What is… CBT for pain

In this series, I dig a little deeper into the meaning of psychology-related terms.

This week’s term: Cognitive behavioural therapy for pain

While initially the idea of a psychological 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 are practiced both in therapy and as homework.

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.  Work is done on pacing to achieve a good balance between activation and rest.

On the cognitive side, reframing automatic negative thoughts is an important component.  Maladaptive behaviours may occur as a result of negative cognitions, and 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 quality of life and overall functioning.

Have you ever tried CBT for pain?  What was your experience like?

 

Want to know more?

 

You can find the rest of my What Is series here.

Have you checked out my book Psych Meds Made Simple?  It’s available on Amazon as an ebook or paperback.

 

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16 thoughts on “What is… CBT for pain

  1. Kit Dunsmore says:

    I am currently doing CBT for sleep. I don’t know if it’s the same for pain, but it takes a lot of work and the results are slow in coming. So much of my effort is going to the CBT program that I don’t have the energy or determination to do much else, which means that some of the other health efforts I was making have slacked off a little. I don’t know if it would be as hard for pain, but I’m guessing it would, because it means putting up with the discomfort while you learn how to reduce your response, just like I am getting even less sleep than I was originally while I work to improve the quality of my sleep. They promise me I will get to sleep more once the quality is improved, but it’s been nearly two months. Hard not to just give up.

  2. BeckiesMentalMess.wordpress.com says:

    It’s funny that you bring this topic up, when this is the one thing I want to bring up with my therapist at next weeks appoinment.
    One, the nail biting and/or Trichotillomania. The pain still felt in my back.
    I want so badly to be able to walk without chronic pain. I hope the CBT treatment will help in these two particular areas.
    Excellent post, Ashley!

  3. Meg says:

    Great post!! Very insightful. I’ve never thought of pain that way, as being something your body reacts to in a way that makes it worse!! Fortunately, I’ve never had physical pain issues, which is a blessing. I’m a total whiner–I fall apart over a headache. I do know this–I’ve never been able to relax physically. I’ve tried progressive muscle relaxation many times, and it seems that the tension I carry is permanent.

  4. Alexis Rose says:

    I haven’t done CBT for pain relief. I was so disconnected from my body that I didnt feel pain. I had to learn that it was okay to feel pain. So maybe in a way I did it for pain too.

  5. Johnzelle says:

    This is so great! I primarily practice from a CBT and DBT base but this post got me thinking about the pain component. I recently became more aware of the psychosomatic disorders (pain) when I was studying for my license exam. I will definitely need to explore this further. And can I just say, your blog is such a great wealth of information. I can’t wait to read your book!

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