What is Cognitive Behavioral Therapy for Chronic Pain

*This blog post was orginially published on the blog of Beyond the Body Health Psychology Services, LLC (owned by Dr. Jennifer Steiner) on 2/22/22.

https://www.beyondthebodypsych.com/blog/what-is-cognitive-behavioral-therapy-for-chronic-pain

I’ve been getting a lot of questions lately about Cognitive-Behavioral Therapy for Chronic Pain.  What is it?  How does it Work?  How is this going to help me with my pain?  Well, here are your answers…

What is Cognitive Behavioral Therapy for Chronic Pain (CBT-CP)?

Cognitive-Behavioral Therapy is an evidence-based psychological intervention (i.e., therapy approach) designed to help people with chronic pain.  The goal of CBT-CP is to help individuals with pain learn coping strategies to better manage the impact of pain on their quality of life and daily functioning, as well as strategies to help them better manage pain triggers.  CBT-CP can also help people to learn strategies to reduce symptoms of depression and anxiety that often accompany living with chronic pain.

How does Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) work?

Cognitive-Behavioral Therapy for Chronic Pain is really just a fancy name for a combination of different coping strategies; some of those strategies are more focused on your thinking (cognitive), and some of those strategies are more focused on your actions (behavioral).

Behavioral strategies:

• Learning to fully recognize ALL of your pain triggers.  Most people know what some of their pain triggers may be, but not everyone is aware of all the factors that may contribute to their experience of pain.  When you hurt all day, every day, it can be hard to keep track of what makes it worse.  However, knowing what triggers pain increases and flares can be helpful because if you know what your unique triggers are, then you can learn ways to combat them.  Your therapist may have you track your pain or keep a pain diary to help you identify pain triggers that you may not have even been thinking about.

• Relaxation techniques to help manage stress, anxiety, and pain intensity.  Did you know that stress can amplify pain, or that extra muscle tension from stress or anxiety can cause pain to become more intense?  Through CBT-CP, your therapist will help explain the biological connection between stress and pain and teach you how to calm your body on a physiological level (that means releasing muscle tension, slowing down your cardiovascular system, and turning off the stress response which when over-activated can make pain more intense); slowing down your body’s stress response can not only help you manage stress, but also pain.  Relaxation exercises can also be a good distraction from pain sensations.

• Techniques to balance activity and pain.  So many people with chronic pain tell me that it is a challenge to engage in the activities that they need to do or want to do without causing more pain or “over-doing-it”.  This can be a real problem, especially if overdoing-it lands you on the couch or in bed for several days of recovery.  The good news is, that there are techniques to help create more balance and help you do more and hurt less.

• Learning tips and tricks to make certain tasks easier

• Learning ways to improve your sleep

  
  

Cognitive Strategies:

• Recognizing how your thinking (about your pain or anything else in your life) relates to your emotions, physiological/bodily responses, pain intensity, and behaviors.  This is sometimes related to your pain triggers as well.

• Recognizing unhelpful thoughts/patterns in thinking (these unhelpful thoughts may be related to increases in pain, worsening depression, thoughts about yourself, or other experiences).

• Learning techniques to help you respond differently to unhelpful thoughts and ultimately change your thinking to better serve you

How is Cognitive-Behavioral Therapy for Chronic Pain (CBT-CP) going to help me with my pain?

CBT-CP is not a cure for chronic pain, and it is likely NOT going to make pain disappear.  However, it can help people who have chronic pain live better lives with their pain.  CBT-CP can help someone to develop coping strategies to help them manage the impact of chronic pain and improve their mental well-being.  Many people find that CBT-CP helps them to:

• Understand and manage pain triggers better

• Manage stress better

• Reduce muscle tension and other physical symptoms of stress and anxiety

• Feel more in control of their pain

• Reduce pain-related depression and anxiety

CBT-CP effective?  What does the research say?

YES!  Cognitive-Behavioral Therapy for Chronic Pain is considered to be the gold standard psychological intervention for chronic pain.  Countless research studies have demonstrated that it is effective for a variety of different chronic pain conditions and that it can produce many of the outcomes described above (Ehde et al, 2014).

That said, even the best interventions do not work for everyone.  Although CBT-CP works for many people, others find different approaches to be a better fit for them.  Acceptance and Commitment Therapy is another evidence-based psychological intervention that falls under the CBT umbrella; both are offered at Beyond the Body Health Psychology Services, LLC.  Usually, the decision to try CBT-CP is made with your therapist, and many try CBT-CP first before moving on to another type of approach.

References:

Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. American Psychologist, 69(2), 153.