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The present study focused on the evaluation of the effects of operant behavioural (OBT) and cognitive behavioural (CBT) treatments for fibromyalgia syndrome (FMS). One hundred and twenty-five patients who fulfilled the American College of Rheumatology criteria for FMS were randomly assigned to OBT (n = 43), CBT (n = 42), or an attention-placebo (AP) treatment (n = 40) that consisted of discussions of FMS-related problems. Assessments of physical functioning, pain, affective distress, and cognitive and behavioural variables were performed pre-treatment and post-treatment as well as 6 and 12 months post-treatment. Patients receiving the OBT or CBT reported a significant reduction in pain intensity post-treatment (all Fs > 3.89, all Ps < 0.01). In addition, the CBT group reported statistically significant improvements in cognitive (all Fs > 7.95, all P < 0.01) and affective variables (all Fs > 2.99, all Ps < 0.02), and the OBT group demonstrated statistically significant improvements in physical functioning and behavioural variables (all Fs > 5.99, all Ps < 0.001) compared with AP. The AP group reported no significant improvement but actually deterioration in the outcome variables. The post-treatment effects for the OBT and CBT groups were maintained at both the 6- and 12-month follow-ups. These results suggest that both OBT and CBT are effective in treating patients with FMS with some differences in the outcome measures specifically targeted by the individual treatments compared with an unstructured discussion group. The AP group showed that unstructured discussion of FMS-related problems may be detrimental. Introduction Fibromyalgia syndrome (FMS) is defined by the presence of widespread pain of at least 3 months' duration and pain upon palpation of at least 11 out of 18 specific tender points (TPs). Patients diagnosed with FMS also report disordered sleep, excessive fatigue, and a range of physical [1, 2], cognitive [3, 4], affective [5, 6], stress-related [7, 8], and behavioural symptoms [9, 10]. The cause of FMS is not known; however, several mechanisms may be involved [11–13]. Two psychologically based treatment approaches, cognitive behaviour therapy (CBT) and operant behaviour therapy (OBT), have been reported to provide benefits for a significant proportion of patients with FMS [14–16]. A meta-analysis [17] of 49 treatment outcome studies compared the efficacy of pharmacological and non-pharmacological treatments. CBT yielded significantly greater improvements in physical status, symptoms, psychological functioning, and functional ability compared with physical therapy and was more effective for FMS symptoms and daily functioning than was pharmacological treatment with antidepressants [17]. These results and a recent evidence-based clinical practice guideline [18] suggest that optimal treatment of FMS should include physical exercise, antidepressant medication, and cognitive behavioural methods. Treatment based on operant conditioning [19] has been applied to a variety of chronic pain syndromes. OBT emphasises increased activity, inclusion of significant others to reduce reinforcement of pain behaviours, and the reduction of pain-contingent medication [19, 20]. Only a few studies have reported on the effectiveness of OBT with patients with FMS [14, 21]. For example, OBT was shown to produce a significant and stable reduction in pain intensity, interference, solicitous behaviour of the spouse, medication, pain behaviours, number of physician visits and days at a hospital, and improvement in sleeping. Sixty-five percent of the OBT-treated patients showed clinically significant improvement when compared with patients who received physical therapy alone [21]. Although OBT and CBT share some common elements, they make different
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