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Cognitive Behavior Therapy for Fibromyalgia: A Meta-Analysis

15 November 2011


Fibromyalgia is a chronic illness involving widespread pain, and many related symptoms such as fatigue, mood disorders, headache, and sleep disturbance. This condition has been traditionally difficult for health care providers to treat with medications. Increasingly, treatment programs for individuals with Fibromyalgia have included psychological therapies such as Cognitive Behavioral Therapy (CBT). CBT has shown preliminary evidence to support its use in Fibromyalgia; however, there is a limited understanding of CBT in this population. This meta-analysis examined all treatment studies, which included at least one group of patients receiving CBT. Functional Status, Pain Symptoms, Depression, Anxiety and Psychological distress were used as separate outcome variables to examine the effects of CBT. A literature review was conducted using Medline, PsycINFO, and the Cochrane Central Register of Controlled Trials. Of the 2000 studies that were found, 29 research studies met criteria for inclusion in the study. This resulted in 1220 participants and 167 effect sizes that could be examined. Effect sizes were corrected using Hedge’s correction for small sample bias aggregated at the study level and the dependent variable level (function, pain, depression, anxiety and psychological distress). All dependent variables in this analysis were significant and at least a medium effect size: Function d=0.65 (95%CI 0.30 – 0.99), Pain Symptoms d=0.85 (95%CI 0.53 – 1.17), Depression d=0.69 (95%CI 0.34 – 1.04), Anxiety d=0.66 (95%CI 0.22 – 1.10), Psychological Distress d=0.76 (95%CI 0.37 – 1.14). Factors that increased effect sizes across outcomes were the number of sessions and the use of a multidisciplinary therapy. In summary, the evidence supporting the use of CBT to treat individuals with Fibromyalgia to improve functioning, decrease pain, depression symptoms, anxiety symptoms and psychological distress is strong.


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