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.
Addressing avoidance
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?
You may also be interested in reading about the gate control theory of pain.
Resources
- CBT for chronic pain therapist manual from the U.S. Department of Veterans Affairs
- FibroGuide for fibromyalgia from the University of Michigan
- Learning About Managing Pain patient workbook
For a different psychotherapeutic approach to living with pain, check out the Acceptance and commitment therapy workbook for chronic pain from the American Psychological Association
The Psychology Corner has an overview of terms covered in the What Is… series, along with a collection of scientifically validated psychological tests.
Ashley L. Peterson
BScPharm BSN MPN
Ashley is a former mental health nurse and pharmacist and the author of four books.
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.
Yeah I bet
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!
I really hope it helps!
I’ll certainly find out soon, I at least hope! 😊
I am horrible with the nail biting! Not just the nails either, but the skin around them. I am often bleeding from it because I chew on them so much.
Ditto. My hands look like bloody little stumps and they hurt! But, does that stop us? Nope.
I can’t wait to see my therapist.
I haven’t done CBT for pain relief. I was so disconnected from my body that I didn’t feel pain. I had to learn that it was okay to feel pain. So maybe in a way I did it for pain too.
That makes sense
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!
Thanks! CBT isn’t something I’ve come across in my own work, but it certainly sounds like an interesting application.
I haven’t tried CBT for anything but it all sounds great!
Great summary. What you write makes sense, why shouldn’t our cognitive processes impact on perceived pain?
I think the key is when it’s first presented that it be done with lots of reassurance that it’s not “pain is all in your head”.
Nicely put
Thanks!