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Cognitive behavioural therapies for fibromyalgia

  1. Kathrin Bernardy1,
  2. Petra Klose2,
  3. Angela J Busch3,
  4. Ernest HS Choy4,
  5. Winfried Häuser5,*

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group

Published Online: 10 SEP 2013

Assessed as up-to-date: 4 SEP 2013

DOI: 10.1002/14651858.CD009796.pub2

How to Cite

Bernardy K, Klose P, Busch AJ, Choy EHS, Häuser W. Cognitive behavioural therapies for fibromyalgia. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD009796. DOI: 10.1002/14651858.CD009796.pub2.

Author Information

  1. 1

    BG University Hospital Bergmannsheil GmbH, Ruhr University Bochum, Department of Pain Medicine, Bochum, Germany

  2. 2

    University of Duisburg-Essen, Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, Essen, Germany

  3. 3

    University of Saskatchewan, School of Physical Therapy, Saskatoon, SK, Canada

  4. 4

    Cardiff University School of Medicine, Section of Rheumatology, Division of Infection and Immunity, Cardiff, UK

  5. 5

    Technische Universität München, Department of Psychosomatic Medicine and Psychotherapy, München, Germany

*Winfried Häuser, Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Langerstr. 3, München, D-81675, Germany.

Publication History

  1. Publication Status: Stable (no update expected for reasons given in 'What's new')
  2. Published Online: 10 SEP 2013



References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Alda 2011 {published and unpublished data}
  • Alda M, Luciano JV, Andrés E, Serrano-Blanco A, Rodero B, Del Hoyo YL, et al. Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: a randomised controlled trial. Arthritis Research Therapy 2011;13:R173.
Ang 2010 {published data only}
Burckhardt 1994 {published data only}
  • Burckhardt CS, Mannerkopi K, Hedenberg L, Bjelle A. A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. Journal of Rheumatology 1994;21:714-20.
Castel 2009 {published and unpublished data}
  • Castel A, Salvat M, Sala J, Rull M. Cognitive-behavioural group treatment with hypnosis: A randomized pilot trial in fibromyalgia. Contemporary Hypnosis 2009;26:48-59.
Castel 2012 {published and unpublished data}
  • Castel A, Cascón R, Padrol A, Sala J, Rull M. Multicomponent cognitive-behavioral group therapy with hypnosis for the treatment of fibromyalgia: long-term outcome. Journal of Pain 2012;13:255-65.
Edinger 2005 {published data only}
Falcao 2008 {published and unpublished data}
  • Falcao DM, Sales L, Leite JR, Feldman D, Valim V, Natour J. Cognitive-behavioral therapy for the treatment of fibromyalgia syndrome: A randomized controlled trial. Journal of Musculoskeletal Pain 2008;16:133-40.
Kashikar-Zuck 2005 {published data only}
  • Kashikar-Zuck S, Swain NF, Jones BA, Graham TB. Efficacy of cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. Journal of Rheumatology 2005;32:1594-602.
Kashikar-Zuck 2012 {published data only}
  • Kashikar-Zuck S, Ting TV, Arnold LM, Bean J, Powers SW, Graham TB, et al. Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: a multi-site, single-blind, randomized, controlled clinical trial. Arthritis Rheumatism 2012;64:297-305.
King 2002 {published data only}
  • King SJ, Wessel J, Bhambhani Y, Sholter D, Maksymowych W. The effects of exercise and education, individually or combined, in women with fibromyalgia. Journal of Rheumatology 2002;29:2620-7.
Luciano 2011 {published data only}
  • Luciano JV, Martínez N, Peñarrubia-María MT, Fernández-Vergel R, García-Campayo J, Verduras C, et al. FibroQoL Study Group. Effectiveness of a psychoeducational treatment program implemented in general practice for fibromyalgia patients: a randomized controlled trial. Clinical Journal of Pain 2011;27:383-91.
Miro 2011 {published data only}
  • 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. Journal of Health Psychology 2011;16:770-82.
Nicassio 1997 {published data only}
  • Nicassio PM, Radojevic V, Weisman MH, Schuman C, Kim J, Schoenfeld-Smith K, Krall T. A comparison of behavioral and educational interventions for fibromyalgia. Journal of Rheumatology 1997;24:2000-7.
Oliver 2001 {published data only}
  • Oliver K, Cronan TA, Walen HR, Tomita M. Effects of social support and education on health care costs for patients with fibromyalgia. Journal of Rheumatology 2001;28:2711-9.
Redondo 2004 {published data only}
Rooks 2007 {published data only}
