Cognitive behavioural therapy (CBT) is a form of talk therapy that helps people identify and develop skills to change negative thoughts and behaviours. CBT states that individuals — not outside situations and events — create their emotional disturbances. By changing their negative thoughts and behaviours, people can change their awareness of disturbance and develop better coping skills. With pain for example CBT does not infer that pain is imagined or all in the head. Far from it, the pain felt we identify as real this can have a catastrophic effect on a persons quality of life and esteem. We have the ability with newer research showing how to develop tools to manage this pain and act against the memory for pain that the brain has maybe created even when tissue damage has healed.
What can CBT do for you? Cognitive behavioural therapy helps provide emotional relief in a few ways. First, it changes the way people view their life disturbances and perception of the world & themselves. CBT can help you change the thoughts, emotions, and behaviours related to your repetitive depressive episodes or panic attacks. For example, it helps you improve coping strategies, and to put your emotional discomfort in better context. To quote stoic philosopher Epictetus `People are disturbed not by things themselves but the view they take of them`
With Chronic pain CBT can help change the physical response in the brain that makes pain worse. The brain regularly creates a memory for pain even if tissue damage is healed. Pain causes stress, and stress affects pain control chemicals in the brain, such as norepinephrine and serotonin. CBT reduces the arousal that impacts these chemicals. This, in effect, may make the body’s natural pain relief response more powerful.
How Does CBT Work?
It is believed that changing your thoughts about pain can change how your body responds to pain.
You may not be able to stop negative events from happening in your life but with practice you can control how your mind manages these events.
A therapist using CBT will help you learn to:
• Identify negative thoughts
• Stop negative thoughts
• Practice using positive thoughts
• Develop healthy thinking
Healthy thinking involves the regularity of self challenging negative automatic thoughts that occur in any given trigger situation. CBT states importantly that its not the event, situation or person causing or maintaining your suffering but often the thinking around it. Your pain is very real but the brain can play a part in it continuing, almost like a memory setting or fixed tune the brain continues to play. If this can be reset there is a good chance of pain reduction.
CBT can also teach you to become more active. This is important because regular, low-impact exercise, such as walking and swimming, can help reduce back pain over the long run.
For CBT to help reduce pain, your treatment goals need to be realistic and your treatment should be done in steps. For example, your goals may be to see friends more and start exercising. It is realistic to see one or two friends at first and take short walks, maybe just down the block. It is not realistic to reconnect with all of your friends all at once and walk 3 miles at once on your first outing. Exercise can help you to deal with chronic pain issues.
What is CBT pain management?
Cognitive behavioural treatment (CBT) for pain management is based upon a CBT model of pain developed through extensive research with patients experiencing physical pain.
Here at our Bristol CBT Pain Clinic our Pain Management Programme (PMP) aims to assist participants learn how to manage their experiences of pain in more helpful and productive ways.
The central concept of our approach is the notion that pain is a complex experience that is not only influenced by its underlying physical experience, but also by an individuals’ thoughts/images, feelings and behaviour.
Our approach to CBT for pain management has the following basic elements:
• A treatment rationale that helps clients understand that thoughts/images and behaviour can affect the pain experience
• Emphasis on the role that clients can play in controlling their own pain.
What is the Pain Management Programme (PMP)?
Our programme teaches coping skills training through a wide variety of cognitive and behavioural pain coping strategies:
Relaxation training techniques.
Activity pacing and pleasant activity scheduling are used to help patients increase the level and range of their activities and return to more ‘normal’ activities and levels of activity in a helpful way.
To maximize the pain control power of CBT, do the following:
• Believe it will work. Some people who try CBT proceed with caution because they worry that health care providers won’t believe the pain is real. If you don’t feel listened to, you won’t engage in the process and do well. Realize that your Therapist knows your pain is real and will work collaboratively to help.
• Actively participate. Like many things, you will get out of CBT what you put into it. The more work you put toward completing your assignments and learning, the better your pain relief outcome will be.
• Complete the program. An issue with CBT is that people don’t always complete all aspects of the recommended program. For the therapy to work for pain management, you have to attend sessions, do your homework, and follow the activity plan – this is critically important.
• Practice new skills. Repeat & Practice the new ways you learn to think and act in response to pain often, even when you’re not in pain. This may also entail keeping a log of your pain and the skills you use to fight it. Practice will help you draw on your CBT skills automatically when you need them.
• Keep an open mind. If you have a persistent need to be right or you can’t stand looking at things a different way, CBT won’t work for pain control. You need to be able to see that there is an alternative way of looking at things that may be a better way and will help you.