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Chronic Pain Treatment and Cognitive Behavioral Therapy

Cognitive behavioral therapy, a form of talk therapy, helps individuals identify and change their negative thoughts, emotions, and behaviors. CBT teaches that people create their own experiences. With CBT, people can learn to change negative thinking and behavior to improve their ability to cope with pain and improve their pain tolerance. It can also enhance your coping strategies and give you new perspectives about pain and provide pain relief. CBT can modify the brain’s response to pain. 

This blog will explain what cognitive behavioral therapy is and how CBT can influence pain management.

Chronic Pain Management and CBT

What Can a Psychologist do to Help You with Chronic Pain?

Cognitive behavioral therapy is a form of psychotherapy where the goal is to help individuals make healthy lifestyle changes that will improve their health. The therapist does not provide medication or procedures; It’s about helping the client create positive changes and engage in healthier behaviors. The process of psychotherapy for pain includes psychoeducation, talk therapy, and patient engagement to learn about and make health-related changes. These health-related changes have two categories:

1) Behavioral changes and

2) Cognitive changes

Cognitive changes refer to learning and acquiring new skills, while behavioral changes relate to the actions taken.

Examples of Cognitive Learning for Chronic Pain Treatment:

  • Increased knowledge of your condition
  • Increased understanding of your options and choices that lead to increased well-being
  • Improved drive and empowerment to make healthy choices
  • Increased Insight 
  •  Becoming a conscious thinker rather than a reactive thinker
  •  Increased tolerance to pain
  • Enhanced coping abilities to deal with pain and stress
  • Increased acceptance

Examples of Behavior Changes for Chronic Pain Treatment:

  • Exercising
  • Beneficial nutrition choices
  • Maintaining a healthy weight
  • Smoking cessation
  • Improving sleep
  • Scheduling activities that bring you joy or are compatible with your values
A supportive therapeutic relationship will provide a safe space to learn about your condition and strategies to make healthier choices. It will increase your awareness of your current decisions to make space for new and intentional decisions.

The cognitive skills you learn make way for the new behavioral changes you will implement; they are used to make behavioral changes. With the support of your therapist, creating and sticking to these changes may be more manageable. You can positively affect your well-being by being open to learning and receiving feedback and being willing to make behavioral changes over time.

How is CBT used to Treat Chronic Pain?

Pain is not as simple as just “injury = (equals) pain”; we must also think of our nervous system, which includes the brain stem and spinal cord — it’s more like “injury (+) nervous system (=) pain.” We have nerves in our body that allow our brains to know we are experiencing pain. Pain is like a fire alarm system. A smoke alarm detects smoke which then activates a loud sound, letting you know there is danger. Pain is similar because it’s like a tactile alarm in our body, produced by our nervous system, that signals to our brain something is wrong.

CBT can target and change one of the variables in the above pain equation — CBT may help us train our nervous system to produce less pain. It is essential to understand the mechanisms of pain to comprehend how CBT can achieve pain reduction. First, we need to know how the nervous system produces pain.

Pain is a sensation, like tingling, itching, numbness. Generally, speaking sensations are produced and connected through the somatosensory cortex of our brains. However, pain generates in the limbic system, where we have our flight or fight response. The limbic system is what creates our experience of pain. It causes pain to have a painful sensation and be distressing or alarming. Our experience of pain causes us to go into fight-or-flight mode, which is our natural danger response. Pain alarms us and alerts us of danger to our bodily integrity, which may cause us to feel irritability (fight) or fear (flight). In other words, the somatosensory cortex works together with the limbic system to set off the sensation of pain (alarm). Moreover, there are other areas of our brain involved in pain. 

Furthermore, the level of threat an injury or illness poses, correlates with our pain tolerance.

The neuromatrix model for pain provides us with an understanding of how the brain and the rest of the nervous system create pain. It helps us understand how we can manage the pain levels we endure.

For example, we might try to manage our perception of pain by decreasing our perception of the pain’s level of threat, alarm, and associated behavioral avoidance.

However, if left untreated, chronic pain can cause alarming, threatening sensations that, over time, become emotionally and physically exhausting.

However, there are cognitive and behavioral methods that can change the nervous system and its pain-producing processes.

