Cognitive Therapy Basics

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?

Fibromyalgia syndrome (FMS) is the medical terminology used to represent a complex clinical disorder of symptoms characterized by soft tissue pain, stiffness, and altered deep pain threshold with psychological fallout.  It can mimic or accompany symptoms of joint injury, but it is not an arthritic or neurological condition.  The disorder affects between 3 to 6 million people – or as many as one in 50 Americans.  About 80 and 90 percent of those diagnosed with fibromyalgia are women. 

There is usually an emotional overlay of depression and anxiety that affects the sufferer.  There are numerous reasons why this is true.  Many within the medical community have discounted fibromyalgia as a bona fide disease.  Patients have been told that they are over-dramatizing their pain and that the stiffness or soreness has been psychologically induced.  Others have been told that the condition was fabricated for attention or perceived by health providers as feigned helplessness.  These assertions from medical experts make patients with FMS feel ignored, mistrusted, alone and without support.  Patients often turn to self-blame, which fuels the pain cycle.The pain and symptoms of fibromyalgia are real and have a definite physical basis. There is no known cause for fibromyalgia.  Some researchers have speculated that physical trauma or viral influences have triggered FMS syndrome in many patients.  There are no known abnormalities in the muscle tissue of fibromyalgia patients that would account for the disease.

Current research has focused on regions of the FMS patient’s brain and the susceptibility of certain brain locations to pain sensitivity.  The brain receives a pain signal from the muscles and stays in a state of alert.  For unknown reasons, the brain fails to let go of the pain signal and sets up a chronic pattern or pain syndrome.  The brain stays in a constant feedback loop, consisting of a system of amplified pain signals.

Recent brain scan research studies have shed new light on this disorder.  Results published in the May 2008 edition of the Journal of American College of Rheumatology shows that neuroscientists have been able to conduct scanning technology to areas of the brain affected by fibromyalgia.  Mild pressure on trigger points of the patient has produced measurable brain response in processing the sensation of pain.  The elevated response of pain in FMS patient’s brain scans was significantly different from those in the control group of the study.  This is one of several studies that validate the reality of fibromyalgia as a disorder affecting the brain’s response to muscular and neuropathic pain.  Hopefully, future studies will lead to new treatment options.

Currently, treatment options consist of the use of a multidisciplinary approach.  Medication management, physical therapy, meditation, exercise, alternative therapies, and cognitive-behavioral therapy are useful.  CBT is a valuable therapeutic treatment option for those suffering from pain syndromes.  One of the byproducts of pain can be the escalation of anxiety and depression.  Likewise, anxiety and depression can intensify the impact of pain and make it more debilitating.

Cognitive-behavioral therapy’s goal is to teach the FMS patient to embrace pain rather than fight it.  Cognitive distortions, such as magnification and “catastrophizing” need to be addressed so that patients learn to de-escalate fueling the pain process.  How one thinks about his pain affects its impact.  One can learn to rationally respond to pain by sayin

Cognitive-behavioral therapy can assist the fibromyalgia patient to identify stressful triggers that exacerbate pain.  This may involve examining family struggles, exploring inner-conflict, and working with core, self-defeating assumptions that affect thinking and behavior.  Teaching the patient mindfulness meditation as a way of relaxing the sympathetic nervous system is beneficial.

Through the use of CBT, a therapist can provide the fibromyalgia patient with structured homework assignments that will help pain sufferers to experiment with new behaviors such as increased involvement and activities.  Motivating the client to set realistic goals for everyday functioning can be helpful.  Encouraging a multidisciplinary approach involving exercise, physical therapy, rehabilitation and pain management are essential.

Fibromyalgia patients fear that their disorder will cause them to lose the ability to function at work and at home.  Teaching patients to focus on what they can do rather than their limitations is important.  There is a tendency for fibromyalgia patients to distort reality by focusing on negative perceptions to the exclusion of the positive.  Helping the patient and family to accept physical limitations is a necessary component to successful treatment.

Fibromyalgia patients can easily get enmeshed in a cycle of pain and associated emotional symptoms.  It is the goal of cognitive-behavioral therapy to assist the patient in coming to terms with his disorder and making plans to manage it.  This is accomplished through acceptance and teaching the patient positive ways of thinking about his condition and multiple ways of treating it.