management
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