Cognitive behavioral therapy for chronic pain: What can it treat?
There is evidence that Cognitive Behavioral Therapy (CBT) works better than taking pain medication long-term for chronic pain treatment. Cognitive Behavioral Therapy (CBT) has been successfully used for people with:
- back pain
- neck pain
- chronic fatigue syndrome
- abdominal and chest pain
- sickle cell anemia, and cancer
- among other disorders
Cognitive Behavioral Therapy (CBT) can be divided into two parts, “functional analysis” and “skills training.” In the first part, the therapist and you identify the stressful problem. Then a determination is made about which thoughts might lead to or worsen the problem. If the thoughts and reactions are deemed inappropriate or unhelpful, the therapist will help you unlearn the unwanted reactions and learn appropriate helpful reactions.
Some common patterns of negative thinking that Cognitive Behavioral Therapy (CBT) therapists seek to change include:
- Generalizing: looking at an event as the start of a never ending cycle.
- Personalizing: accepting blame automatically when something bad occurs and feeling like it’s “all about me.”
- Polarizing: insisting on viewing or seeing situations as all black or all white, with no shades of gray.
- Catastrophizing: anticipating the worst and exaggerating perceived failures and symptoms, especially in regard to chronic pain.
- Filtering: exaggerating the negative aspects of a situation and minimizing the positive ones.
Cognitive Behavioral Therapy (CBT) seeks to help you get beyond these negative ways of thinking. Cognitive Behavioral Therapy (CBT) tries to help you change your views of the world from overwhelming thoughts. Many therapists emphasize maintaining a level of composure—remaining as calm and balanced as possible no matter what the degree of reaction.
- Cool thoughts are usually simple statements of fact. No particular emotion is suggested by these statements. “Most days I have chronic pain.”
- Warm thoughts are linked to a mild degree of reaction and typically are associated with preferences. It’s normal to be distressed when situations or events don’t happen as you would like. “I wish I didn’t have to hurt today.”
- Hot thoughts are associated with intense emotions and significant distress such as panic, heavy depression, or intense anger, out of proportion to the situation. “If I have to continue living in chronic pain, I’d rather be dead.” Often, it is not the situation that causes all the emotional distress; it is the person’s thoughts about the situation.
The primary goals of Cognitive Behavioral Therapy (CBT) are to:
- Identify unrealistic, distorted, self-defeating, and irrational thoughts and beliefs that create more distress and misery than necessary.
- Challenge and dispute these irrational thoughts and beliefs.
- Develop more healthy beliefs and attitudes.
- Increase the confidence that you have the ability to successfully manage adverse situations and events. You can cope with difficult situations by applying learned problem-solving techniques.
Cognitive Behavioral Therapy (CBT) helps you to change your thought processes and focus on doing things for yourself in positive ways. Therapists operate on the assumption that emotional and behavioral reactions to pain are learned and therefore can be unlearned.
You may benefit in many ways from Cognitive Behavioral Therapy (CBT) therapy. Some of the more obvious benefits include:
- Improved pain management—truly less pain, and certainly less suffering.
- An increased belief in your own capability to successfully handle life’s problems—a sense of self-efficacy: “I can do that!”
- Lowered stress level. Heightened ability to relax.
- A better quality of life.
- Better relationships with others.
Although Cognitive Behavioral Therapy (CBT) takes less time than other forms of psychotherapy, success is not something that happens overnight. Generally, the Cognitive Behavioral Therapy (CBT) therapist and the client meet for between five and twenty sessions, each one lasting between thirty and ninety minutes. During the first few sessions, the client and therapist join forces to identify the client’s problem, discuss the goals the client wants to achieve out of the therapy, and discuss ways to reach those goals. It is a collaborative effort. According to the National Association of Cognitive-Behavioral Therapists (NACBT) therapists do not tell clients what their goals should be or what they should tolerate. Rather, they interact with the client and show him or her how to think and behave in a way that will enable the client to reach his or her desired goals. Therapists don’t tell their clients what to do so much as explore and discover what the clients want and then teach them how to get it. Therapists often distinguish between healthy and unhealthy responses to situations. Responses typically are seen as unhealthy when they are extreme emotional reactions, totally out of proportion to reality. Additionally, for pain clients, when a reaction is self-defeating and causes more pain, it is also considered unhealthy. The varying degrees of these unhealthy reactions have been labeled as “cool,” “warm,” or “hot.” For example, when you are in chronic pain and catastrophize, you see your life as nothing more than a painful condition that will only get worse. Cognitive Behavioral Therapy (CBT) helps with these “hot thoughts” by teaching you that although you may be in pain—this and every moment—it can be managed. It is not a hopeless condition and need not consume you or necessarily get worse. These “cool thoughts” diminish suffering. Cognitive Behavioral Therapy (CBT) encourages you to realize that you must play an active role in your therapy. You must be an involved participant, and it is imperative that you understand that you can change the pain. Once you stop believing you are a passive victim in a situation over which you have no control, real changes can and will begin to happen. Usually Cognitive Behavioral Therapy (CBT) therapists have a specific agenda and structure their sessions to work on specific techniques and concepts. For Cognitive Behavioral Therapy (CBT) to be successful, you must be willing to do homework and practice what you have learned during your sessions with the therapist. One of the most encouraging aspects of Cognitive Behavioral Therapy (CBT) is that learning and growing do not stop once treatments with the therapist are finished. You can continue to practice and develop additional coping skills. Researchers have found that even Cognitive Behavioral Therapy (CBT) computer programs have been helpful for some clients.
More Cognitive Behavioral Therapy (CBT) Benefits
Whether from one-on-one sessions, group therapy, or even computer sessions, Cognitive Behavioral Therapy (CBT) has been shown to be beneficial, especially in treating depression, stress, anxiety, or situations that are affected by these conditions, such as chronic pain. Cognitive Behavioral Therapy (CBT) can change the way you think about pain, which ultimately can change the way you feel pain. It also can help you become more active, which is another way to lessen pain. You can take a more active role in your Cognitive Behavioral Therapy (CBT) pain treatment by monitoring your progress. By keeping a written record of the strength of your pain, moods, how much pain medication you are taking, and your activity levels, you can gain insight into how well the Cognitive Behavioral Therapy (CBT) treatment is working. As with any psychoanalytical therapy, there is always a chance that it won’t be effective for some people or that problems will return once the active therapy is over. Therapists often schedule return visits, and clients are always encouraged to continue building on their successes. This blog post is an excerpt from A Day Without Pain (Revised) by Mel Pohl, MD, FASAM; Published by Central Recovery Press (CRP).