Multicomponent CBT for fibromyalgia and rheumatological pain

Domain II · Behavioural & cognitive

What it is

This is a family of manualised programmes, not one branded therapy. The programmes combine pain education, cognitive and behavioural coping skills, operant work on pain behaviour, graded activity or exercise, and involvement of the partner. They are run by a psychologist, often with a…

Format

• Formats in the sources
• Generic rheumatological-pain CBT (Div12): individual or small group, 8 to 12 sessions.

Who practises it, and how they are trained or regulated

• Thieme/Flor/Turk FM group CBT or OBT: 15 weekly 2-hour sessions in groups of five patients. Each group is co-led by an experienced psychologist and a rheumatologist, who have done a joint 2-day training. Spouses attend sessions 1, 5, 9 and 13. There is weekly homework for patients and spouses. The trial included only married women with a willing spouse.
• Skill acquisition (roughly sessions 2 to 10). Goals: relaxation; activity regulation (quota-based increase for avoiders, pacing for persisters); operant work on pain behaviour; cognitive restructuring; distraction; problem solving; assertiveness; exercise. Partner sessions are placed at intervals through this phase. Move on when each skill is practised at home at the agreed frequency and shows some effect on diary…
• Version followed: a composite with no single founder or manual. The component structure follows the APA Division 12 entry "Multi-component CBT for rheumatologic pain" (8 to 12 sessions; education, symptom self-management skills, lifestyle change and relapse prevention). For fibromyalgia (FM) it uses the manualised group CBT and operant behavioural treatment (OBT) of Thieme, Flor and Turk (2006), and the tailored CBT…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Present this as experimental.
• Plans that rely on a single skill; aim for at least three.
• Partners who push back. Rehearse responses in a partner session.
• All-or-nothing conclusions after a first flare; normalise flares in advance.
• Statements that are too positive to believe; the patient must find them credible.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.