Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome - a systematic review and metaanalysis of randomized controlled trials
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Objective.: We performed the first systematic review with metaanalysis of the efficacy of cognitive-behavioral therapies (CBT) in fibromyalgia syndrome (FM). Methods.: We screened Cochrane Library, Medline, PsychINFO, and Scopus (through June 2009) and the reference sections of original studies and systematic reviews for CBT in FM. Randomized controlled trials (RCT) comparing CBT to controls were analyzed. Primary outcomes were pain, sleep, fatigue, and health-related quality of life (HRQOL). Secondary outcomes were depressed mood, self-efficacy pain, and healthcare-seeking behavior. Effects were summarized using standardized mean differences (SMD). Results.: A total of 14 out of 27 RCT with 910 subjects with a median treatment time of 27 hours (range 6–75) over a median of 9 weeks (range 5–15) were included. CBT reduced depressed mood (SMD −0.24, 95% CI −0.40, −0.08; p = 0.004) at posttreatment. Sensitivity analyses showed that the positive effect on depressed mood could not be distinguished from some risks of bias. There was no significant effect on pain, fatigue, sleep, and HRQOL at posttreatment and at followup. There was a significant effect on self-efficacy pain posttreatment (SMD 0.85, 95% CI 0.25, 1.46; p = 0.006) and at followup (SMD 0.90, 95% CI 0.14, 1.66; p = 0.02). Operant behavioral therapy significantly reduced the number of physician visits at followup (SMD −1.57, 95% CI −2.00, −1.14; p < 0.001). Conclusion.: CBT can be considered to improve coping with pain and to reduce depressed mood and healthcare-seeking behavior in FM.
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A review of studies with FM patients (Bernardy et al. 2010) showed that the CBT approach provides a greater sense of control over symptoms.
“Similar results are mentioned in review of studies with FM patients (Bernardy et al. 2010), showing clearly that the CBT approach provides a greater sense of control over the symptoms (Clauw 2014).”
From Efficacy of Combined Cognitive-Behavioral Therapy for Insomnia and Pain in Patients with Fibromyalgia: A Randomized Controlled Trial (2018) · cites this paper as Bernardy et al. 2010
The Abstract reports that CBT significantly improved pain self-efficacy after treatment and at follow-up, supporting a greater sense of control over pain. The claim extends that finding to FM symptoms generally; the Abstract reports no significant effect on pain, fatigue, or sleep symptoms themselves. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPsychological intervention is a key component of chronic pain management, with cognitive-behavioral therapy and acceptance and commitment therapy as two of the most recommended and evidence-supported approaches.
“Psychological intervention appears as a key component of chronic pain management, with cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) as two of the most recommended and evidence-supported approaches (Bernardy et al., 2010; Hann and McCracken, 2014; Williams 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., 2010
The Summary of evidence (page unavailable) reports that CBT improved depressed mood and pain self-efficacy in fibromyalgia, supporting a limited evidence-based role. But the Implications for clinical practice (page unavailable) say CBT cannot be recommended for fibromyalgia’s key symptoms, including pain. The paper does not establish that CBT is among the most recommended approaches for chronic pain generally, and it does not assess ACT. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor CBT, the findings are similar to those in high quality reviews; for example, Bernady 2010 used Cochrane methods including GRADE in a review of psychological interventions for adults with fibromyalgia, including 29 RCTs, and this agreement extends to CBT in rheumatoid arthritis (Prothero 2018).
“For CBT, the findings are similar to those in high quality reviews. For example, Bernady 2010 used Cochrane methods including GRADE in a review of psychological interventions for adults with fibromyalgia, including 29 RCTs. This agreement extends to CBT in rheumatoid arthritis (Prothero 2018).”
From Psychological therapies for the management of chronic pain (excluding headache) in adults (2020) · cites this paper as Bernady 2010
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Experimental — accuracy not yet measuredAnother meta-analysis concluded that the efficacy of CBT in treating depression could not be distinguished without some risk of bias.
“Another meta-analysis concluded that the efficacy of CBT in treating depression could not be distinguished without some risk of bias [56].”
From Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial (2011) · cites this paper as [56]
A recent meta-analysis in which quality of life was assessed suggested that CBT is not effective for the achievement of this outcome.
“However, a recent meta-analysis in which quality of life was assessed [56] suggested that CBT is not effective for the achievement of this outcome.”
From Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial (2011) · cites this paper as [56]
EA may be implicated in the etiology of various forms of psychopathology and recovery of mental illness might be mediated through reductions in EA.
“It has been said that EA may be implicated in the etiology of various forms of psychopathology and that recovery of mental illness might be mediated through reductions in EA [5].”
From Experiential Avoidance in Primary Care Providers: Psychometric Properties of the Brazilian “Acceptance and Action Questionnaire” (AAQ-II) and Its Criterion Validity on Mood Disorder-Related Psychological Distress (2022) · cites this paper as [5]
The Abstract and Summary of evidence report CBT outcomes in fibromyalgia, including depressed mood and pain self-efficacy. Searches for experiential avoidance, psychopathology etiology, and recovery mediated by reductions in avoidance found no passage addressing the attributed claim. No page numbers were available in our copy. (LLM, conf=0.75)
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- Authors
- BERNARDY, K., FÜBER, N., KÖLLNER, V., & HÄUSER, W.
- Affiliations
- Universitätsklinikum des Saarlandes (DE)
- Corresponding author
- HÄUSER, WINFRIED
- Venue
- The Journal of Rheumatology
- Publisher
- The Journal of Rheumatology
- Published
- 2010-08-03
- Volume
- 37
- Issue
- 10
- Pages
- 1991-2005
- ISSN
- 0315-162X (ISSN-L)
- 1499-2752
- OpenAlex
- W2056292060
- Cited by
- 266
- References
- 60
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 10 · 2023: 12 · 2022: 12 · 2021: 12 · 2020: 16 · 2019: 11 · 2018: 14 · 2017: 16 · 2016: 26 · 2015: 17 · 2014: 19 · 2013: 29 · 2012: 35
- FWCI
- 3.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Rheumatology (publishedVersion)
- PubMed (publishedVersion)
- mediaTUM – the media and publications repository of the Technical University Munich (Technical University Munich) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- fibromyalgia, cognitive behavioral therapy, pain self-efficacy, depressive mood, health-seeking behavior, pain coping, health-related quality of life, fatigue, sleep
- MeSH terms
- Fibromyalgia, Humans, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Databases, Bibliographic, Treatment Outcome
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