Treating Chronic Pain with Cognitive Behavioral Therapy

What is Cognitive Behavioral Therapy? 

Traditionally, Cognitive Behavioral Therapy (CBT) is a form of psychotherapy designed to be a short-term treatment for a number of disorders and problems such as anxiety, depression, insomnia, and a variety of phobias. In psychotherapy, CBT works by using positive self-talk to tackle situations that are uncomfortable and problematic for the patient.

For example, suppose you suffer from an extreme phobia of animals and come across a dog while walking. 

You’d probably panic a little and start thinking thoughts like: “I can’t go near it!”, “It might bite me!”, “What if it has rabies?”, and “What if it kills me?”

Because of those thoughts and all of the bad things that could happen, you become afraid so you avoid the dog and take a different route home and you feel better, for a little while, that is until the next time you see a dog. 

You panic even more because you start to think about how if you go near it it might bite you, and it might have rabies, or even kill you and you’re afraid so you avoid it again and decide never to walk home that route again and add an extra mile to your walk just so you can avoid the possibility of seeing a dog and feeling that fear. This is an example of what CBT calls a negative cycle. It shows how negative thoughts create negative feelings, which lead to patterns of avoidance, which creates more negative thoughts, and so on.

Now let’s look at how Cognitive Behavioral Therapy would address this problem.

When you see the dog and start panicking, CBT would ask you to change the way you think and think to yourself more positively about the situation. You’d try to think things like: “Lots of people have walked past dogs and lived to tell the tale”, “My fear doesn’t control me.”, “I only need to walk a short distance”, and “I can do this!”

You start to feel a little bit more confident so you do it! You walk past the dog and head home. It was scary, but you did it!

Now the next time you see a dog, you’re still going to be a little scared. But now you know you can do it! You think about that and you feel proud and optimistic, so you walk past the dog again and little by little your fear decreases until you’re able to walk past the dog with almost no problem!

This is what CBT calls a positive cycle. By using positive thoughts to create positive feelings and actions, CBT is an effective form of psychotherapy. 

However, my element of change is not about using Cognitive Behavioral Therapy for mental illness, it’s about using it for chronic pain. 

Cognitive Behavioral Therapy is not a very common means of treating chronic pain, but can be so effective in treating it that patients no longer need to take medications to deal with their pain. 

This is because the way you talk to yourself actually affects your body. Studies at the Mayo Clinic in Minnesota, USA have found that frequent negative self-talk can cause long and short term health problems such as high blood pressure, palpitations, and problems with the immune system and for those who deal with chronic pain, negative self talk can increase that pain. 

I would know. I spent the majority of 2016 dealing with an illness called Postural Orthostatic Tachycardia Syndrome and was in a wheelchair, unable to stand most of the time without extreme dizziness, before going to the Pediatric Pain Rehabilitation Program at the Mayo Clinic in Minnesota, USA where they taught me CBT. This is my story:

The Science is Behind Using CBT to Treat Chronic Pain as Well

We already know the profound effect that the mind can have on the body through things like the placebo effect. But let’s look directly at how the mind can affect the body’s perception of pain and how Cognitive Behavioral Therapy can be used to treat pain accordingly. 

Messages of pain in the body don’t travel directly from pain receptors to the brain. When pain messages reach your spinal cord, they meet up with nerve cells that act as gatekeepers. These cells filter the pain messages on their way to the brain. For example, if you do something like touch a hot stove, the gate opens wide and the “oww” message travels straight to the brain, while weak pain messages like tiny scrapes are filtered or even blocked out by the gate since they don’t require immediate attention. 

Messages from the brain can also affect the perception of pain. If the brain is stressed, it may send signals to the peripheral nerves and spinal cord to release chemicals that actually make the pain worse. This is called windup or sensitization. Sensitization is especially common in those with chronic pain because the body is already focusing a lot of attention on the area of the flare-up and become oversensitized in response to pain.

Cognitive Behavioral Therapy can literally retrain the brain so that it feels less pain. Through positive self-talk, those with chronic pain can end their pain catastrophizing, which decreases sensitization, and in turn decreases the perception of pain. It can also help in causing the brain to release natural painkillers such as endorphins, which can help decrease the need for pain medications.

However, Awareness Still Needs to be Spread

While Cognitive Behavioral Therapy is a recognized success in the field of psychology, many doctors, psychologists, and psychiatrists still don’t know how to use it to treat chronic pain. Upon returning from the Mayo Clinic, I was unable to find a single doctor who had experience in using Cognitive Behavioral Therapy to treat chronic pain in my home state of Hawai`i.

You can help to raise awareness about the effectiveness of CBT by sharing the information in this page with anyone who you think might benefit from it, by encouraging your loved ones who suffer from chronic pain to think positively because their thoughts really do affect their bodies, and by talking to your physicians about CBT if you think it’s something you could benefit from.

If you’d like to learn more about Cognitive Behavioral Therapy and the effect it’s had on my life. I will be available to talk through this link from 6:00PM to 7:00PM PST on April 28th.

The Mayo Clinic. (2008). “Teens and Beating Chronic Pain” . 
The Mayo Clinic. (2008). “Cognitive Behavioral Therapy”.

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