title: Tailored cognitive-behavioral therapy for fibromyalgia: two case studies.
abstract: OBJECTIVE
  To illustrate a multidisciplinary group treatment for patients with fibromyalgia (FM) tailored to the patient's cognitive-behavioral pattern.
  
  
  METHODS
  In a case-study design the tailored treatment approaches of two FM patients were described. One patient characterized by avoidance behavior (pain-avoidance pattern) participated in a group treatment aimed at changing pain-avoidance mechanisms and one patient characterized by continuing with activities in spite of pain (pain-persistence pattern) participated in a group treatment aimed at changing pain-persistence mechanisms. Assessments were made at baseline, post-treatment and at 6-months follow-up.
  
  
  RESULTS
  Comparison of the pretest, post-test and follow-up scores on pain, functional disability, fatigue and psychological distress showed clinically significant improvements for both patients.
  
  
  CONCLUSIONS
  The heterogeneity of patients regarding pain-related cognitive-behavioral mechanisms has been proposed to underlie varying treatment outcomes in FM patients. These results demonstrate that a group treatment tailored to pain-avoidance and pain-persistence patterns is feasible and can result in clinically significant changes for FM patients.
  
  
  CONCLUSIONS
  FM offers a great challenge for clinicians due to the lack of effective treatment options. These case studies suggests that tailored CBT and exercise training directed at specific patient patterns can contribute to the improvement of the care of FM patients.
authors.affiliation: Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. s.vankoulil@mps.umcn.nl
authors.forename: S
authors.initials: S
authors.lastname: van Koulil
authors.forename: W
authors.initials: W
authors.lastname: van Lankveld
authors.forename: F W
authors.initials: FW
authors.lastname: Kraaimaat
authors.forename: T
authors.initials: T
authors.lastname: van Helmond
authors.forename: A
authors.initials: A
authors.lastname: Vedder
authors.forename: H
authors.initials: H
authors.lastname: van Hoorn
authors.forename: H
authors.initials: H
authors.lastname: Cats
authors.forename: P L C M
authors.initials: PL
authors.lastname: van Riel
authors.forename: A W M
authors.initials: AW
authors.lastname: Evers
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D001362:Avoidance Learning; D015928:Cognitive Behavioral Therapy / Q000458:organization & administration*; D005221:Fatigue / Q000209:etiology; D005239:Fear; D005240:Feasibility Studies; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology*; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D010147:Pain Measurement; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D012648:Self Care / Q000379:methods / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology; D016896:Treatment Outcome