What is cognitive behaviour therapy (CBT)



What is cognitive behaviour therapy (CBT) for pain?

Cognitive therapy

Our 'cognitive processes' are our thoughts which include our ideas, mental images, beliefs and attitudes. Cognitive therapy is based on the idea that some ways of thinking can make pain problems more difficult to manage. During cognitive therapy, you’re helped to understand your current thought patterns. In particular, to identify any unhelpful ideas or thoughts which you have that can make it harder to manage your pain or any limitations or other ways of coping with your pain. The aim is to help you understand your immediate thoughts and decide whether they are helpful or not, and replace or alter what you think so that it supports you to achieve your goals.

Behaviour therapy

This aims to change any behaviours that are not helpful, as well as using learning principles such as repetition and reward to help you do different things and in different situations. Various techniques are used. For example, a common unhelpful behaviour is to avoid situations that increase your pain. In some people this avoidance can affect day-to-day life, and it certainly reduces your ability to develop strength and flexibility in coping. The therapist works with you to gradually cope when you face up to the situations you don’t feel comfortable with, for example, by using deep breathing and other techniques.

Cognitive behaviour therapy - CBT

This is a mixture of cognitive and behaviour therapies. They are often combined because what we do often reflects how we think about certain things or situations. The emphasis on cognitive or behavioural aspects of therapy can vary, depending on the situation being worked on. Most of the time in pain management, we use them together an equal amount.

Why use it for pain?

Pain is a strong and unpleasant experience. It brings out immediate ‘automatic’ thoughts and emotions that we’ve probably used since we were young. Although these thoughts and emotions are often real, they’re not very helpful, so it’s useful to review them and replace them with more helpful thoughts.

While you’re learning how to manage pain, you’re often introduced to new ways of going about activities – like working to quota (‘pacing’), or asking for help. And by using these new ways of doing things, it can bring up thoughts or judgements about yourself and your situation that don’t help you keep on using the new skills (or at least make it feel unpleasant).

What do I have to do?

There isn’t any one single way to go about identifying and working through your particular thoughts and emotions. The way we’ll go about it with you is specially developed for you.

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Take a look at this picture – what goes through your mind if this was you going about mowing the lawns, and you had to stop halfway through? Jot your thought in the speech bubble.

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Take a look at this picture – what goes through your mind if this was you going fishing, but you had to stop casting after 10 minutes? Jot your thought in the speech bubble.

Take a look at this picture – what goes through your mind if this was you welding, but you had to stop because your wrist was starting to bother you? Jot your thought in the speech bubble.

When you have a thought, sometimes your feeling will be clearer than the thought – but feelings are usually influenced by thoughts. Once you’ve worked out your thoughts – think about the feeling or emotion you had at that time and jot this in the thought bubble for each picture above.

When you’ve worked out the feelings, it’s helpful to see what lies underneath those thoughts – why do you have them? What’s the meaning of those thoughts? These intermediate thoughts are like rules and assumptions about how the world is or should be. And underlying these intermediate thoughts are deep beliefs about ourselves.

Because these are a series of thoughts, and thoughts can be tested to see if they’re realistic or helpful. If they’re not helping you, or they’re untrue, it may be time to work on a new thought that you can deliberately choose to use in those situations.

|Automatic thought |Emotion |Underlying belief |

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|Evidence for |Evidence against |New statement |

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Behaviours

Cognitions

Behaviours

Emotions

Cognitions

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