Can cognitive-behavioral therapy lessen 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 superior to a matched education treatment in reducing the interfering effects of pain and other aspects of fibromyalgia on daily living.

Within the group that received CBT in the trial, which is published in Arthritis & Rheumatology, improvements were at least partly attributable to reductions in what’s known as catastrophizing, a state comprised of cognitive and emotional processes such as helplessness, rumination, and magnification of pain complaints.

Neuroimaging tests indicated that CBT exerts these effects by altering the connectivity of specific regions of the brain. Therefore, changes in the brain circuitry underlying pain catastrophizing may underpin CBT’s benefits for patients with fibromyalgia, a condition characterized by function-impairing symptoms such as widespread pain, fatigue, cognitive difficulties, and psychosocial distress.

“These findings contribute to a growing literature highlighting the benefits of non-pharmacologic treatments—including CBT—for chronic pain conditions such as fibromyalgia,” said corresponding author Jeungchan Lee, PhD, of Spaulding Rehabilitation Hospital and Harvard Medical School. “Identifying the multiple biopsychosocial mechanisms by which these treatments help to alleviate pain may help to facilitate the practice of precision pain medicine and improve treatment outcomes for the many patients suffering from chronic pain.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/art.42672

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.

The Effects of Cognitive Behaviour Therapy on Parents of Children With Autism




 

Image result for York U Research Identifies Effects of Cognitive Behaviour Therapy on Parents of Children With Autism

 




 

Parents of children with autism experience a greater impact from their child’s therapy than once thought, according to new research out of York University’s Faculty of Health.

Jonathan Weiss, Associate Professor in the Department of Psychology, Faculty of Health and CIHR Chair in Autism Spectrum Disorders (ASD) Treatment and Care Research, discovered that parents who participate in cognitive therapy with their children with autism also experience a real benefit that improves the family experience.

Approximately 70 per cent of children with autism struggle with emotional or behavioural problems, and may benefit from cognitive behaviour therapy to improve their ability to manage their emotions.

 




“Most of the time when parents bring in their kids for cognitive behaviour therapy, they are in a separate room learning what their children are doing, and are not being co-therapists,” said Weiss. “What’s unique about what we studied is what happens when parents are partners in the process from start to finish. Increasingly we know that it’s helpful for kids with autism, specifically, and now we have proven that it’s helpful for their parents too.”

Jessica Jannarone, a parent involved in the York U Faculty of Health study, Parental Outcomes Following Participation in Cognitive Behavior Therapy for Children with Autism Spectrum Disorder, led by Professor Jonathan Weiss shares her experience of the impact of cognitive behaviour therapy with her son.

Parents who took part in the study were involved in a randomized controlled trial. They were asked to complete surveys before and after the treatment and were compared to parents who had not begun therapy.

Weiss and Ph.D student Andrea Maughan, examined changes in parent mental health, mindfulness, and perceptions of their children, during a trial of cognitive behaviour therapy for 57 children with ASD aged 8-12 who did not have an intellectual disability. The study, published in the Journal of Autism and Developmental Disorders, showed that parents who participated in cognitive therapy with their children, experienced improvements in their own depression, emotion regulation, and mindful parenting.

“The research showed that parents improved their abilities to handle their own emotions and to see themselves in a more positive light,” said Weiss. “It helped them to become more aware of their parenting and all of the good they do as parents.”

In the study, parents were co-therapists with their child’s therapist and were tasked with employing the same strategies alongside their children. This allowed the parents to learn to help themselves in the process. Parents were required to write down their children’s thoughts during activities.

“As a parent participating in the SAS:OR Program, I have grown as much as my son did. I used to use a “one size fits all” strategy with my son – now he and I have many tools to manage through difficult moments,” said Jessica Jannarone, a parent involved in study. “The ability to talk about our feelings, identify triggers, and think proactively about approaches has brought both positivity and comfort to our lives. Watching my son develop in this program and find a way to start handling his feelings has been the greatest gift of all.”

Weiss added the findings also speak to the importance for health care providers to involve parents in the process of delivering care to children with autism.

“We know parents of children with autism, in addition to all the positive experiences they have, also experience high levels of distress. So if we can do something to reduce that, we have a responsibility to try to do so.”

Autism and virtual reality – Newcastle University shows how virtual reality can help children with autism overcome their fears!


Autism Awareness Butterfly

Autism Awareness Butterfly

This morning Newcastle University published the following press release . We are reposting it in full because we think that it represents a brilliant opportunity for the autism community.

“Immersive reality can help children with autism spectrum disorder overcome their fears and phobias, new research has shown.

In a study published today in PLOS ONE, experts at Newcastle University describe how, following treatment in an immersive virtual reality room, eight out of nine children were able to tackle the situation they feared. Four children were found to have completely overcome their phobias. The effect of the treatment was still in place one year later. A video show the treatment in action.

