Behavioral Modification Therapy

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Behavioral modification therapy, or behavior therapy, involves the use of techniques that promote positive behaviors and decrease negative behaviors through a systematic process of positive and negative feedback. Behavioral modification essentially works to change the way individuals respond mentally and/or physically to a particular event. It can be used in a wide variety of situations, from treating drug or alcohol addiction to promoting the completion of everyday tasks, such as brushing one’s teeth. Due to the persistent pain, stiffness, fatigue, and sleep difficulties many fibromyalgia patients face, behavior modification can be a useful component of a comprehensive fibromyalgia treatment plan.

Bennett et al., (1996) demonstrated the usefulness of behavior modification when incorporated into a group treatment outpatient program for fibromyalgia patients. The program consisted of once-weekly group therapy sessions, approximately 90 minutes in duration, over a six month period. Therapy sessions consisted of formal lectures, emphasized behavior modification techniques, stress reduction techniques, and provided participants with strategies to increase and improve their physical fitness. Support sessions were also provided for spouses and significant others. After conclusion of the six month program, patients were followed for a two year period and compared to other fibromyalgia patients who did not participate in the program. At the end of the six months of treatment, 70% of patients (73) demonstrated reduced numbers of tender points and an overall functional improvement of 25%. Thirty-three patients completed the two year follow-up and continued to show improvement in both tender points and overall functioning. Although the benefits observed in this study cannot be directly related to the behavioral modification techniques that were taught in the sessions, since they were combined with other therapeutic approaches, this study nevertheless offers support for the use of behavior modification as an important component to the successful management of fibromyalgia-related symptoms (Bennett et al., 1996).

Behavior modification has also been demonstrated to have a beneficial effect on several symptoms experienced by fibromyalgia patients, including sleep disturbances. Non-restorative and disturbed sleep is a hallmark symptom of fibromyalgia. A number of behavior therapies are useful at making the sleeping environment more conducive to restful sleep. Sleep hygiene is a term used to describe a group of behaviors and practices that can promote good sleep. These may include: maintaining regular sleep/wake patterns; spending only an appropriate amount of time in bed; avoiding napping (which can disrupt normal sleep/wake patterns); avoiding large meals and stimulants such as caffeine and nicotine immediately prior to bedtime; obtaining adequate amounts of exposure to natural light; having a regular and relaxing bedtime routine; and sleeping in a temperately comfortable bedroom free from extraneous distractions (such as household noises or television). In addition to sleep hygiene, behaviors that promote relaxation (such as progressive muscle relaxation and breathing exercises) can also be useful. In addition to sleep hygiene, another form of behavior modification has also demonstrated to result in significant improvements in sleep quality among fibromyalgia patients.

Cognitive behavioral therapy (CBT) combines behavioral therapy with cognitive therapy, which focuses on an individual’s thoughts and beliefs and how they influence that person’s moods and actions. CBT has repeatedly been shown to not only improve sleep among fibromyalgia patients, but also to help improve pain, anxiety, depression, and overall functioning (Edinger et al., 2005; Miro et al., 2011; Woolfolk et al., 2012).

Exercise can also help to promote sleep, as well as help improve the pain, stiffness, fatigue, and depression commonly associated with fibromyalgia (Busch et al., 2009; Hauser et al., 2010). Unfortunately, however, adopting and maintaining a regular exercise routine can be difficult due to the constant pain and fatigue associated with fibromyalgia. Furthermore, exercise may temporarily increase levels of pain and stiffness while the body adjusts to the increased frequency of movement. Fortunately, behavioral modifications can help to promote and sustain the adoption of a regular exercise regimen. Simple behaviors like setting attainable goals can be important first steps. For example, a fibromyalgia patient who has never exercised should likely not start out planning to walk five miles every day. Attainment of such an ambitious goal is likely going to be hindered by a low level of physical conditioning, as well as the physical limitations brought on by the fibromyalgia itself. Rather, such an individual might consider walking to the end of her street every day for the first week, then gradually increasing the length of her walks by an extra block or two every other day. Over time, the distance walked will hopefully increase, as will physical conditioning. To reinforce the positive behavior, the individual might reward herself with a dinner out with friends or a shopping trip each time a new distance is achieved. Another behavior that can promote and sustain physical exercise regimens is to exercise with a partner. The positive influences of social interaction and encouragement can provide the necessary feedback, both positive and negative, to help sustain the behavior.

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References

1.        Bennett RM, Burckhardt CS, Clark SR, O’Reilly CA, Wiens AN, Campbell SM. Group treatment of fibromyalgia: a 6 month outpatient program. J Rheumatol. 1996;23(3):521-528.

2.        Sleep Hygiene. The National Sleep Foundation.  Spring 2003; Accessed April 25, 2012.

3.        Insomnia. Treatments and drugs.  Mayo Clinic. January 7, 2011; Accessed April 25, 2012.

4.        Psychotherapies. National Institute of Mental Health.Accessed April 25, 2012.

5.        Edinger JD, Wohlgemuth WK, Krystal AD, Rice JR. Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial. Arch Intern Med. 2005;165(21):2527-2535.

6.        Miró E, Lupiáñez J, Martínez MP, Sánchez AI, Díaz-Piedra C, Guzmán MA, Buela-Casal G.

Cognitive-behavioral therapy for insomnia improves attentional function in fibromyalgia syndrome: a pilot, randomized controlled trial. J Health Psychol. 2011 Jul;16(5):770-782.

7.        Busch AJ, Overend TJ, Schachter CL. Fibromyalgia treatment: the role of exercise and physical activity. Int J Clin Rheumtol. 2009;4:343–380.

8.        Hauser W, Klose P, Langhorst J, et al. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther. 2010;12:R79.

Woolfolk RL, Allen LA, Apter JT. Affective-cognitive behavioral therapy for fibromyalgia: a randomized controlled trial. Pain Res Treat. 2012;Article ID 937873, 6 pages. doi:10.1155/2012/937873

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