Cognitive Behavioral Therapy for Chronic Pain, Unpacking the Basics: Sessions 1 and 2
Main points, no filter
✅ CBT-CP isn’t about curing your pain. It’s about helping pain stop shrinking your life.
✅ The intake is about your story, not a checklist. What pain has taken. What’s helped. What’s made things worse. And what you want back.
✅ This isn’t cookie-cutter therapy. There’s structure, but the therapy fits you — not the other way around.
✅ Chronic pain is physical, emotional, and social. our thoughts, emotions, behaviors, stress, and relationships all play a role in how pain shows up.
✅ The pain cycle can be interrupted. When we know how pain keeps feeding itself, we know exactly where to step in and create change.
What Is Cognitive Behavioral Therapy for Chronic Pain (CBT-CP)?
o Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) is an evidence-based treatment for managing chronic pain
o Sessions have structure, but they are unique to the individual
o Treatment will focus on all aspects of chronic pain, including the biological, psychological, and social impacts it has
As promised, this blog series is going to break down CBT-CP and let you know what you can expect during the treatment sessions. It is not intended to be a workbook, but rather an in depth, honest look at what therapy can look like and how it can be tailored and unique for you.
What to Expect From CBT-CP Sessions (No Workbooks, No Cookie-Cutter Therapy)
Trust me, if I meet with a personal trainer, I don’t want them to just hand me a sheet of paper with exercises and tell me to work on them on my own. And I wouldn’t expect someone to have that approach to therapy either. I want someone to speak to me, listen to me, get to know me, and understand my journey.
That is how I approach being a therapist. Your journey got you where you are, so help me to understand it so we can work together to make good changes for the future.
Keep reading to see what you can expect in the first few weeks of treatment. Notice I say the first “few weeks”, because we have plenty of wiggle room here. We are going to make the therapy fit you, not make you fit the therapy. Have you ever seen the movie Monster in Law, where she talks about how she is making her wedding dress to fit her, she isn’t forcing herself to fit into the wedding dress? No? Anyway…
Session 1 of CBT-CP: The Intake Session (Yes, We’re Talking About That One)
You probably hate the word “intake”. You might associate it with a provider asking you a million questions, interrupting you, and asking you to rate a lot of things on a scale of 0-10. You might be picturing somebody sitting in front of a computer, typing away, feeling as though they aren’t really hearing a word that you are saying. Maybe you are picturing somebody looking at x-rays and telling you that “everything came back normal so nothing is wrong”. Don’t get me wrong, I am going to ask you questions. And I am going to listen to all of your answers, thoughts, and concerns. I am not going to make assumptions, and I am not going to tell you that you need to learn to live with chronic pain.
Why the CBT-CP Intake Session Feels Different
Well first, I prefer to write my answers down on paper old school versus type them on my computer. You are gonna see every shade of pen ink. Relax, I’m kidding. Well, sort of. I am going to write things down. But it’s because everything you have to tell me about your pain journey is incredibly important for me to understand who you are and be able to help you move forward.
What a CBT-CP Intake Focuses On: Going Beyond Pain Scales
o Listen to your unique experience and journey with pain (because chronic pain is a journey, not something that can be simplified into a single accident or experience)
o Work with you to understand what has worked to manage your pain, and what hasn’t (and what’s made it worse, because that happens too)
o Ask you to make small changes and try new things to see what makes a difference (we will talk about these changes together; I won’t decide them for you)
o Support you, be present, and help motivate you
What I Ask During a CBT-CP Intake Session
o What the chronic pain has taken from you
o What a “good pain” day looks like (you know the days I mean, sometimes they are few and far between)
o What a “bad pain” day looks like (you definitely know what these days look like, and you might feel like they are almost every day)
Identifying What Has Helped — And What Has Made Chronic Pain Worse
I’m not just going to ask what treatments you’ve tried, what medications you’ve taken, and why you aren’t engaging in more physical activity. Yes, I am going to ask about what you’ve tried, but I am going to ask about what worked and what didn’t. I am going to ask about the things that used to work and then stopped. I am going to ask what you want to see differently. I suspect you might be thinking, “well, I don’t want to be in pain”, and I respect that answer. But I also won’t lie and say we can simply do that. You’ve heard me say before that chronic pain is chronic. So unfortunately, we cannot cure it, and we can’t necessarily get that traditional 0-10 pain score down to a specific number. We may not be able to get you back to a specific activity like running marathons, but what we can do is make your world bigger, and help you to improve your quality of life. Sometimes this includes figuring out new passions, hobbies, or social activities.
Session 2 of CBT-CP: The Psychoeducation Session. The session where your therapist talks too much
Ahh, the psychoeducational session. The session where she reads from the manual. Not quite. Am I going to provide some psychoeducation in this session? Of course. But we are going to talk this one through together, because your experience with the pieces of the puzzle in this session are very important in knowing some different directions we can move toward for positive, long-lasting changes.