Around 150,000 children in the UK are thought to have autism spectrum disorder and it affects four times more boys than girls. A study released earlier this month found that the condition costs the UK £32bn every year. Many people with autism spectrum disorder have a fear or phobia which can be so distressing that they and their families completely avoid the situation.

Each of the nine boys, aged between seven and 13 and with a diagnosis of autism spectrum disorder, was immersed into a virtual environment which gradually introduced them to a scene of the real-life situation they feared. This included getting on a busy bus, crossing a bridge, going shopping or talking to an avatar shop assistant.


Supported by a psychologist, they were given breathing and relaxation exercises in the controllable and safe virtual environment to help them to learn to cope with that situation.

Fears and phobias

Dr Jeremy Parr, Clinical Senior Lecturer specialising in Paediatric Neurodisability at Newcastle University’s Institute of Neuroscience said: “Phobias have a huge impact on a child with autism and on the whole family. Parents often find themselves taking action to avoid the situation the child fears, which can impact on school and leisure activities.

“Currently the main treatment is cognitive behaviour therapy but that often doesn’t work for a child with autism as it relies on imagination. People with autism can find imagination difficult so by providing the scene in front of the child’s eyes we help them learn how to manage their fears.”

The Newcastle University team worked with company Third Eye Technologies in their unique Immersive Blue Room to create personalised scenarios. Accompanied by a psychologist, the child was completely surrounded with audio visual images representing the ‘real world’ in the 360 degree seamless screened room with no point of external reference. This meant they did not have to wear a headset or goggles. They moved around the scene using ipad controls, interacting and navigating through the scenario as they wished allowing them to fully control the environment.

Children were observed by their parents via a video-link which enabled them to watch the techniques used to help their child. This had obvious benefits as Newcastle University researcher Dr Morag Maskey explains: “One boy was so fearful shopping that he would walk behind his parents with his hood up, refusing to even speak to people he knew.

“We created a petrol station kiosk scene in the Blue Room where he picked up a newspaper. With the help of the psychologist who was in the room with him, he learnt to control his anxiety with breathing and stretching exercises. He then built up confidence over four sessions until he held a conversation with the shop assistant avatar.

“At home his parents encouraged him to do more of the shopping on his own and use the techniques they had seen him practice.

“The therapy was so successful that he is now able to go shopping with his friends.”

Another nine-year-old boy in the study had a fear of crowded buses and underground trains which meant as his family had no car, they could face a 40 minute wait for an emptier bus or experience his difficult behaviour on a crowded bus. Building up his confidence with a scene of a bus that became more crowded over the four sessions has given a new lease of life to his family who are now able to board any bus – regardless of how many people are on it.

Treating phobias

Dr Parr from Newcastle University’s Institute of Neuroscience, added: “Parents told us that they could see the difference in their children over the course of the four session programme – their children are now much better at coping with the situations that they once found distressing. Twelve months later, the children are still able to cope.

“This treatment has led to big changes in the lives of some families. To see a child who couldn’t get on a crowded bus do so after just four weeks of treatment is amazing.”

The flexibility of the Blue Room means that scenes can be gradually built up in complexity and noise level, allowing a graded exposure and element of control that cannot be achieved in real life. However, the technology has a wide range of applications as Paul Smith, CEO of Third Eye Technologies explains: “Immersive reality environments offer a powerful tool for training as participants can navigate through scenarios at their own discretion and therefore be taken closer to reality than ever before becoming active members of a  360 degree virtual world. The work performed shows that although participants appreciate that they are in a replicated environment, within a very short period of time they start reacting and behaving as they do in the real world. ‘

“The young people in this study were able to navigate through an environment such as a street or a school and interact with objects and people, rehearsing their newly-learned skills. Because there is no point of external reference and because it’s in true perspective people genuinely think they’re in the environment – which is why it’s so effective.

“When we were approached to take part in this study, it was an area of work we had never considered but it shows how innovative use of the latest technology can help in surprising areas such as health.”

Carol Povey, Director of The National Autistic Society’s Centre for Autism, said: “Some people with autism can struggle in everyday social situations that many of us take for granted, such as boarding a bus or going to the local shop to buy a pint of milk.  A chance to explore stressful scenarios in a safe, virtual environment could help those whose lives are dominated by anxiety to better manage their fears, improving their quality of life.”

Baroness Hilary Armstrong social exclusion who has been following the work said: “The Blue Room has given children with autism the opportunity to deal with their fears and anxieties in a remarkable way. This has changed their lives, and the lives of their families. This is exciting progress that has the potential to offer real opportunities to many more children and young people with autism.”

The Newcastle University team are continuing their work in this area, and will shortly begin a new project that will investigate the treatment being used in the NHS in North East England.