Cognitive Therapy Basics

Biofeedback studies have shown that Fibromyalgia patients who received treatments had fewer tender points, lower pain intensity and morning stiffness.  Biofeedback is a technique in which patients are trained to improve their health by learning to control certain internal bodily processes such as muscle tension causing pain, blood pressure, or anxiety.  It is a basic way of learning self-control tools that will be used throughout life. Recent biofeedback developments now provide a tool for improving functioning of the central nervous system.

Biofeedback is non-invasive and painless. It can expose the sources of physical pain, like headache or back pain, and gives us the information we need to reduce or eliminate the pain. It can help people with Fibromyalgia and Chronic Fatigue by eliminating pain and improving energy.

The most frequently used types of biofeedback therapy:  Electromyography (EMG) – measures muscle tension, Thermal biofeedback – measures skin temperature, and Neurofeedback or electroencephalography (EEG) – measures brain wave activity.

During a biofeedback session electrodes are attached to the skin. The electrodes feed information into devices that measure one’s internal involuntary responses.  The patient is then given mental exercises by the practitioner. This allows the mental activities that cause the physiologic responses to be identified, which make it possible to teach the patient how to gain control over them.  When a person has learned how to control his/her symptoms, the feedback displays the positive changes.

Biofeedback has been proven to be an effective therapy for many conditions.  It is primarily used to treat high blood pressure, chronic pain, tension headache, migraine headache, and urinary incontinence.  Studies have shown that most patients who respond best from biofeedback have conditions that are brought on by or made worse by stress.  This would imply that relaxation is the most important factor for success.

The FM treatment using electro-encephalogram (EEG) is based on the research of Mary Lee Esty, Ph.D.; Stuart Donaldson, Ph.D.; and Len Ochs, Ph.D. Technology is used to detect and treat brain dysfunction that has been caused by a mild traumatic brain injury such as in an automobile accident. Patients first have a brain mapping performed to identify areas of the brain which have been injured and are functioning abnormally in terms of brain-wave activity. Electrical activity produced by the brain reflects a person’s level of functioning and can be monitored by EEG. A condition known as “EEG slowing” is present in people who have suffered damage to the brain and nervous system as a result of trauma and go on to develop Fibromyalgia or other chronic conditions.

The Flexyx Neurotherapy System (FNS) is both a brainwave biofeedback and treatment system, as well as an evaluation system. It is for patients with central nervous system dysfunctions, cognitive dysfunction (memory, etc.), mood disorders, low energy, movement difficulties, trouble with balance, and pain problems.  FNS is an advanced form of biofeedback which, returns a feedback signal to the patient connected to the EEG. This form of EEG uses electrodes connected to the skin.  Researchers have found that FM patients concentrate better when they close their eyes, which lessens sensory stimulation.

Flexyx Neurofeedback System is also non-invasive and painless.  The patient sits in a comfortable chair and wears dark glasses that generate feedback. The patient need only relax.  The treatment measures brain waves, and directs the brain waves back to the person as a reflection (mirrored).  FNS resets the natural, self-regulation skills we are unaware of in our brain and nervous system so they can function normally.  This makes it possible to implement the best treatment plan.

After the treatments are completed, surface Electromyography (sEMG) therapy is usually conducted to help retrain muscles, and Myofascial Release Therapy is used to restore proper muscle balance, obtain optimum posture, and address other neuromuscular problems.  There may be other treatment options discussed and utilized depending on the findings and your therapist.

The hope is to help chronic pain sufferers develop greater awareness and deliberate control over the physiological processes that are outside conscious awareness.

Occupational Therapy (OT), helps people regain, develop and build skills that are important for independent living, health and happiness.  Fibromyalgia sufferers can experience physical, emotional, or other challenges that prevent them from living the life they once led.  Chronic pain and depression can make it difficult for FM patients to do everyday tasks or be as active and as independent as they’d like.  If you have trouble performing daily activities because of these limitations OT may be able to help you.

Most FM patients find there are certain things they do on a daily basis that seem to make their pain worse. These activities frequently involve the repetitive use of muscles or continued tensing of a muscle, such as the muscles of the upper back while looking at a computer screen. You need to note these associations and determine how you can modify or eliminate them. That’s where occupational therapy can help. OT is designed to help Fibromyalgia Syndrome and other chronic pain patients regain the independent lifestyle they once knew before the onset of their illness.  Occupational therapists are trained in both physical and psychiatric rehabilitation.

An occupational therapy program is customized for the patient by combining an evaluation of medical history, environmental issues and personal goals.  Therapy includes solutions for pain due to repetitive movements in the work place or elsewhere.  Job modifications, changes in ergonomics, and a reduction in work hours may be necessary.  Sometimes an occupational therapist can work with the patient’s employer or supervisors, educating them about FM and discussing contributing factors in the workplace.  You might be taught to conserve your energy, use appropriate splints if needed, and minimize tissue trauma.

Occupational therapy should help you maximize function through strengthening activities, retraining cognitive and visual-perceptual skills and helping prevent misalignment of the vertebrae.  If you have had a back injury, ergonomics encourages the use of proper equipment and lifting techniques.  For muscle pain, the proper positioning of body and equipment can help prevent everything from mild soreness to serious tears and strains.  For eyestrain, headache and fatigue, you might need adjustments in lighting, noise levels, posture and work positions can help relieve physical and mental stress.