What Psychoeducation Looks Like in Cognitive Behavioral Therapy for Chronic Pain
o The Cognitive Behavioral Therapy (CBT) and chronic pain model
o The chronic pain cycle
o The biopsychosocial impact of chronic pain (because chronic pain doesn’t just impact how you are feeling physically)
The Cognitive Behavioral Therapy and Chronic Pain Model Explained
If you’ve been following along, I recently discussed what cognitive behavioral therapy for chronic pain is. The basic relationship goes like this. Our thoughts, feelings, and actions (or behaviors) are all related and can impact one another. With chronic pain, we are adding in an additional factor, the pain itself. Your pain can impact your thoughts, feelings, and actions, and your thoughts, feelings, and actions can impact your chronic pain. For example, think about how your pain may increase when you are feeling angry and tense. The pain becomes an additional piece of the puzzle that has a daily impact on your life.
How the chronic pain cycle works
1) You have chronic pain
2) That chronic pain results in you not being as active
3) When we can’t do the activities we enjoy, we begin to experience negative emotions
4) When we feel down and negative, we isolate and avoid
5) When we isolate and avoid, we feel more distressed
6) The more distressed we feel, the more chronic pain we experience
It’s a vicious cycle. And when you have chronic pain, it goes round and round. Another way to look at it is like a tornado. Not only does it spiral around and around, but the deeper the spiral goes, the more wicked and intense it becomes. The more intense it becomes, the more difficult it is to get out. The impact of chronic pain works this way too. The benefit here is that because we understand how the cycle works, we know where we can intervene to “break” it and help to get you out.
The Biopsychosocial Model of Chronic Pain
o This is the intersection of factors that impact chronic pain and includes…
o Biological
o Psychological
o Social
Chronic pain isn’t just about one single accident, injury, or moment in time. Maybe there was an accident that occurred, led to an injury, and ultimately led to chronic pain. Maybe it was a surgery gone wrong. Maybe it is a pain that has just gotten progressively worse over time, without being able to identify a cause. Regardless of the “how”, chronic pain impacts many factors in your life. In treatment, we are going to talk about the specific and unique factors that impact you. But for now, I will speak generally and talk about what kinds of things could fit into each of the above categories.
Biological Factors That Influence Chronic Pain
o Medical concerns
o Pain
Psychological Factors That Maintain Chronic Pain
o Thoughts
o Emotions
Social Factors That Can Worsen Chronic Pain
o Personal relationships
o Work
o Activities
How Thoughts, Emotions, and Behavior Fuel Chronic Pain
Think about your first thought on a “bad pain day”. I suspect it isn’t something positive. Maybe you think “I can’t do this again” or “when will this end” or “why is this happening to me”? Perhaps the thought is “I am a failure” or “I can’t take care of my family”. Generally, any thought you have on a bad pain day isn’t going to be a good thought. These thoughts are awful. And common. So common on a bad pain day. And…these thoughts are super unhelpful. How about the emotions? After these thoughts, how do you feel? I am going to go ahead and assume that they are not happy, confident, good, productive, or any other positive emotions you can think of. They are likely down, depressing, disheartening, exhausting, and overwhelming thoughts. They may have become your typical day to day thoughts and it might feel like you no longer have control of them. This is where we can do the work in therapy to change these thoughts, and we will talk in detail about that in a few weeks when we break down our cognitive coping sessions.
When you are hurting from chronic pain, you often don’t feel up to engaging in typical activities, socializing, or being the life of the party. This can start to negatively impact relationships with friends and family. Maybe sitting in the bleachers at your child’s baseball game, sitting in a hard restaurant chair for hours, or going for an after dinner walk with your spouse has become too painful. You might start to feel like you are missing out on life, and missing out might lead to tension in your relationships.
What are some of those specific biopsychosocial factors that can impact your pain?
o Degenerative changes
o Muscle tension
o Social isolation
o Depression
o Stress and worry
o Overactivity
o Underactivity
o Catastrophizing
As you can see, there are many factors that can negatively impact your chronic pain. These might not all apply to you, and you likely also have additional unique factors that impact your pain. We will talk about these factors in treatment and which ones are most important for you to make changes to. Maybe you want to be able to go spend time with friends. Maybe it’s about being able to get through a work day. Or maybe you just want to go watch your child play a sport. We will work together, think outside the box, and try to find a way to get you back to doing the things that are important to you.
Two Sessions Into CBT-CP — And Just Getting Started
Yep, that breaks down what you can expect in the first two sessions of CBT-CP. But remember, like I said, we can always take more time to focus on specific areas as needed. Do you want to learn more about CBT-CP and how it can help you manage your chronic pain? Continue following along in the coming weeks as I break down each session. Ready to jump in and take control of your chronic pain now? Schedule a consult today! As always, you can try some skills and techniques out on your own by downloading the free Pain Coach App (here for Google Play) Pain Coach - Apps on Google Play or (here for Apple) Pain Coach by VA App - App Store.