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Since stress may worsen the pain experience, the development of individual strategies for coping with stress is essential to reduce the impact of FMS on daily life. The aim of the study was to investigate whether a group based stress management cognitive behaviour therapy (CBT) programme could influence self-reported stress, wellbeing and life control, as well as self-reported pain behaviour in female FMS patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2015.04.027_s_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      48 female FMS patient were randomized into a cognitive behaviour therapy treatment group (\n                      <jats:italic>n<\/jats:italic>\n                      = 24) and a waitlist control group (\n                      <jats:italic>n<\/jats:italic>\n                      = 24) . When the 6 months waitlist period was over the control group received the same CBT programme. This allowed two analytical approaches, one based on the randomized controlled trial design and one based on a before-and-after design to improve the statistical power of the study. Four psychometric instruments were used: The West Haven-Yale Multidimensional Pain Inventory (three parts, MPI-1 to MPI-3), the Maastricht Questionnaire, the Everyday Life Stress, and the Montgomery-\u00c5sberg Depression rating scale \u2013 self-reported. Primary outcome was the MPI-1 dimension \u2018life control\u2019, secondary outcomes were the MPI-1 dimensions \u2018interference\u2019, \u2018affective distress\u2019 and \u2018support from spouses or significant others\u2019, the various MPI-2 dimensions, the \u2018general activity level\u2019 in the MPI-3 dimension, and \u2018vital exhaustion\u2019, \u2018stress behaviour\u2019, and \u2018depression\u2019. The only tertiary outcome was the MPI-1 dimension \u2018pain severity\u2019.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2015.04.027_s_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the RCT design the West Haven-Yale Multidimensional Pain Inventory dimensions \u2018life control\u2019, \u2018interference from pain\u2019, \u2018affective distress\u2019, \u2018support from spouses or significant others\u2019, and \u2018distracting responses\u2019 and ratings for depression improved in the treatment group as compared with the control group. In the before-and after design these improvements were maintained and enhanced during 1-year follow-up, and so was the \u2018vital exhaustion\u2019 and \u2018stress behaviour\u2019. \u2018Pain severity\u2019 was rated higher after the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2015.04.027_s_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cognitive behaviour therapy improved the life control in a female population with FMS. Coping behaviour in response to chronic pain was improved at the same time and in spite of higher subjective ratings of pain. Positive effects were seen on depression, vital exhaustion and stress behaviour. The effects of therapy were maintained and enhanced during the follow up period. It appears that women with FMS after the CBT treatment, according to this protocol obtained tools leading to better acceptance of their disorder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_j.sjpain.2015.04.027_s_005\">\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>FMS is a disorder with great therapeutic challenges. Total abolishment of pain symptoms is extremely difficult or impossible to achieve. Thus, the development of individual strategies for coping with pain is essential to reduce its impact on daily life. Since stress may worsen the pain experience, coping with stress might be a promising route to accomplishing that goal. In evaluations of interventions for pain it is important to monitor the effect on behaviour responses to pain and not only ratings of pain itself.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.sjpain.2015.04.027","type":"journal-article","created":{"date-parts":[[2015,6,15]],"date-time":"2015-06-15T17:03:06Z","timestamp":1434387786000},"page":"11-21","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":25,"title":["Cognitive behaviour therapy in women with fibromyalgia: A randomized clinical trial"],"prefix":"10.1515","volume":"9","author":[{"given":"Bo","family":"Karlsson","sequence":"first","affiliation":[{"name":"Uppsala University , Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section , Uppsala , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunilla","family":"Burell","sequence":"additional","affiliation":[{"name":"Uppsala University , Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section , Uppsala , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulla-Maria","family":"Anderberg","sequence":"additional","affiliation":[{"name":"Uppsala University , Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section , Uppsala , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Sv\u00e4rdsudd","sequence":"additional","affiliation":[{"name":"Uppsala University , Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section , Uppsala , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2015,10,1]]},"reference":[{"key":"2025120909585169569_j_j.sjpain.2015.04.027_ref_001","doi-asserted-by":"crossref","unstructured":"Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, Fam AG, Farber SJ, Fiechtner JJ, Franklin CM, Gatter RA Hamaty D, Lessard J, Lichtbbroun AS, Masi AT, McCain GA, Reynolds WJ, Romano TJ, Russel IJ, Sheon RP. 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