An occupational therapist can help you identify what aspects of the way you carry out your daily routine is helping or hindering your healing.  Patients are also taught stress management, how to assert themselves, time management, and planning/pacing skills, in order to help to reduce stress, anxiety, and fatigue.  Occupational therapy can help you discover what job or home activities could be increasing your neck, back, or arm pain.  Your therapist can watch you at work and make specific recommendations for reducing the strain on your body and provide specific therapy and exercises to help improve range of motion and reduce pain.

Here are a few tips to optimize your workspace for comfort:  Allow enough leg room under your workstation and use a document holder so that your documents are at the same height and distance as your computer screen.  Your feet should be flat on the floor, your knees should be level with your hips, and good lower back support is a must. Avoid positions in which your body is twisted.  Sit about an arm’s length away from your screen and tilt the screen back a little.  Your arms should rest at your sides with your elbows at a right angle and your wrists need to be straight.  Cushioned grips and ergonomically-designed tools to reduce vibration, pressure and relieve stress are beneficial and something as simple as a pillow behind your lower back or a stool to raise your feet can provide relief.

Posture or movement training is often required for FM sufferers to undo lifelong bad habits which can cause or increase pain and to re-educate muscles and joints that have become misaligned.  The muscles in the back of your neck, between your shoulder blades and your upper and mid back experience chronic tension. Stretches and strengthening are crucial.  Lumbar (lower & mid back) support is even more so.  Fibromyalgia patients who have significant problems with foot pain resulting from poor posture or body mechanics may also benefit from special shoe inserts (orthotics) prescribed by a podiatrist.

If there are techniques we can use to better our quality of life by lessening our pain, why not do it?  We need to take advantage of every opportunity to make our lives better!  If we don’t, who will?

Cognitive-Behavioral Therapy (CBT) is often used to teach Fibromyalgia and other chronic pain sufferers how to cope with their illnesses.  It is said to help treat many conditions and diseases like FM, back pain, rheumatoid arthritis and cancer.  It helps determine how well a patient manages their pain and teaches them how to take control of it.  Depression plays a key role in the inability to be proactive in our treatment.  So, our state of mind is very important when it comes to getting better.

Studies show that when FM patients effectively deal with the particular symptoms and over-lapping conditions of their illness and of their lives, they feel better. Cognitive-behavioral therapy (CBT) increases a patients’ belief in their own power to cope with the things they face and helps them develop ways for dealing with depression and stressful situations.

The goal of CBT is to make patients aware of self-defeating behaviors and emotions so that they can be changed consciously. Healthy, positive thoughts and emotions supersede the negative, resulting in a powerful influence on your life and lessening your pain.  Over time, the idea that you are helpless against the pain goes away and, instead, you learn that you can manage the pain.  Many studies show an improved quality of life and overall reduction in average pain scores.

Cognitive behavioral therapy has shown to be as beneficial as anti-depressant medications for patients with depression.  In one large study there were considerably higher results of reaction and remission from depression when cognitive behavior therapy was used in addition to anti-depressant medications than when either method was used alone.  CBT is used to change the patients negative feelings and social withdrawal.

Cognitive therapy is very helpful in defining and setting limits (something I know I have a problem with) and is vitally important for FM patients. Many “Fibromytes” live their lives in extremes. We push ourselves too far and suddenly we break-down. This reverses the way we view ourselves, we become demoralized, feel worthless, and give up our power to cope with the simplest tasks. One important goal of cognitive therapy is to help us find a middle ground. Patients learn to prioritize their responsibilities, and drop some of the less important tasks or delegate them to others. My biggest problem is just saying “NO”.  I want to please everyone and prove to them and myself that I can do whatever is asked of me.  When I reach my limits and cannot complete a task, I tend to go through a period of self-loathing.  Learning to say “NO” and other coping skills can ultimately lead to a more manageable life. We can learn to view ourselves and others in a better light.

CBT is also a useful treatment for anxiety disorders, including phobias, panic attacks, and obsessive-compulsive disorders. In CBT, patients learn to be aware of and change negative thinking patterns. It is a way to gain conscious control over unwanted thoughts or feelings which are, as a rule, connected to anxiety.  Those of us who suffer from panic attacks learn our bodies’ negative responses and actions during an attack and CBT helps us find ways to counteract the reason for the attacks.  CBT can also help improve quality of sleep so we can hopefully reduce some of our medications.

Cognitive therapy requires approximately six to twenty sessions that last one hour.  The cognitive therapy program may involve keeping a diary to look at all aspects of your daily activities, coping skills and mind-set.  This helps you learn what changes need to be made, limits that need to be set and a way to organize and prioritize activities.  Many of these things contribute to stress and can make your pain better or worse.  Setting limits keeps us from getting discouraged and helps us learn to take each task one step at a time.  CBT also helps us confront negative thoughts and emotions and we are taught how to reverse them.  It all boils down to self-perception:  self-loathing, worthlessness, helplessness, hopelessness, negative self-talk, believing that other people view us the same way.  CBT helps us reverse those thought processes so we can pick ourselves up and keep going.  Patients will learn to find things we once enjoyed doing and make the time to do them with the help of learning how to schedule activities without being overwhelmed.

As we know accomplishing too much too soon can often cause a relapse of symptoms. We should respect these relapses and slow down. We should not consider them a sign of failure.  That’s just how Fibromyalgia works. Don’t be so hard on yourself!