Cognitive-behavioral and operant-behavioral therapy for people with fibromyalgia.

The current article reviews the cognitive-behavioral (CB) and operant-behavioral perspectives on chronic pain and suggests an answer to the question why changes in behaviors, attitudes, and emotions are associated with decreases in pain severity and impact discussing potential psychobiological mechanisms that may underlie cognitive and behavioral techniques. The impact of learning such as classical and operant conditioning in behaviors and physical responses including baroreflex sensitivity (BRS), as well as the influence of cognitions on pain perception and impact will be presented to explain general efficacy of cognitive-behavior therapy (CBT) and operant-behavioral therapy (OBT) in the treatment of people with fibromyalgia (FM) describing some of the limitations of published outcome studies. We discuss advances in moderation and mediation of treatment outcomes. Lastly, we will discuss the need for research that takes into account evidence-based medicine, methods that address treatment responders and non-responders, individual trajectories, how we might advance and refine CBT and OBT, and strategies related to relapse prevention, maintenance, and adherence-enhancement taking advantage of evolving, technological methods of service delivery. We provide recommendations of how to move forward in approaching studies of CBT and OBT efficacy as a function of better understanding of patient characteristics and contextual factors. We advocate for the potential of the CB perspective and principle of learning for all health care providers regardless of discipline or training and will give examples for making more effective the patient-rheumatologist-relationship by using the principles discussed.