CBT chronic pain - Veterans Affairs

Cognitive Behavioral Therapy

for Chronic Pain

Therapist Manual

Jennifer L. Murphy, Ph.D. &

John D. McKellar, Ph.D. ? Susan D. Raffa, Ph.D. ? Michael E. Clark, Ph.D.

Robert D. Kerns, Ph.D. ? Bradley E. Karlin, Ph.D.

The image on the cover shows a network of the nerve cells

which carry sensory information from the external world to the

spinal cord and brain. The image was captured at the Bosch

Institute Advanced Microscopy Facility, University of Sydney

and is used with permission from: Dr. Michael Lovelace

and Professor Tailoi Chan-Ling, Retinal and Developmental

Neurobiology Laboratory, Discipline of Anatomy and

Histology, University of Sydney; Professor Patricia Armati and

Dr. Roberta Chow, Brain and Mind Science Research Institute

and Nerve Research Foundation, University of Sydney.

Cognitive Behavioral Therapy

for Chronic Pain

Among Veterans

Therapist Manual

Suggested Citation: Murphy, J.L., McKellar, J.D., Raffa, S.D., Clark, M.E., Kerns, R.D., &

Karlin, B.E. Cognitive behavioral therapy for chronic pain among veterans: Therapist manual.

Washington, DC: U.S. Department of Veterans Affairs.

Table of Contents

Title Page.............................................................................................................................................................................................. 2

Table of Figures.................................................................................................................................................................................... 6

Acknowledgements...............................................................................................................................................................................7

Preface................................................................................................................................................................................................... 8

Part 1: Background, Theory, and Case Conceptualization..........................................................9

Introduction.........................................................................................................................................................................................10

What is Cognitive Behavioral Therapy for Chronic Pain?.......................................................................................................... 10

Organization of Manual............................................................................................................................................................... 10

Chronic Pain: Foundational Information............................................................................................................................................ 11

Definitions.................................................................................................................................................................................... 11

Types and Locations of Pain........................................................................................................................................................12

Treatment Options for Chronic Pain............................................................................................................................................15

History, Components, and Support..................................................................................................................................................... 20

Chronic Pain: A Historical Overview..........................................................................................................................................20

CBT-CP: Theoretical Components..............................................................................................................................................20

CBT-CP Intervention...................................................................................................................................................................25

Case Conceptualization.......................................................................................................................................................................29

Case Examples.............................................................................................................................................................................29

Case Considerations.....................................................................................................................................................................30

Therapist Considerations.................................................................................................................................................................... 31

Chronic Pain Experience............................................................................................................................................................. 31

Special Topics..............................................................................................................................................................................31

Part 2: Cognitive Behavioral Treatment for Chronic Pain..........................................................37

Structure of Treatment........................................................................................................................................................................38

Content of Treatment: CBT-CP Protocol............................................................................................................................................ 44

Session 1: Interview and Assessment..........................................................................................................................................44

Session 2: Treatment Orientation................................................................................................................................................. 47

Session 3: Assessment Feedback and Goal Setting..................................................................................................................... 51

Session 4: Exercise and Pacing.................................................................................................................................................... 55

Session 5: Relaxation Training....................................................................................................................................................62

Session 6: Pleasant Activities 1................................................................................................................................................... 67

Session 7: Pleasant Activities 2................................................................................................................................................... 71

Session 8: Cognitive Coping 1....................................................................................................................................................73

Session 9: Cognitive Coping 2....................................................................................................................................................76

Session 10: Sleep......................................................................................................................................................................... 78

Session 11: Discharge Planning...................................................................................................................................................82

Session 12: Booster Session........................................................................................................................................................ 86

Conclusions.................................................................................................................................................................. 88

References.................................................................................................................................................................... 89

Appendix....................................................................................................................................................................... 95

Therapist Manual

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