Cognitive Behavioral Therapy (CBT) to Help Chronic Pain

Medically Reviewed
person receiving Cognitive Behavioral Therapy CBT for chronic pain
CBT is a type of talk therapy that can help alleviate chronic pain symptoms.Adobe Stock; Canva; Everyday Health
Cognitive behavioral therapy (CBT) is a form of talk therapy that helps you recognize how your own thoughts and emotions affect your behavior.

The approach is used to help people with a variety of conditions, including chronic pain disorders, which affect about 50.2 million adults in the United States.

How It Works

With CBT, a mental health expert leads structured sessions, usually by asking targeted questions. The goal is for you to identify negative thoughts and behaviors while learning how to implement healthier habits.

RELATED: 8 Great Pain Relievers You Aren't Using

When it comes to chronic pain, the theory behind CBT is that if you can change the way you think, you can change the way you respond to what’s physically happening in your body.

You’re essentially learning new strategies to manage your discomfort by shifting your focus and perspective, even if the pain doesn’t go away.

CBT typically includes the following steps:

  1. Recognize what is troubling you.
  2. Become aware of your thoughts and emotions in relation to the problem you’re facing.
  3. Identify negative or harmful thinking patterns that may be contributing to your difficult situation.
  4. Stop negative thoughts, beliefs, and behaviors and replace them with positive or helpful habits.
CBT mostly focuses on what’s going on in the patient’s current life, rather than past issues.

Chronic Pain Symptom Relief

Scientific research has shown CBT can improve symptoms of chronic pain, including specific types of pain, such as:

One review examined data on more than 59 studies that included more than 5,000 participants with various types of chronic pain. Investigators found that CBT had a positive, though modest, effect on reducing pain, disability, and distress associated with chronic pain.

A study published in the Annals of Internal Medicine included 850 participants who were on long-term opioid treatment for chronic pain. Results showed those who received CBT combined with yoga and breathing exercises for three months reported lower pain intensity one year later, though they didn’t cut back on their opioid medication use. The patients also said they noticed better sleep and an improved ability to complete daily tasks.

Improvement for Chronic Low Back Pain, Musculoskeletal Pain Intensity

Research has previously shown that an online CBT program was beneficial for individuals with chronic low back pain.

And a meta-analysis of studies published in the journal Pain examined different psychological treatments for fibromyalgia (a disorder characterized by widespread musculoskeletal pain symptoms) and found CBT was better than other psychological approaches at decreasing pain intensity.

Other Benefits

According to the American Psychological Association, CBT has been shown to help with various other disorders.

Research published in?Cognitive Therapy and Research examined 106 meta-analyses that assessed CBT’s effectiveness in treating an array of medical conditions.

The authors of the study write, “This meta-review suggests CBT works, it improves the quality of life for people living with many different mental and physical conditions. For some conditions, we do not currently know precisely by how much it works, only that it will provide small to moderate effects.”

In addition to chronic pain, CBT can be beneficial treatment for the following:

General Health and Wellness Benefits of Cognitive Behavioral Therapy

You don’t have to suffer from chronic pain or another health condition to benefit from CBT; anyone can use the therapy to help lower stress levels and live a better life.

Several studies have shown CBT is more effective than other intervention types at helping to lower workplace stress.

Research has found that CBT interventions may improve low self-esteem in certain individuals.

CBT essentially helps individuals discover how to become their own therapists, according to the American Psychological Association.

Ideally, you will learn coping skills that will help you manage your own thoughts and behaviors in a positive way.

These strategies can prove to be useful in a variety of situations and challenges, whether you’re dealing with pain or not. Some people undergo CBT to help with matters such as grief, relationship troubles, or problems at work.

How to Use CBT

The first step is to find a therapist. Many types of mental health experts are trained to practice this type of treatment.

According to the Association for Behavioral and Cognitive Therapies (ABCT), the following professionals may offer CBT:

  • Psychologists
  • Psychiatrists
  • Clinical social workers
  • Professional counselors
Your primary care physician may suggest a therapist for you, or you might want to talk to friends and family members to find out if they have recommendations.

The ABCT also provides a directory on their site to help you locate clinicians in your area. The Academy of Cognitive and Behavioral Therapies offers a similar feature to help you find a therapist.

It’s important to choose a clinician who makes you feel comfortable. Your first session should be a consultation, so you can get a feel for what to expect.

You might want to ask whether the therapist under consideration is licensed by your state. Some professionals are specifically certified in CBT, so you can inquire about that distinction as well.

If you prefer to see someone who specializes in CBT for chronic pain, ask about their success in helping patients with your specific condition.

What to Expect

CBT sessions may be conducted in person or via a virtual format, such as videoconferencing.

At first, you and your therapist will work on understanding your medical history and goals.

Your clinician will likely personalize your sessions to help meet your specific needs.

During the meetings, your therapist will encourage you to talk about your thoughts and feelings by asking interactive questions.

You’ll also discuss different strategies to help change your negative thoughts or behaviors.

For example, your therapist might help you identify unhealthy beliefs about your pain. Then you can develop ways to talk to yourself and others about your struggles. You may also learn how to implement pain management skills in your daily life.

Your therapist might assign you homework to complete. This could include activities like reading helpful materials, performing relaxation exercises, or keeping a journal of your thoughts.

CBT is considered a short-term treatment approach, but results don’t happen overnight.

Therapy sessions typically take place over 5 to 20 meetings, and you’ll have to continue practicing the techniques you learn to achieve a successful, long-term outcome.

Fees: Is Cognitive Behavioral Therapy Expensive? Will Insurance Cover It?

The cost of CBT will depend greatly on your health insurance coverage and where you receive the therapy.

If you have health insurance, call the company to find out if your plan covers therapy. Every policy is different, but many allow for a certain number of sessions each year.

According to the Anxiety & Depression Association of America (ADAA), a CBT session can run $100 or more per hour.

If you don’t have insurance and can’t afford to pay for CBT, federally funded health centers may offer you a discounted rate based on your income. Additionally, some colleges and universities offer low-cost therapy sessions with graduate students.

Considerations

Generally, there aren’t any physical risks to undergoing CBT, but the therapy can be emotionally unpleasant at times. You may have to confront uncomfortable thoughts that can trigger painful emotions.

A skilled therapist can help you work through these challenges so you’re equipped to cope with your negative thoughts or fears.

Keep in mind that CBT therapy doesn’t work for everyone. You have to be committed to changing your thought process for the long run. Another potential downside is that CBT doesn’t focus on past issues in someone’s life that might need to be resolved.

Some patients with history of trauma may benefit from trauma-focused CBT

or other trauma and PTSD focused therapies.

Additionally, CBT can sometimes cause negative reactions. One study?surveyed 100 CBT therapists and found that the therapists reported side effects from CBT in 43 of 98 patients studied. The most common undesirable results were negative well-being or distress, worsening symptoms, and strains in family relations.

Editorial Sources and Fact-Checking

Show Less