CBT in the Treatment of Chronic Pain

Cognitive Behavioural Therapy (CBT) is one of the leading psychotherapies used to address chronic pain, and there’s good reason why. CBT explores clients’ underlying thought, behavioural, and emotional patterns, the relationship between them, and associated environmental circumstances that might sustain symptoms of distress. It encourages clients to develop new skills to change unhealthy ingrained patterns to in turn change their symptoms. CBT has been extensively researched and is widely used in the treatment of depression, anxiety, stress, anger, addictions, eating disorders, obsessive compulsive disorder, panic disorder, bipolar affective disorder, schizophrenia, and chronic pain, among other concerns.

Pain refers to an unpleasant sensory experience usually accompanied by a strong adverse emotional response. In fact, the same centres of the brain that process physical pain also process emotional pain, so oftentimes when one form [of pain] exists, the other may follow. Chronic pain can contribute to low mood (depressive symptoms), increased worry about health concerns (anxious symptoms), and increased use of the healthcare system, which can be emotionally taxing in itself. It can cause strain on relationships, long-term disability, a loss of one’s life as they knew it, and a loss of one’s identity. CBT is an effective treatment to address all of these concerns, because it emphasizes changing one’s habits within the means available to them, which can be empowering, because even if we can’t change our external or physical realities, we retain the option to shift our mindset.

With increased studies in neurobiology, largely due to advancements in brain imaging technology and accessibility of these technologies, the leading approaches in the field are shifting away from the older thinking that our brains and bodies should be treated separately. A more holistic approach is being adopted, treating the brain and body concurrently to affect changes in clients’ presenting symptoms. You might notice that if we change how our bodies feel physically, we tend to change how we feel emotionally, which often brings changes in our thoughts and behaviours, and vice versa, since they’re all considered interconnected in the CBT model. It also follows that the saying “it’s all in your head” misses the mark, because even if a difficulty is originally psychological in nature, if left untreated, it can impact one’s physiology, disrupting hormones, neurotransmitters, blood pressure, and various other body functions. And our mental and/or physical states can become entrenched; that is, our systems can become acclimatized to staying stuck in a certain ‘mode’ (e.g. feeling depressed or stressed), thereby contributing to symptom chronicity, thus calling for an active, change-oriented approach to therapy.

CBT encourages goal-setting, which can help address the low motivation frequently seen in clients dealing with chronic pain. It involves practices to identify and challenge inaccurate beliefs accompanying the pain, and helps develop cognitive behavioural coping strategies, such as pacing daily activities and shifting negative thoughts. CBT also integrates relaxation practices which teach clients how to decrease emotional reactivity to physical pain by changing how they respond to it (e.g. with calming practices rather than panic), which uncouples the negative association between experiencing physical pain and getting emotionally upset. Relaxation practices are helpful because decreased body tension is less likely to exacerbate the experience of physical pain (think about the powerful impact lamaze can have on childbirth, or relaxing your muscles when getting a needle).

CBT is often combined with mindfulness-based practices, such as Mindfulness-Based Cognitive Therapy (MBCT), which teaches participants to notice pain non-judgmentally, with curiosity and acceptance. This change in perspective often results in less emotional reactivity to pain (mental or physical), thereby cultivating a greater tolerance, which can be a central goal in the treatment of chronic pain. Luckily, in Canada it’s becoming increasingly common for rehab centres to integrate these types of approaches to enhance recovery.


Pain management strategies you can try at home:

  • Notice your beliefs about pain. Are they limiting you?
  • Practice spreading out your daily activities and/or planning to tackle strenuous tasks when you tend to feel better in the day, or leave them for “good days”
  • Anticipate needing extra recovery time after strenuous activities and don’t judge yourself for it.
  • Resist the urge to push beyond your limits. Take a break if you need one. Pushing yourself too hard can be counterproductive, leading to longer recovery times.
  • Getting proper sleep can reduce emotional reactivity (i.e. crankiness).
  • If the pain disturbs your sleep, relaxation training and meditation can offer a restful alternative that’s nearly as restorative as REM sleep.
  • Practice mindfulness: focus on the present moment with non-judgment, curiosity, and acceptance. Connect with a mindfulness-based therapist if you’d like to learn more.