Reumatismo 4/2012 275 REVIEW Reumatismo, 2012; 64 (4): 275-285 Cognitive-behavioral and operant-behavioral therapy for people with fibromyalgia K. Thieme 1 , D.C. Turk 2 1 Department of Medical Psychology, Philipps-University of Marburg; 2 Department of Anesthesiology & Pain Medicine, University of Washington n INTRODUCTION T he notion that pain is psychosocial as well as physiological is not a new with perhaps the first systematic discussion dat- ing back almost 50 years (1). Both histori- cal and recent models of the experience of pain assert that the experience of pain is maintained by an interdependent set of psy- chosocial, behavioral, as well as biomedi- cal factors (2, 3). This multidimensional view of chronic pain forms the basis for the use of the cognitive-behavioral (CB) and operant-behavioral (OB) perspectives. It is important to distinguish between the un- derlying rationales and principles of these two perspectives and various psychologi- cal techniques that are based on psychoso- cial and behavioral principles. Following a description of the central assumptions of the CB and OB perspectives, we will pro- vide a brief overview of psychobiological mechanisms useful for selecting the relevant cognitive and behavioral techniques that are used to help individuals manage their pain and associated symptoms, and summarize evidence for the efficacy of cognitive-be- havior therapy (CBT) and operant behav- ioral therapy (OBT) approaches that make use of different combinations of these tech- niques. We then discuss how these perspec- tives can be used in the collaboration among rheumatologist, rehabilitation professionals, and behavioral health providers to enhance adherence, generalization, and maintenance of treatment benefits. Specifically, the fol- lowing questions will be addressed: 1. How is pain perception influenced by learning (i.e., classical and operant con- ditioning)? SUMMARY The current article reviews the cognitive-behavioral (CB) and operant-behavioral perspectives on chronic pain and suggests an answer to the question why changes in behaviors, attitudes, and emotions are associated with decreases in pain severity and impact discussing potential psychobiological mechanisms that may underlie cognitive and behavioral techniques. The impact of learning such as classical and operant conditioning in be- haviors and physical responses including baroreflex sensitivity (BRS), as well as the influence of cognitions on pain perception and impact will be presented to explain general efficacy of cognitive-behavior therapy (CBT) and operant-behavioral therapy (OBT) in the treatment of people with fibromyalgia (FM) describing some of the limitations of published outcome studies. We discuss advances in moderation and mediation of treatment outcomes. Lastly, we will discuss the need for research that takes into account evidence-based medicine, meth- ods that address treatment responders and non-responders, individual trajectories, how we might advance and refine CBT and OBT, and strategies related to relapse prevention, maintenance, and adherence-enhancement taking advantage of evolving, technological methods of service delivery. We provide recommendations of how to move forward in approaching studies of CBT and OBT efficacy as a function of better understanding of patient characteristics and contextual factors. We advocate for the potential of the CB perspective and principle of learning for all health care providers regardless of discipline or training and will give examples for making more effective the patient-rheumatologist-relationship by using the principles discussed. Key words: Cognitive-behavioral therapy, operant-behavioral therapy, psychobiological mechanisms. Reumatismo, 2012; 64 (4): 275-285 Corresponding author: Dr. Kati Thieme Department of Medical Psychology Philipps-University of Marburg Karl-von-Frisch-Str. 5 35032 Marburg, Germany