CBT – Talking Therapy for Persistent Pain

What Is Cognitive Behavioural Therapy (CBT)?

Cognitive behavioural therapy is a type of talking therapy. It can help people manage difficult situations by changing the way they think and act. CBT is often used to help people with anxiety or depression and can be helpful for many different mental and physical health conditions. CBT can also be used to help manage pain.

CBT is based on the idea that our feelings, thoughts, sensations and actions are all connected. During CBT sessions, a therapist will work with their patient to break down problems into these separate parts (feelings, thoughts, sensations and actions). By working with the therapist, you’re able to work through the areas to decide which thoughts might be unhelpful or unrealistic, their effect on each other and on you. This helps to work out how to change unhelpful thoughts and behaviours. You’ll then work with the therapist to implement these changes in your daily life and discuss them at each therapy session. The eventual aim is to learn skills that you can apply, beyond the treatment sessions.

What can CBT teach you?

CBT teaches you useful and practical skills that can be used in everyday life, focussing on your capacity to change your thoughts, feelings and behaviours. It can work as well as medicine in treating some mental health problems, and it can also be helpful when medicine hasn’t been effective enough.

How long will CBT take?

CBT can be completed in a fairly short period of time compared to other talking therapies. It’s versatile since you can work alone with a therapist or as part of a group. You could also do it online or by using self-help books.

Is CBT suitable for everyone?

CBT may be helpful to many people, but it may not be suitable for everyone. It is more helpful to commit to the process to get the most out of it, attend regular sessions and do the homework required between sessions. It might not be suitable for people with complex mental health or learning difficulties. It can make you feel anxious or uncomfortable at times, when confronting your own emotions. It also might not deal with wider problems such as social or family situations that may be affecting your health and wellbeing.

Can pain affect you physically and mentally?

Sudden, severe pain can affect you physically, causing your heartbeat and breathing to speed up, make you sweat, your blood pressure to rise, and your pupils to enlarge.

Continuous or long-term (chronic) pain may cause depression and other mental health conditions which can make pain feel worse. Pain may also cause disturbed sleep, weight loss, less interest in activities and low energy, appetite and sex drive. Therefore your mental health can be both the cause, and an effect of continuous or long-term pain.

How can CBT help manage pain?

CBT can be used for continuous and long-term pain management, sometimes in conjunction with medicine or other types of therapies, and sometimes on its own.

When we experience pain, the feeling may get mixed up with our emotions and the other things that are affecting us in our lives. CBT for pain management is based on the principle that pain not only affects your body, but also your emotions, your relationships, work, friends, family, and that all these areas are related.

The vicious cycle of pain

Long-term pain may make you feel as though you’re unable to cope with your pain. Thoughts about your pain or condition may become exaggerated and you may begin to avoid activities out of fear of the pain hurting you or getting worse. You may want to avoid being active, and to rest more. Resting too much can make you stiff and weak, which can worsen symptoms. This might make it difficult to carry on with normal activities, cause feelings of depression and affect your relationships and work. All of this can make your pain harder to deal with. This is sometimes called a “vicious cycle” of pain.

CBT can help to take back control

CBT can help you cope and manage your pain by:

• identifying negative thoughts and behaviours and change them into more realistic thoughts about the current situation.
• helping you to slowly become more active with exercises and appropriate rest periods.
• equipping you to plan your daily tasks and pace your level of activity appropriately, to avoid overdoing things.
• teaching you relaxation techniques including muscle relaxation, stretch-based relaxation and techniques to reduce stress and anxiety.

This can help you to take back control of your life so that you can do more and feel better. This may help you to break the vicious cycle of pain.

Which Types of Pain Can CBT Be Helpful For?

CBT is often used to treat low back pain, headaches and fibromyalgia pain, as well as other types of pain.

Headaches

Stress and sleep problems can be a cause of tension headaches. Cognitive behavioural therapy can help you to cope better with stress by guiding you to be more active and teaching you relaxation techniques. CBT may also help with sleep problems.

Low Back Pain

By changing your thoughts about back pain from negative to positive , CBT may help you manage your pain. With practice, you may be able to control how your mind manages your back pain, even though you might not be able to stop the physical pain. Positive thinking, calming your mind and body, and using techniques such as yoga, massage or positive imagery, may help you to feel better and reduce pain. CBT can teach you to become more active. Over time, regular, low-impact exercise like walking or swimming can help reduce your back pain and is one of the ways to ease the pain yourself.

Fibromyalgia Pain

Fibromyalgia is a long-term condition that causes pain over the entire body. It’s not known exactly what causes it. People with fibromyalgia may be more sensitive to pain, have headaches, sleep difficulties and low mood. If you have fibromyalgia, CBT may help you cope with your pain, as well as sleep disturbances, headaches and low mood.

Who can provide Talking Therapies and CBT?

In the UK, talking therapies including, CBT are available on the NHS:

• You can find an NHS talking therapy here: https://www.nhs.uk/service-search/mental-health/find-an-nhs-talking-therapies-service
• You can ask your GP for a referral
• You can choose to pay for therapy privately
• Find out if a CBT therapist is accredited on the CBT Register UK website: https://babcp.com/CBTRegister/Search#/