  • Rooks DS, Gautam S, Romeling M, Cross ML, Stratigakis D, Evans B, et al. Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Archives of Internal Medicine 2007;12:2192-200.
Soares 2002 {published data only}
  • Soares JJF, Grossi G. A randomised, controlled comparison of educational and behavioral interventions for woman with fibromyalgia. Scandinavian Journal of Occupational Therapy 2002;9:35-45.
Thieme 2003 {published data only}
Thieme 2006 {published and unpublished data}
  • Thieme K, Flor H, Turk DC. Psychological pain treatment in fibromyalgia syndrome: Efficacy of operant behavioral and cognitive behavioral treatments. Arthritis Research & Therapy 2006;8:R121.
Vlayen 1996 {published data only}
  • Vlaeyen JW, Teeken-Gruben NJ, Goossens ME, Mölken MP, Pett RA, Eek H, Heuts PH. Cognitive-educational treatment of fibromyalgia: A randomized clinical trial. I. Clinical effects. Journal of Rheumatology 1996;23:1237-45.
Wigers 1996 {published data only}
Williams 2010 {published data only}
Woolfolk 2012 {published data only}
  • Woolfolk RL, Allen LA, Apter JT. Affective-cognitive behavioral therapy for fibromyalgia: a randomized controlled trial. Pain Research Treatment 2012;2012:937873.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Anderson 2007 {published data only}
Carleton 2011 {published data only}
  • Carleton RN, Richter AA, Asmundson GJ. Attention modification in persons with fibromyalgia: a double blind, randomized clinical trial. Cognitive Behaviour Therapy 2011;40:279-90.
De Voogd 2003 {published data only}
  • De Voogd JN, Knipping AA, de Blécourt ACE, van Rijswijk MH. Treatment of fibromyalgia syndrome with psychomotor therapy and marital counselling. Journal of Musculoskeletal Pain 2003;1:273-80.
Garcia 2006 {published data only}
  • Garcia J, Simon MA, Duran M, Canceller J, Aneiros FJ. Differential efficacy of a cognitive-behavioral intervention versus pharmacological treatment in the management of fibromyalgic syndrome. Psychology, Health & Medicine 2006;11:498-50.
Goeppinger 2009 {published data only}
Goldenberg 1994 {published data only}
  • Goldenberg DL, Kaplan KH, Nadeau MG, Brodeur C, Smith S, Schmid CH. A controlled study of stress-reduction, cognitive-behavioral treatment program in fibromyalgia. Journal of Musculoskeletal Pain 1994;2:53-66.
Haugli 2008 {published data only}
  • Haugli L, Steen E, Laerum E, Nygard R, Finset A. Pychological distress and employment status. Effects of a group learning programme for patients with chronic musculoskeletal pain. Psychology, Health & Medicine 2003;8:135-48.
Langford 2010 {published data only}
  • Langford. The efficacy of a combined cognitive-behavioural and interpersonal therapy approach to the treatment of fibromyalgia syndrome: A randomized controlled trial. Dissertation Abstracts International: Section B: The Sciences and Engineering 2010;71:2052.
Lommel 2011 {published data only}
  • Lommel K, Bandyopadhyay A, Martin C, Kapoor S, Crofford L. A pilot study of a combined intervention for management of juvenile primary fibromyalgia symptoms in adolescents in an inpatient psychiatric unit. International Journal of Adolescent Medicine and Health 2011;23:193-7.
Lorig 2008 {published data only}
Martinez-Valero 2008 {published data only}
  • Martínez-Valero C, Castel A, Capafons A, Sala J, Espejo B, Cardeña E. Hypnotic treatment synergizes the psychological treatment of fibromyalgia: a pilot study. The American Journal of Clinical Hypnosis 2008;50:311-21.
Solomon 2002 {published data only}
  • Solomon DH, Warsi A, Brown-Stevenson T, Farrell M, Gauthier S, Mikels D, Lee TH. Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network. Journal of Rheumatology 2002;29:362-8.
Stuifbergen 2010 {published data only}
  • Stuifbergen AK, Blozis SA, Becker H, Phillips L, Timmerman G, Kullberg V, et al. A randomized controlled trial of a wellness intervention for women with fibromyalgia syndrome. Clinical Rehabilitation 2010;24:305-18.
Van Oosterwijck 2013 {published data only}
  • Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, Nijs J. Pain Physiology Education Improves Health Status and Endogenous Pain Inhibition in Fibromyalgia: A Double-Blind Randomized Controlled Trial. Clin J Pain 2013;Jan 30:epub ahead of print.
Williams 2002 {published data only}
  • Williams DA, Cary MA, Groner KH, Chaplin W, Glazer LJ, Rodriguez AM, Clauw DJ. Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention. Journal of Rheumatology 2002;29:1280-6.

