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Cognitive Therapy - How It Helps 

Carol Burckhardt Ph.D



All comprehensive fibromyalgia (FM) treatment programs include non-drug components such as cognitive-behavioral treatment.  This broad treatment area emphasizes the relationship between thoughts, beliefs, emotions and behavior.  In fact, it assumes that thoughts are powerful determiners of how we feel and behave and that altering maladaptive thought patterns will result in desirable behavior changes.  Cognitive strategies include education in recognizing thought patterns that are maladaptive along with learning and practice of specific techniques for decreasing distress, pain, fatigue, and anxiety.   Cognitive therapy contains 4 components: 

(1) coping skills training
(2) self-control training
(3) problem-solving skills training
(4) cognitive restructuring methods 

Although I have found that most people with FM already engage in a number of  positive coping strategies, are ready to learn relaxation strategies and able to develop better ways to solve problems, when approaching the area of cognitive restructuring  some people respond skeptically. “Oh, here we go again!  Just thinking positively doesn’t take my symptoms away.”  “If  I change the way I think about my pain and  my pain decreases, people (my family, my work colleagues, my doctor) are going to believe that fibromyalgia is ‘all in my head.’”  “What am I supposed to do, try to fool myself into believing that things are different?”  Let’s explore cognitive restructuring with the goal of understanding better what it is and what it isn’t and what its potential is for helping people with FM manage their symptoms better.

Have you ever worried about anything?  Have you ever felt your body relax when someone said a kind word to you?  If so, you have experienced the intimate connection between thoughts and feelings.  Think about it, when you worry your body responds with sensations of anxiety (knots in your stomach, increased heart rate, sweaty palms, insomnia).  Yet, the negative things you are worrying about aren’t actually happening at the time that you are worrying.  They are happening only in your thoughts.  On the positive side, if someone says, “I’m really sorry that you are in so much pain,”  or, “I want to help in any way I can,” you may feel your muscles relax, your stomach stop churning,  and your breathing become less shallow.  Again, these body reactions happen even though the helper only said something to you.  She didn’t massage your muscles, give you a Zantac or even tell you to breathe deeply.  If you want to try out this connection in a simple way, think about eating a lemon or savoring a piece of Godiva chocolate and see what happens. Bet you start to salivate.  What I’m trying to convince you of is that a very powerful connection exists between how you think, how you perceive messages from yourself and others, and how you feel both emotionally and physically.     

These ongoing thoughts are the little voice in your head that babbles to you all the time.  Sometimes people I see in counseling aren’t aware that they are constantly engaged in a running automatic dialog.  If that seems to be the case, I ask them to spend the next week listening to themselves.  Invariably, they come back with all sorts of tales that their conscious mind has been telling them.  This cognitive part is always actively evaluating, rationalizing, scheming, analyzing and distorting reality at times.   Have you ever said something and then wondered, “Why did I say that?” followed by, “That was a dumb thing to say.”  Or maybe your neighbor brought over a plate of freshly baked cookies.  You smiled, thanked her and felt both a little happy and a little sad.  Then you realized that your thoughts were centering around, “She probably thinks I can’t cook.  I look like such a mess and my house is a disaster.  I’m just inadequate.”   

All people engage in cognitive distortions from time to time.  Some very common negative thoughts that people with FM have include:

               “Why me?” Life isn’t fair.” 
               “My pain will never get better.”
               “I shouldn’t ask for help.”
               “No one understands me.”

What cognitive restructuring focuses on is helping you to identify the long-standing patterns of automatic thinking associated with unhappiness, anxiety, depression, and physical symptoms.  Once these patterns are identified, you can decide if you wish to change them.   In other words, cognitive restructuring is an active, individual process that you control.  A good therapist serves as a guide to the process, often asking questions such as, “Can you think of an alternative way to view this situation?” “Is believing that you are worthless helpful to you?”  “Is your pain always this bad?”  “Who told you that you should .................... ?”   Sometimes she/he might suggest a different label like, “Instead of seeing yourself as a martyr, maybe you could think of yourself as a nurturer.”  “Maybe instead of telling yourself that you should do something, you could ask yourself if you want to do it.”  These questions and suggestions are meant to help you reframe or restructure your thoughts into more realistic and helpful thoughts.  As these new thoughts and belief become more a part of you, they won’t feel foreign or feigned.  For example,  reframing the belief that life isn’t fair into, “perhaps that is true, but believing and telling myself that doesn’t help me feel any better;  instead I will tell myself that living my life to the fullest is more important than being frustrated about whether it is fair,” is likely to change your emotional state from one of depression and anger to one of peace and  joy.  As the ancient writer of Proverbs said, “ A depressed spirit saps one’s strength but a happy mind is good medicine.(17:22) ”       

Recently one of my patients, an attorney, described reading a legal document in which the writer had delimited a period of time not with the usual words “grace period” but with the phrase, “days of grace.” We began conversing about the lyrical quality of that phrase when compared to the more familiar term so fraught with images of deadlines and escalating interest.  Suddenly, I found myself flashing back to the breakfast table of my childhood and my father, in his morning prayer, thanking God for the “night of rest and for this day of grace.” (At the age of 92, this is still his morning prayer.)  And I experienced what Gendlin in his book, Focusing, called the felt sense--that strong bodily sensation of meaning and connection.

Also see Dr. Bennett & Nelson's 2006 review on Cognitive Behavioral Therapy.



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