What is CBT?

...Why therapy for pain?


For many years, pain was seen as a "biomedical" issue - the result of tissue damage and system dysfunction, exclusively. We now know this isn't true. Research tells us that the causes of - and effective treatments for - pain are biopsychosocial. This means that there are 3 equally important domains we must address in order to get well: biological, psychological (thoughts, beliefs, emotions, coping behaviors), and social. For this reason, medications and medical interventions alone are not enough.

Cognitive Behavioral Therapy (CBT) is a scientifically-supported treatment for chronic pain and illness, injury (e.g. concussion), anxiety, depression, sleep, family conflict, and other issues. CBT targets both sides of pain and illness by identifying and resolving stressors that trigger flare-ups, and by teaching skills to manage pain after it starts.

 

CBT focuses on the relationship between thoughts (what's happening in your head), feelings (emotions + physical sensations), and behaviors (how you act) - a cycle that can maintain and exacerbate pain. For example, the thought, "I'm broken, I'll never get better" might trigger feelings of sadness, hopelessness and fear. Emotions then manifest physically: for example, stomach "butterflies," nausea, and headaches are common physical manifestations of stress and anxiety. Stress and anxiety, natural consequences of being sick or in pain, subsequently trigger and exacerbate physical symptoms and pain. These thoughts, negative emotions, and physical feelings then lead to unhealthy behaviors like staying in bed, missing work or school and isolating from friends - which ultimately make pain worse. 

 

Research shows that the experience of pain is mediated by multiple factors, including stress, anxiety, mood and attention. High stress, high anxiety, low mood, and focusing on pain actually make pain feel worse. The converse is also true: being relaxed, happy and distracted can help pain feel less bad.

 

CBT addresses the negative emotions that commonly accompany pain like depression and anxiety, helps challenge and change negative self-talk, and replaces unhealthy responses to pain and illness with healthier ones. CBT encourages the development of strategies to decrease and cope with pain, and helps you reclaim control when pain seems to be in charge. CBT also addresses activity reduction - a common result of pain and illness - and helps people learn to take back their lives, so that they can return to work, school and the activities they love. CBT is a collaborative, goal-oriented approach, which means that you work together with your pain coach to achieve your goals. 

If you're looking for CBT resources for pain, this workbook combines pain education with cognitive and behavioral pain management strategies for children, teens and adults, and can be used by any chronic pain patient or health provider!