CBT for Chronic Pain: What It Is & How It Helps
Main points, no filter
o Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) is an evidence-based treatment shown to be effective in managing chronic pain
o CBT isn’t just another cookie cutter treatment
o Chronic pain may be chronic, but it can also be managed
o You can learn ways to improve your quality of life and get back to feeling like you
If you haven’t already read our blog about chronic pain, check that out here. This article from Cleveland Clinic breaks down chronic pain causes and the different types of experiences with chronic pain.
Keep reading for information about Dr. Pimble’s approach to chronic pain management.
What is Cognitive Behavioral Therapy (CBT)?
If you have ever looked into therapy or spoken to a friend or family member that has gone, then you have probably heard the term “CBT”. You may have heard of CBT as being the “gold standard” treatment for some diagnoses. Or maybe when you hear CBT, you think, “ugh, another cookie cutter treatment”. Let’s talk about what CBT really is (and what it isn’t).
CBT is
o Structured (with your input)
o Goal-oriented (your goals, not mine)
o Tailored to you (unique for your needs and wants)
o Effective (check out the stats, this treatment works)
o Evidence-based (backed by research)
CBT is not
o Cookie cutter
o One size fits all
o Your therapist reading from a manual
Yes, we have manuals and clinician workbooks when it comes to using CBT. But that doesn’t mean that we are reading from these books word for word and forcing you into a category or treatment that doesn’t work for you. What it means is that the framework and theory we are basing your care on has been researched. Extensively. It means these skills and tools have been shown to be effective for a variety of diagnoses and that we will work with you to see which of these tools might work best for you. You get to choose your goals and what you’d like to see differently. I certainly wouldn’t want to invest the time or energy on working toward a goal that isn’t important to me, and I don’t expect you to do that either. Together, we’ll talk about what’s important to you and the changes you’d like to make. Then we will make a realistic plan of how to get there.
CBT focuses on
o The relationship between thoughts, feelings, and actions
o Identifying and changing unhelpful behaviors (lack of behavior is a behavior in itself)
o Identifying and changing unhelpful thought patterns
o Setting reasonable, attainable goals
So, what does CBT look like in action? Think about it like this. If you live in the DMV, then you are familiar with the driving and traffic in the area. It’s a bit…well…let’s just say intense. So, imagine this. You are driving on 695 in the right-hand lane, doing the speed limit (I know, I know, just listen). A car comes flying up behind you and cuts around and in front of you, and slams on their breaks. You need to slam on your brakes to prevent yourself from hitting them. What do you do in this situation? You probably don’t say thank you. You may have a few choice words that you blurt out, perhaps an unfriendly hand gesture. So now you’re irritated. You might be driving more aggressively, you might be in a bad mood. Maybe you allow this to follow you around all day, even staying up in bed thinking about how annoyed you are at the situation. So. What just happened? A series of events, or an antecedent, behavior, and consequence. A car cut you off, you responded automatically (insert choice words or hand gesture here), and it then impacted your emotions for the rest of the day. But what if we changed what we could control here? We can’t change the car cutting you off, but we can change your reaction (or automatic thoughts), and in turn your emotions and mood. This is a very simplified example of how CBT can work.
Automatic Thoughts can be helpful…and harmful
The downside of automatic thoughts is that they are, well, automatic. This can be awesome in some situations, and super frustrating and unhelpful in other situations. Our brains are extremely efficient. They learn information from the moment we are born, and they don’t stop. Our brain learns to identify patterns to make things easier for us. Have you ever heard the phrase, “it’s like riding a bike?” Think about behaviors you learned that are really easy now, like tying your shoes, buttoning your shirt, or driving a vehicle. All of these things make our lives simpler and make tasks more manageable. But unfortunately, our brain also makes our thoughts more efficient by putting them into categories. When we are young and learning more new things, these categories can be helpful. For example, as a child, all or nothing thinking can be helpful, such as when crossing a street. You only walk when the crosswalk says walk, you never deviate from this. As adults, we learn that the world is full of shades of gray and automatic thoughts are not always helpful. Keep an eye out in the coming weeks to read a breakdown of automatic thoughts and how we can learn to challenge and change them.
Why CBT-CP for chronic pain management?
