In this lesson, you will learn about Cognitive Behavioral Therapy (CBT) and how it can help people with chronic pain.

What is CBT?

CBT is a psychotherapeutic approach to understanding how thoughts, feelings and behaviours interact. In basic terms, it is a therapy that dissects the way you think, feel, and act. By better understanding these, CBT can help change unhelpful thought/behavioral patterns.

Once harmful patterns are identified, work is done to replace them with healthier ones.

Disclaimer:

True CBT is done with a trained therapist. It occurs over a number of sessions, with homework in between. In these sessions, the therapist helps the client talk through their challenges and reach their goals. The homework allows the client to practice what they’ve learned.

In 8-12 sessions, CBT can be life changing. However, sessions can cost over $200 per session. Not everyone has the time or money for this.

This course is not true CBT. However, we have included common techniques used in CBT. These can still be helpful without breaking the bank.

CBT and Chronic Pain

CBT can help you to understand your pain, adjust your feelings about pain, and work towards pain-related goals.

This process exposes unhelpful thought/behavioral patterns that affect your pain. For instance, can you think of a time where you avoided or gave up important things in your life because of pain?

These tools and techniques can help you take back control of how you spend your time. As a result, your quality of life improves as you begin to engage in your life again.

The objective of CBT for chronic pain is to reduce the negative impact of pain on your life. This involves improving physical/emotional functioning and increasing your coping skills. This, in turn, can lead to the reduction of pain intensity.

In true CBT for chronic pain (facilitated by a therapist), this objective is reached through six stages. They are assessment, reconceptualization of pain, skills acquisition, rehearsal, maintenance, and follow-up. Some of these require the therapists’ expertise. For example, the assessment of your condition and the follow-up. However, there are some concepts that we can borrow from other sections here; in particular, the reconceptualization of pain and skills acquisition.

This course can help you to learn about how to re-conceptualize your pain and gain some skills. Although, it is up to you to rehearse (practice) and maintain these skills!

The skills that CBT focuses on are cognitive and behavioral skills that can affect your perception of pain. Some of these skills include exercise, relaxation, and cognitive strategies. A big part of this involves shifting your current beliefs. For example, you may currently believe that any form of activity will hurt you, so you avoid doing many things. Shifting this belief will help you become more active and engage more in your life, leading to positive outcomes.

The following lessons will focus on helping you gain skills to better cope with pain. Some of the skills are meant to break you out of the pain cycle. After some time, your pain may eventually improve with practice of these skills.

The Psychology of Pain

As you now know, thoughts, feelings, and behaviors interact; however, pain also interacts with these. Can you think about how pain could affect each of these parts of you?

Here are some examples:

Likewise, your thoughts, feelings, and behaviors can also affect your pain. Here’s how:

If you are constantly thinking “it will hurt if I go up the stairs”, you might avoid the stairs. You may also feel shame that you cannot go up the stairs like before. This can make you feel (or notice) greater pain when using the stairs. You’re expecting and focussing on the pain when you tackle the stairs.

What is pain?

Pain acts as a danger alarm. It signals injury or threat of injury. Chronic pain can occur when pain is reinforced through conditioning.

Yes. Just like Pavlov’s dog. Except instead of drooling, it’s pain. The metaphorical bell in this situation can be several things. For example, a movement that originally caused pain due to an injury. It can be a place associated with pain, or a time of day.

Pain pathways in the brain become amplified and reinforced over time. The injury heals but the pain sticks around.

Cycle of Chronic Pain

Have you ever heard of a positive feedback loop? It is a process where the product of the process triggers the same process to continue. In short, it amplifies change.

The cycle of chronic pain is a positive feedback loop. As the cycle continues, pain and restrictions get worse.

The cycle goes like this:

Pain may cause you to lower your level of activity. This can decondition the muscles, causing muscle loss. Then, not being able to move like before may cause negative self-perception. This may create shame. So, you may start to avoid all potentially painful activities. This causes you to withdraw from your social circle. You become distressed as this leads to further disability. These processes reinforce chronic pain, and the cycle continues.

CBT attempts to break you out of this cycle. In the following lessons, we will cover techniques to help with this.

Practice 

Practice is necessary with CBT. It is the only way to reframe your thinking. For this reason, there are several worksheets found throughout the course. These worksheets will help you practice various techniques. You can download the worksheets directly from each lesson. They will be listed under the “Practice” section – like this one.

Reflect 

This course includes opportunities to reflect on what you’ve learned through guiding questions. You will find prompts throughout the lessons and under the “Reflect” sections. It may help to write your thoughts down as you go or discuss with someone you trust.

In the next lesson, you will learn how to set achievable goals. These goals will help you focus your efforts to improving specific areas related to pain.

You must take the quiz before proceeding to the next lesson.