References to studies awaiting assessment

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Jensen 2012 {published data only}
  • Jensen KB, Kosek E, Wicksell R, Kemani M, Olsson G, Merle JV, et al. Cognitive Behavioral Therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia. Pain 2012;153:1495-503.
Martinez 2013 {published data only}
  • Martínez MP, Miró E, Sánchez AI, Díaz-Piedra C, Cáliz R, Vlaeyen JW, Buela-Casal G. Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial. J Behav Med 2013;Jun 7:epub ahead of print.
Sanchez 2012 {published data only}
  • Sanchez A, Diaz-Piedra C, Miro E, Martinez MP, Galvez R, Buela-Casal G. Effects of cognitive-behavioral therapy for insomnia on polysomnographic parameters in fibromyalgia patients. International Journal of Clinical and Health Psychology 2012;12:39-53.
Wicksell 2012 {published data only}

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to studies awaiting assessment
  4. Additional references
Altman 2003
Begg 1994
Bennett 2006
Bernardy 2010
  • Bernardy K, Füber N, Köllner V, Häuser W. Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome - a systematic review and meta-analysis of randomized controlled trials. Journal of Rheumatology 2010;37(10):1991-2005.
Bernardy 2011
  • Bernardy K, Füber N, Klose P, Häuser W. Efficacy of hypnosis/guided imagery in fibromyalgia syndrome--a systematic review and meta-analysis of controlled trials. BMC Musculoskeletal Disorders 2011;15:12.
Bliddal 2009
Brachaniec 2009
  • Brachaniec M, Depaul V, Elliott M, Moore L, Sherwin P. Partnership in action: an innovative knowledge translation approach to improve outcomes for persons with fibromyalgia. Physiotherapy Canada 2009;61:123-32.
Bradley 2009
Branco 2010
  • Branco JC, Bannwarth B, Failde I, Abello Carbonell J, Blotman F, Spaeth M, et al. Prevalence of fibromyalgia: a survey in five European countries. Seminars in Arthritis and Rheumatism 2010;39(6):448-53.
Brown 2006
Brozek 2009
  • Brozek JL, Akl EA, Alonso-Coello P, Lang D, Jaeschke R, Williams JW, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy 2009;64(5):669-77.
Burckhardt 2005a
  • Burckhardt CS, Goldenberg D, Crofford L, Gerwin R, Gowans S, Jackson K, et al. Guideline for the management of fibromyalgia syndrome. Pain in adults and children. APS Clinical Practice Guideline Series No. 4. Glenview, IL: American Pain Society, 2005.
Burckhardt 2005b
Busch 2007
Carville 2008
  • Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D, et al. EULAR evidence based recommendations for the management of fibromyalgia syndrome. Annals of the Rheumatic Diseases 2008;67(4):536-41.
Choi 2010
  • Choi CJ, Knutsen R, Oda K, Fraser GE, Knutsen SF. The association between incident self-reported fibromyalgia and nonpsychiatric factors: 25-years follow-up of the Adventist Health Study. Journal of Pain 2010;11(10):994-1003.
Cipriani 2009
  • Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 2009;373(9665):746-58.
Cohen 1988
  • Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates, 1988.
Dell' Osso 2012
  • Dell'Osso L, Carmassi C, Consoli G, Conversano C, Ramacciotti CE, Musetti L, et al. Lifetime post-traumatic stress symptoms are related to the health-related quality of life and severity of pain/fatigue in patients with fibromyalgia. Clinical and Experimental Rheumatology 2012;29:S73-8.
Dworkin 2008
  • Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. Journal of Pain 2008;9(2):105-21.
Dworkin 2009
  • Dworkin RH, Turk DC, McDermott MP, Peirce-Sandner S, Burke LB, Cowan P, et al. Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations. Pain 2009;146(3):238-44.
