Exercise, relaxation and stress management

Mindfulness training (mindfulness-based stress reduction, or MBSR) aims to help people pay more attention to their thoughts, feelings, and surroundings – without judging or wanting to change them. This is meant to improve your self-awareness and allow you to experience events, activities or moments in a more intensive way and enjoy them more.

Mindfulness training also aims to help you recognize negative thoughts and feelings that are easy to get caught up in, and then distance yourself from them.

There is very little good-quality research in this area, though, so we can’t yet know for sure whether these goals can actually be achieved through mindfulness training.

Various approaches are used. For instance, people try to become more aware of everyday things such as the taste of their food, or the wind in their face when they go on walks. Or they may try to avoid reacting immediately to what others say or do, and instead slow down and take their time. Meditation and yoga can be used in mindfulness training too. All of these approaches aim to stop our “autopilot” that makes us react automatically to things without us being aware of it.

Mindfulness courses are offered by some adult education centers (In German: Volkshochschulen) and statutory health insurers in Germany – and sometimes subsidized too. It is also possible to learn mindfulness techniques with the help of an online course, an app, CD or audio file. Mindfulness is often used in psychological treatments too.

Biofeedback involves trying to consciously influence subconscious body functions and learn to control them better. This is also meant to help people manage pain better.

Biofeedback can be carried out by a doctor, a therapist or at home with a portable biofeedback device – after being shown how to use it properly. It involves placing electrodes on your body to measure things like muscle tension or brain activity. You can monitor these different measurements on a screen and try to influence them by consciously relaxing your muscles or thinking particular thoughts.

Relaxation techniques such as progressive muscle relaxation or autogenic training can help you to reduce tension in your muscles and let your body relax.

Progressive muscle relaxation involves concentrating on certain groups of muscles, consciously tensing them and then relaxing them again. This is repeated with other muscle groups until the entire body is relaxed. The aim is to become more aware of your body and learn to consciously achieve physical and mental relaxation.

In autogenic training you picture different parts of your body, focus on how they feel, then consciously relax them. People who are very good at it can even influence involuntary bodily functions like their heartbeat, helping them to achieve deep physical relaxation.

Relaxation techniques can be learned in classes or with the help of video or audio instructions. They are often used in multimodal pain management and psychological treatments too.

Other ways to relax and relieve symptoms include guided self-hypnosis and visualization techniques (also known as “guided imagery”).

There are only a few small studies on relaxation techniques, mindfulness training and biofeedback in people who have fibromyalgia, so it isn't possible to say whether they work here. But that doesn’t mean that they don’t work. Further research is needed to properly assess how effective they are.

In patient education programs, people are given information about their disease, the treatment options and strategies to cope better in everyday life. They also have the opportunity to talk to others in similar situations. Patient education is mainly organized by support groups and is often an integral part of multimodal pain management approaches.