In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is cognitive behavioural therapy (CBT) for chronic pain.
While initially, the idea of a psychological form of treatment for a physical problem may sound a bit odd at first, it makes more sense when you consider how inextricably connected mind and body are.
CBT for pain does not take the perspective that pain is “all in your head“; instead, it’s focused on changing what the mind is doing in response to the pain signals. CBT for pain has been shown in research studies to be effective in a variety of chronic pain conditions including fibromyalgia and chronic headaches.
Typically it’s multi-component, meaning more than one type of CBT technique is used. There is usually a cognitive component, focused on thoughts about the pain experience, a relaxation component, and elements of behaviour change. Skills practice happens in therapy and as homework.
Managing automatic arousal responses
When our bodies perceive a stressor such as pain, it triggers automatic adjustments in muscle tension, heart rate, blood flow, and brain activity. When these responses are triggered chronically, this can become very hard on the body.
Practicing relaxation strategies can help to interrupt these automatic responses. Biofeedback can facilitate this by giving an immediate indication of the level of physiological arousal. Strategies include progressive muscle relaxation, visual imagery, and mindfulness. It’s not just a matter of applying these strategies once in a while, but practicing them regularly to be able to override the body’s learned physiological responses.
Avoidance of activities is a common response to chronic pain, and CBT for pain treats that in much the same way it would any other kind of avoidance reaction. There is an emphasis on behavioural activation, including both physical activity and normally pleasurable activities. Pacing is practiced to achieve a good balance between activation and rest.
Reframing cognitions to change maladaptive behaviours
On the cognitive side, reframing automatic negative thoughts is an important component. Maladaptive behaviours may occur as a result of negative cognitions, and these can actually worsen the pain. Cognitions that may be targeted include catastrophizing and interpreting present moment pain as a sign of lasting physical damage occurring. The therapy tries to improve pain self-efficacy, i.e. the individual’s belief that they have the power to do something to affect their level of pain.
Therapy also covers lasting lifestyle changes, anticipating obstacles, and long-term maintenance skills, including stress management, goal-setting, and problem-solving. The overall goal is to improve the quality of life and overall functioning.
Have you ever tried CBT for chronic pain? What was your experience like?
Want to know more?
- The University of Michigan FibroGuide for fibromyalgia.
- U.S. Department of Veterans Affairs has a CBT for chronic pain therapist manual
- For another psychological approach to pain management, the American Psychological Association has an acceptance and commitment therapy workbook for chronic pain.
You can find the rest of the what is… series in the Psychology Corner.
The CBT Fundamentals mini-ebook, available from the MH@H Download Centre, provides an introduction to cognitive behavioural therapy concepts along with workbook exercises.