Eccleston 2009
  • Eccleston C, Williams ACDC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD007407.pub2]
Eccleston 2012
  • Eccleston C, Palermo TM, Williams AC, Lewandowski A, Morley S, Fisher E, Law E. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews 2012, Issue 12. [DOI: 10.1002/14651858.CD003968]
Egger 1997
Eich 2012
  • Eich W, Häuser W, Arnold B, Bernardy K, Brückle W, Eidmann U, et al. Fibromyalgia syndrome: General principles and coordination of clinical care and patient education. Schmerz 2012;26:268-75.
Fitzcharles 2012
  • Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choinière M, et al. 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome. 2012.
Fordyce 1976
  • Fordyce WE. Behavioral Methods in Chronic Pain and Illness. St. Louis: Mosby, 1976.
Forseth 1999
  • Forseth KO, Husby G, Gran JT, Førre O. Prognostic factors for the development of fibromyalgia in women with self-reported musculoskeletal pain. A prospective study. Journal of Rheumatology 1999;26(11):2458-67.
Furukawa 2006
  • Furukawa TA, Barbui C, Cipriani A, Brambilla P, Watanabe N. Imputing missing standard deviations in meta-analyses can provide accurate results. Journal of Clinical Epidemiology 2006;59:7-10.
Glombiewski 2010
Guyatt 2006
  • Guyatt G, Gutterman D, Baumann M, Adrizzio-Harris D, Hylek E, Phillips B, et al. Grading strength of recommendations and quality of evidence in clinical guidelines - Report from an ACCP working group. Chest 2006;129:182-7.
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from
Häuser 2008
  • Häuser W, Zimmer C, Felde E, Köllner V. What are the key symptoms of fibromyalgia? Results of a survey of the German Fibromyalgia Association [Was sind die Kernsymptome des Fibromyalgiesyndroms? Umfrageergebnisse der Deutschen Fibromyalgievereinigung]. Schmerz 2008;22(2):176-83.
Häuser 2010
  • Häuser W, Hayo S, Biewer W, Gesmann M, Kühn-Becker H, Petzke F, et al. Diagnosis of fibromyalgia syndrome - a comparison of Association of the Medical Scientific Societies in Germany, survey, and American College of Rheumatology criteria. Clinical Journal of Pain 2010;26(6):505-11.
Häuser 2011
Häuser 2013
Jensen 2011
Kashikar-Zuck 2010
Koulil 2007
  • Koulil SV, Effting M, Kraaimaat FW, Lankveld WV, Helmond TV, Cats H, et al. A review of cognitive behaviour therapies and exercise programmes for fibromyalgia patients: state of the art and future directions. Annals of the Rheumatic Diseases 66;5:571-81.
Köllner 2012
  • Köllner V, Häuser W, Klimczyk K, Kühn-Becker H, Settan M, Weigl M, Bernardy K. Psychotherapy for patients with fibromyalgia syndrome: Systematic review, meta-analysis and guideline. Schmerz 2012;26:291-6.
Lange 2010
  • Lange M, Petermann F. Influence of depression on fibromyalgia: a systematic review. Schmerz 2010;24(4):26-33.
Lawrence 2008
Lee 2012
Loevinger 2012
  • Loevinger BL, Shirtcliff EA, Muller D, Alonso C, Coe CL. Delineating psychological and biomedical profiles in a heterogeneous fibromyalgia population using cluster analysis. Clinical Rheumatology 2012;31:677-85.
Lumley 2011
McBeth 2012
  • McBeth J, Prescott G, Scotland G, Lovell K, Keeley P, Hannaford P, et al. Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Archives of Internal Medicine 2012;172:48-57.
Mease 2009
  • Mease P, Arnold LM, Choy EH, Clauw DJ, Crofford LJ, Glass JM, et al. OMERACT Fibromyalgia Working Group. Fibromyalgia syndrome module at OMERACT 9: domain construct. Journal of Rheumatology 2009;36(10):2318-29.
Moore 2010a
