cognitive behaviour therapy

Posted on ADHD

Cannabis for attention issues? How the body’s cannabinoids may influence the symptoms and treatment of ADHD

Medical cannabis relieves symptoms in children with autism

Cannabis, including marijuana and products containing cannabinoids and THC—the primary psychoactive compound in marijuana—has been hailed as a remedy for conditions ranging from anxiety and sleep issues to epilepsy and cancer pain.

Nursing researcher Dr. Jennie Ryan from Thomas Jefferson University is studying the effects of cannabis on symptoms of attention deficit hyperactivity disorder (ADHD). Current medical guidelines for treating ADHD include medications like Adderall and cognitive behavioural therapy. As with most treatments, these options can offer benefits while also presenting certain downsides. Dr. Ryan notes, “Parents are interested in cannabidiol, which does not contain THC. However, we currently lack sufficient scientific evidence to support its use.”

In a recent review paper, Dr. Ryan and her colleagues examined the scientific literature to gather evidence regarding the interactions between cannabis and ADHD. The researchers specifically focused on how cannabis use impacts ADHD symptoms. Additionally, since the human body produces its cannabinoids through the endocannabinoid system, they explored how this endogenous system might influence ADHD. They analyzed both clinical and preclinical findings, which collectively suggest that cannabis affects the endocannabinoid system in various ways, ultimately influencing attention, hyperactivity, and anxiety.

“Dr. Ryan acknowledges that there is a relationship between cannabis use and ADHD. However, she notes that this relationship is complicated by the wide variety of cannabis products available, the numerous types of endocannabinoids, their biological pathways, and the different ways ADHD can present in individuals. Separating and understanding all these factors is extremely challenging. Additionally, researchers studying cannabis face legal restrictions surrounding marijuana that hinder their efforts.”

Co-author Brooke Worster, MD, specializes in pain management and palliative care, says she suspected the published evidence would be sparse. When that was what they found, “I wasn’t super surprised,” she says. “Still, it is shocking how many holes there are. We have a lot of work ahead.”

Posted on Fibromyalgia

2 types of cognitive behavioural therapy (CBT) are equally effective for treating fibromyalgia.

Maria Hedman-Lagerlöf

Maria Hedman-Lagerlöf CREDIT Andreas Beronius

A recent study led by researchers at Karolinska Institutet found that there are no significant differences between exposure-based CBT and traditional CBT when it comes to treating fibromyalgia. Both forms of treatment resulted in a noticeable reduction in symptoms for people affected by the disease. This study, published in the journal PAIN, is one of the largest to date to compare different treatment options for fibromyalgia.



Approximately 200,000 people in Sweden are currently living with fibromyalgia, a long-term pain syndrome that causes widespread pain, fatigue, and stiffness in the body, resulting in significant suffering for patients. There is currently no cure for fibromyalgia, and existing drugs often provide inadequate relief, highlighting the need for more effective treatment methods. While cognitive behavioural therapy (CBT) has shown some effectiveness, there is a shortage of trained CBT practitioners and a lack of knowledge about which CBT methods are most effective.


The study compared two different forms of internet-delivered cognitive behavioural therapy in terms of how effectively they reduce the symptoms and functional impact of fibromyalgia.

In short, exposure-based CBT entails the participant systematically and repeatedly confronting situations, activities, and stimuli that the patient has previously avoided due to the association with pain, psychological discomfort, or symptoms such as fatigue and cognitive problems.

In traditional CBT, participants are presented with various strategies to work on during treatment, such as relaxation techniques, activity planning, physical exercise, and methods for managing negative thoughts and improving sleep.

The study showed that traditional CBT was, in general, equivalent to the newer treatment form of exposure-based CBT. 

“Despite our hypothesis, our study shows that the traditional form can be equally effective,” says Maria Hedman-Lagerlöf, psychologist and researcher at Karolinska Institutet.

The randomized study involved 274 people with fibromyalgia, who were randomly assigned to be treated with traditional or exposure-based CBT. The treatments were delivered online, and all participants had regular contact with their therapist. 

Participants were asked to answer questions about their mood and symptoms before, during, and after treatment. Following the 10-week treatment, 60 percent of those who received exposure-based CBT and 59 percent of those who received traditional CBT reported that the treatment had helped them.