Because nothing changes if nothing changes. If we continue to engage in our current behaviors, we will continue to get our current results. Chronic pain is difficult to manage, and having an illness that is chronic is exhausting, and often quite disheartening. CBT-CP can help you to learn new strategies and give you a fresh perspective on managing that daily pain. Managing your pain helps to put you back in the driver’s seat and start calling the shots again.
I hear you, you’ve already tried
o Primary care
o Physical therapy
o Injections
o Medication
o Surgery
You’ve tried it all. You’ve been to a physical therapist, primary care doctor, acupuncturist, and chiropractor. You’ve tried medication, injection therapy, maybe you’ve even had surgery. But the pain remains. Unfortunately, it’s chronic. But that doesn’t mean that treatment doesn’t exist, and it doesn’t mean that you need to “learn to live with it”. You can learn to manage the pain. What we need to do is think outside the box. We need to make your world bigger, so the pain is smaller. With CBT-CP, we can do just that. While we cannot cure chronic pain, we can learn ways to manage the pain to improve your overall quality of life and get you back to doing what’s important to you. But don’t get me wrong, there is a place for all of the above treatment options. Sometimes we just need to combine them with a little something else too. That’s where therapy comes in.
CBT-CP overview
o Evidence-based, research backed treatment (the data shows us it works)
o 12 sessions, including the intake and optional booster session (we can add additional sessions as we see fit together)
o Weekly or biweekly therapy, 50 minutes per session
o Skills practice on your own between sessions
o Support from a professional with years of experience in chronic pain management
o Convenience of virtual or in person appointments (hybrid works too!)
That’s right. Three months. Just a quarter of a year. How much time have you invested in physical therapy and other treatments for chronic pain? How much time have you spent waiting for that specialist appointment? I just ask that you try and make changes for three months and see what happens. Not so bad in the grand scheme of things. But keep in mind, if there are areas that you would like to focus more on, we can certainly add in additional sessions as you see fit. Like I said, while this treatment is based on a structure, we will adjust it to meet your needs.
What do CBT-CP sessions look like?
o Session 1: Intake. This is when we get to talk about your experience with chronic pain. Tell me about what has worked and what hasn’t.
o Session 2: This is where we talk about the intersection between biological, psychological, and social aspects that impact chronic pain.
o Session 3: Goal setting session. Together. Tell me what you want to see differently and we will figure out how we may be able to make that happen.
o Session 4: Exercise and Activity Pacing. Don’t let the word exercise intimidate you. I will meet you where you are and we will make small, intentional changes.
o Session 5: Relaxation. One of my personal favorites. In this session we work on relaxing your mind and your body. Your body isn’t going to relax if your mind won’t, and vice versa.
o Session 6 & 7: Pleasant Activities. During these sessions we will get you back to doing things that are important to you, or maybe we will find new things that bring you happiness.
o Session 8 & 9: Cognitive Coping. In these sessions we will talk about the unhelpful thoughts that get in the way, and how we can challenge and change these thoughts.
o Session 10: Sleep. Chronic pain often equals chronic sleep issues. In this session we will talk about how we can get you a better night’s rest.
o Session 11: Relapse Prevention. A good defense is a good offense. This is where we make a plan to combat those flares and bad pain days.
o Session 12: Booster. A little refresher can come in handy!
Therapy for chronic pain is your opportunity to be heard. And I want to hear all of it. The good, bad, and ugly. I want to know your previous experiences with providers. The types of pain. The where, when, and how long. I don’t just want to hear a number from 0-10, I want to know if the pain is throbbing, tingling, aching, burning, or something different.
This infographic from the Cleveland Clinic highlights the types of pain. I want to know if you can relate.
I want to understand your experience. What worked? What didn’t work? What have you been told about your pain? Because only then can we work together to manage your pain. I want to know where you’ve been, what you’ve missed, and where you want to go. I want to know you now, and understand the you “before the pain”, so that we can find a new path forward to get you feeling like yourself again. I can’t rewind the clock. But I can work with you to help you move forward and create a new normal that works for you.
Stay tuned in the following weeks as I break down the sessions of CBT-CP. Want to try out some skills now? Check out the Pain Coach app (here for Google Play) Pain Coach - Apps on Google Play or (here for Apple) Pain Coach by VA App - App Store. Ready to jump in and start therapy now? Schedule a consult today!