What is Cognitive-Behavioral Therapy for Chronic Pain?

Chronic pain is a common medical condition in the United States that is caused from a variety of injuries and illnesses. Chronic pain is very complex and difficult to treat; usually people have better results when a variety of approaches are used, such as medication, psychotherapy, physical therapy or other form of movement/exercise, and even, at times, surgery. One form of psychotherapy for chronic pain is called Cognitive Behavioral Therapy for Chronic Pain (CBT-CP). CBT-CP has been shown to be very effective in improving quality of life, helping people return to work and play, and reducing pain. The overall premise of general CBT is that thoughts, feelings, and behaviors all influence each other and the outcome of this influence can more or less helpful to a person as they work to resolve problems, improve relationships, and try to live a more meaningful life. For example, a person might have recurrent thoughts of “I’m not good enough” which influences feelings of sadness and shame, which in turn influences behaviors that are not so productive such as spending a lot of time alone, not putting in for a promotion, or not making a treatment appointment. This same overall premise is what CBT-CP is based on. This model might put it in a different perspective:

Notice how the arrows are bi-directional (thoughts influence behaviors and vice versa, emotions influence behaviors and vice versa, and all of those things influence one’s experience with pain). If you have chronic pain, you might have noticed how you are more aware of your pain when you are feeling depressed, mad, or are more focused on your pain. Or perhaps you notice your pain more when you exercise too much, do the dishes for too long, or the opposite, when you stay in bed or sit for a long period of time.

CBT-CP uses a theory called the “Gate Theory”, which suggests that certain factors open and close a theoretical “gate” in the body which allows more or less pain messages to get through. So the strategies of CBT-CP help a person narrow, or “close” the “pain gate” by teaching them skills that will make the connection between thoughts, feelings, behaviors, and pain work to their advantage. Techniques that are used in CBT-PC are modifying your thoughts, using visualization or diaphragmatic breathing to relax the body and mind, improving your sleep, pacing your activities, and a number of techniques. By learning and regularly using the techniques you can learn how to be in the drivers seat, instead of your pain.

There are many great resources available to help you understand the many options for treating pain. The American Chronic Pain Association has a lengthy, but very good, document on the various types of treatment for chronic pain. You can link to that document here http://www.theacpa.org/uploads/documents/ACPA_Resource_Guide_2015_Final%20edited%20(3).pdf.

I’ll be talking more about chronic pain over the month of February, so check back soon! And if you have any questions or would like to get started in treatment give me a call at 539-777-1129 or email me at Dr.Leedy@legacycounselingservice.com.