“The fact that both treatments were associated with a significant reduction in the participants’ symptoms and functional impairment and that the effects were sustained for 12 months after completion of the treatment, indicates that the internet, as a treatment format, can be of great clinical benefit for people with fibromyalgia,” says Maria Hedman-Lagerlöf. “This is good news because it enables more people to access treatment.”

The study is the second largest to compare different psychological treatment options for fibromyalgia, according to the researchers.

“Our study is also one of the first to compare with another active, established psychological treatment,” says Maria Hedman-Lagerlöf.

Posted on Fibromyalgia

Can cognitive-behavioral therapy reduce fibromyalgia pain?

Pain - what works best?
Pain – what works best?

In a recent randomized clinical trial of patients with fibromyalgia, cognitive-behavioral therapy (CBT), which uses structured techniques to alter distorted thoughts and negative moods, was found to be more effective than a matched education treatment in reducing the impact of pain and other aspects of fibromyalgia on daily living.

In the study published in Arthritis & Rheumatology, it was found that the group that received Cognitive Behavioral Therapy (CBT) experienced improvements. These improvements were partly due to reduced catastrophizing, which includes cognitive and emotional processes such as feelings of helplessness, rumination, and exaggeration of pain complaints.

Neuroimaging tests have shown that cognitive behavioral therapy (CBT) works by changing the connections between specific regions of the brain. This suggests that alterations in the brain circuitry associated with pain catastrophizing could be the reason why CBT is beneficial for fibromyalgia patients. Fibromyalgia is a condition marked by debilitating symptoms like widespread pain, fatigue, cognitive challenges, and psychosocial distress.

“According to corresponding author Jeungchan Lee, PhD, from Spaulding Rehabilitation Hospital and Harvard Medical School, these findings add to the growing body of research that emphasizes the benefits of non-pharmacologic treatments, such as CBT, for chronic pain conditions like fibromyalgia. Understanding the various biopsychosocial mechanisms through which these treatments reduce pain could help advance the practice of precision pain medicine and enhance treatment outcomes for the numerous patients affected by chronic pain.”

Posted on Pain Management

Cognitive Behavioral Therapy for Chronic Pain

Dr. David Talavera presented his talk, “Cognitive Behavioral Therapy for Chronic Pain,” for our Pain Science Lecture Series, March 2023 edition. The presentation provided an overview of Cognitive Behavioral Therapy (CBT) for Chronic Pain and outlined the importance of coping with emotions, thoughts, and behaviors often impacted by chronic pain.

Posted on Pain Management

Cognitive behavior therapy significantly reduced depression and anxiety in chronic pain patients

MS and depression


The results of a study presented today at the Annual European Congress of Rheumatology (EULAR) has shown that Acceptance and Commitment Therapy, a form of cognitive behavioural therapy (CBT) that focuses on psychological flexibility and behaviour change, provided a significant reduction in self-reported depression and anxiety among patients participating in a pain rehabilitation programme.

This treatment also resulted in significant increases in self-efficacy, activity engagement and pain acceptance.

To assess the potential benefits of an 8-week programme of group Acceptance and Commitment Therapy (ACT) in people with persistent pain, measures of pain acceptance and activity engagement were taken using the Chronic Pain Acceptance Questionnaire. Measures of psychological distress using the Hospital Anxiety and Depression Scale and self-efficacy were also taken at assessment, on the final day of the programme, and at the follow up six-month review.

For those chronic pain patients with scores at all three time points, there were statistically significant improvements in all parameters between baseline and at six-months follow-up, including the change in mean score of depression, anxiety, self-efficacy, activity engagement and pain willingness (p<0.001).

“To further validate the role of ACT in the treatment of chronic pain, specifically in a rheumatology context, a randomised controlled clinical trial that includes measures of physical and social functioning within a Rheumatology service would be desirable,” said lead author Dr. Noirin Nealon Lennox from Ulster University in Northern Ireland.

ACT is a form of CBT that includes a specific therapeutic process referred to as “psychological flexibility”. ACT focuses on behaviour change consistent with patients’ core values rather than targeting symptom reduction alone. Evidence for this approach to the treatment of chronic pain has been mounting since the mid 2000’s. A previous systematic review had concluded that ACT is efficacious for enhancing physical function and decreasing distress among adults with chronic pain attending a pain rehabilitation programme.

In this study, patients were referred into the ACT programme by three consultant rheumatologists over a five-year period. Over one hundred patients’ outcome measures were available for a retrospective analysis.