Cognition and Chronic Pain Treatment

Cognitive behavioral therapy provides psychoeducation, expanding the client’s knowledge about pain and the nervous system. When a client gains understanding on how pain is constructed in the body and brain, they can focus on developing a cognitive-based skillset to produce positive, healthy lifestyle changes. It helps the client understand that it is safe to engage in appropriate activities for their diagnosis without feeling an overwhelming sense of threat or alarm. It allows them to remain grounded while experiencing or living with pain.

Coping Skills Found in CBT that may help with Chronic Pain Treatment Include:

– Practicing diaphragmatic breathing to increase relaxation and slow down your automatic response to pain.

– Increase self-awareness of what you think, feel, and you when experiencing pain; increase awareness of your automatic reactions when experiencing pain

– Learning about multiple ways and perspectives in which one can see or react to pain.

– Learning to be a conscious thinker and make intentional decisions regarding your response to pain.

– Understanding the way pain works, including understanding, pain does not always equal harm

– Exploring new activities that may distract you from pain

– Exploring the practice of acceptance; accepting the pain can be there without being a constant source of distress.

We often try to minimize or avoid pain to try to control it. However, we can also look at the other variables to help decrease pain. We may also allow the pain to be there while staying grounded and reducing our perception.

When practiced repeatedly, these skills can make an individual’s experience of pain more tolerable, and they may begin to rate pain less severely. They can also help your nervous system retrain the way it experiences pain. The skills take a lot of practice and energy, but the more you do it, the easier it becomes, and the more likely your nervous system becomes less reactive and inflammatory.

Behavior and Chronic Pain Treatment

CBT may provide behavioral components that encourage healthy lifestyles and help regulate the nervous system.

You’ll be encouraged to make lifestyle changes like including contemplative practices in your routine. For example, an individual may choose to engage in mindful meditation, tai-chi, or yoga. These therapies target the nervous system in traditional ways and help it be less reactive.

A psychologist that is helping you manage your pain may teach you how to do diaphragmatic breathing. It’s a type of deep breathing that uses the lower portion of your lungs. By doing diaphragmatic breathing, you are turning on your parasympathetic nervous system and the relaxation response in your brain. Your therapist may also incorporate mindfulness with your diaphragmatic breathing. Mindfulness teaches us to be fully present, without attachment or judgment. If your mind wanders, that’s OK; bring your thoughts back to your breathing. They may encourage you to do this exercise a few minutes a day, which will help relax your nervous system, teach you how to redirect your attention, and increase self-awareness. 

Mild aerobic exercise may also be another essential lifestyle intervention that may help reduce pain. Stationary biking, walking, and pool exercises are all examples of mild aerobic exercise. These types of exercise aren’t too strenuous and are not hard on the joints but still may increase your heart rate moderately for a brief amount of time. After engaging in physical activity for approx. 20 to 30 minutes, the brain releases neurotransmitters, which also help relax the nervous system.

Mild aerobic exercises and contemplative practices may help reduce levels of pain. However, a dramatic reduction does not happen overnight, but it may bring average pain levels to something more manageable.

Furthermore, CBT also includes a reflective format of talk therapy. Pain may bring negative and anxious feelings and emotions into your life. CBT can help you manage those thoughts and reduce symptoms of associated anxiety, depression, or sadness. Moreover, if you have a recent diagnosis, adjusting to a new lifestyle may be difficult. CBT for pain may help you retrain your nervous system’s ability to produce pain and manage the thoughts associated with chronic pain or illness.

Chronic Pain Management with CBT in Florida

If you’re experiencing chronic pain in Florida, we’re here to help!


Hello, I’m Dr. Carolina Raeburn, a licensed Clinical Psychologist with a subspecialty in neuropsychology in Miami. I help people with emotional concerns, adjusting to life changes, or those who want to improve their quality of life. I offer coaching and bespoke psychotherapy for individuals and couples, providing cognitive behavioral therapy, depression treatment, anxiety treatment, panic attack treatment, stress management, as well as help those going through life changes, such as grief and loss, chronic and terminal illness, injuries, retirement, perfectionism, and much more.

If you have any questions about my services, please feel free to reach out through the contact form. Or, if you’re ready to start your path to a better tomorrow, please make your appointment today.

*All the information published in this article is for informational and educational purposes only and is not a substitute for professional medical advice or treatment. Any information provided here is offered in generic form. Please consult your healthcare provider if you have any questions or concerns. 

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