  • Moore AR, Eccleston C, Derry S, Wiffen P, Bell RF, Straube S, et al. "Evidence" in chronic pain-establishing best practice in the reporting of systematic reviews. Pain 2010;150(3):386-9.
Moore 2010b
  • Moore RA, Smugar SS, Wang H, Peloso PM, Gammaitoni A. Numbers-needed-to-treat analyses--do timing, dropouts, and outcome matter? Pooled analysis of two randomized, placebo-controlled chronic low back pain trials. Pain 2010;151:592-7.
Moore 2010c
  • Moore RA, Derry S, McQuay HJ, Straube S, Aldington D, Wiffen P. Clinical effectiveness: an approach to clinical trial design more relevant to clinical practice, acknowledging the importance of individual differences. Pain 2010;149:173-6.
Moore 2011
  • Moore RA, Wiffen PJ, Derry S, McQuay HJ. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 3, Issue 2011. [DOI: 10.1002/14651858.CD007938]
Mork 2010
Mork 2012
Morley 2011
National Institutes of Health 2011
  • National Institutes of Health. National Centre for Alternative and Complementary Medicine. What Is complementary and alternative medicine?. (accessed 15 May 2011).
Norman 2001
  • Norman GR, Sridhar FG, Guyatt GH, Walter SD. Relation of distribution- and anchor-based approaches in interpretation of changes in health-related quality of life. Medical Care 2001;39(10):1039-47.
Nüesch 2013
  • Nüesch E, Häuser W, Bernardy K, Barth J, Jüni P. Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis. Annals of Rheumatic Diseases 2013;72:955-62.
RevMan 2011 [Computer program]
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Rheumatologist Los Angeles 2012
  • Rheumatologist Los Angeles. What are the psychological therapies available for fibromyalgia?. Accessed July 27,2012.
Saxe 2012
  • Saxe PA, Arnold LM, Palmer RH, Gendreau RM, Chen W. Short-term (2-week) effects of discontinuing milnacipran in patients with fibromyalgia. Current Medical Research and Opinion 2012;28:815-21.
Schmidt 2011
  • Schmidt S, Grossman P, Schwarzer B, Jena S, Naumann J, Walach H. Treating fibromyalgia with mindfulness-based stress reduction: results from a 3-armed randomized controlled trial. Pain 2011;152:361-9.
Schulz 2010
Smythe 1981
  • Smythe HA. Fibrositis and other diffuse musculoskeletal syndromes. In: Kelley WN, Harris Jr ED, Ruddy S, Sledge CB editor(s). Textbook of Rheumatology. First Edition. Philadelphia: WB Saunders, 1981.
Sommer 2012a
Sommer 2012b
Theadom 2009
Thieme 2007
Thieme 2009
  • Thieme K, Gracely RH. Are psychological treatments effective for fibromyalgia pain?. Current Rheumatology Reports 2009;11(6):443-50.
Thurns 2011
Tort 2012
van Koulil 2011
  • van Koulil S, Kraaimaat FW, van Lankveld W, van Helmond T, Vedder A, van Hoorn H, et al. Cognitive-behavioral mechanisms in a pain-avoidance and a pain-persistence treatment for high-risk fibromyalgia patients. Arthritis Care and Research (Hoboken) 2010;62:1377-85.
Veehof 2011
Wampold 2005
Warsi 2003
Williams 2012
Winkelmann 2011
  • Winkelmann A, Perrot S, Schaefer C, Ryan K, Chandran A, Sadosky A, et al. Impact of fibromyalgia severity on health economic costs: results from a European cross-sectional study. Applied Health Economics and Health Policy 2011;9(2):125-36.
Winkelmann 2012
  • Winkelmann A, Häuser W, Friedel E, Moog-Egan M, Seeger D, Settan M, et al. Physiotherapy and physical therapies for fibromyalgia syndrome: Systematic review, meta-analysis and guideline. Schmerz 2012;26:276-86.
Wolfe 1990
Wolfe 1997
Wolfe 2010
Wolfe 2013
Yates 2005
Yunus 1981
  • Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL. Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls. Seminars in Arthritis and Rheumatism 1981;11(1):151-71.