Cognitive Behavioral Therapy is a treatment approach that combines techniques to help people identify and correct faulty patterns of thoughts, feelings, and behaviors. The goal is to increase function and reduce pain.
A Brief History
Cognitive Behavioral Therapy was developed in the mid-1970s by Dr. John Sarno, a clinical professor of rehabilitation medicine at New York University School of Medicine. It is based on his belief that most lower back pain results from unconscious emotional factors, particularly feelings of stress and anxiety in the muscles of the lower back and abdomen.
According to Dr. Sarno, when people unconsciously repress feelings or emotions they often experience physical symptoms in the body as a consequence of the unconscious mind acting to protect them in some way.
Treating Low Back Pain with CBT
He believes that most people who develop lower back pain have repressed anger toward someone else or themselves, which he calls ‘core beliefs’. Core beliefs are often formed in childhood and are the result of unresolved emotional conflicts. The pain creates fear, further suppressing emotions, resulting in a vicious cycle.
Dr. Sarno’s approach focuses on getting patients to become aware of these unconscious emotions and how they affect their physical well-being through persistent pain. He teaches people to reinterpret the pain in a positive way, as a sign that they can now initiate the healing process.
How Cognitive Behavioral Therapy Works
Cognitive Behavioral Therapy takes place in six to eight weekly sessions, each lasting an hour. The first session is about education and explaining how pain might develop. The remaining sessions are spent discussing memories in the patient’s life that may be linked to the pain, identifying repressed emotions, and working out strategies to deal with them.
The interactive sessions aim to help patients become aware of patterns that can trigger their pain, such as poor time management or expectations set too high by family members. They also explore how a patient’s thoughts and emotions affect the sensations in the lower back. A key part of Cognitive Behavioral Therapy is becoming aware of ‘early warning signs’ so they can be acted upon before pain becomes a problem.
Cognitive Behavioral Therapy for Lower Back Pain focuses on the mind-body connection and how emotions affect physical health, partially through stress hormones such as cortisol, which have been linked to chronic pain.
The Approach’s Value
In some cases, Cognitive Behavioral Therapy for Lower Back Pain permanently reduces or eliminates pain. In one study, 78% of people with chronic lower back pain reported that treatment was successful and they were able to return to work.
A review of research found that the approach was effective for chronic lower back pain, but not acute low back pain. In addition to treatment sessions, Cognitive Behavioral Therapy for Lower Back Pain encourages people with lower back pain to keep a daily diary. This helps them become more aware of their thoughts and behavior patterns that may be contributing to or exacerbating the pain.
When to Seek Cognitive Behavioral Therapy for Lower Back Pain
People who meet the following criteria would likely benefit from Cognitive Behavioral Therapy for Lower Back Pain:
- Have experienced pain in their lower back at least once a day for the previous three months.
- Have been unable to take medication or engage in physical therapy because it hasn’t worked for them in the past.
- Do not have a severe, progressive illness that could be causing their lower back pain.
Patients with the most severe pain and functional disabilities may need additional medication, acupuncture, and physical therapy.
Final Thoughts
Chronic lower back pain is a prevalent and costly condition. People with chronic lower back pain must receive effective treatment that focuses on self-management or self-care measures.
Cognitive Behavioral Therapy for Lower Back Pain may be an effective intervention for this group of people. Still, the approach works best when both patient and therapist are committed to participating in all sessions without exceptions.
If you suffer from chronic back pain and want to learn more about this approach, contact Progressive Pain Management to discuss your treatment options.
Living with chronic pain is often associated with a decreased quality of life, and diminished state of mind and can put a lot of stress on one’s mental health. When your body aches, you know the pain is just not “in your head,” and the discomfort is real. Pain becomes your whole world.
Frequently, patients consider conventional ways of thinking: reducing activities and resting will reduce pain. However, the opposite typically occurs. When you reduce movement and daily activities, your body automatically reduces its capacity to function properly. This change in behavior leads to negative thoughts about pain – “will I ever be pain-free?” or “nothing helps my pain.”
This type of negative thinking affects other aspects of your life, leading to anxiety and depression. That is when therapies like Cognitive Behavioral Therapy are helpful.
Cognitive Behavioral Therapy for Chronic Pain
What is Cognitive Behavioral Therapy?
Cognitive behavioral therapy (CBT) is a form of talk therapy. It has been researched and proven effective across a myriad of diagnosed conditions. It helps people identify and develop skills to change negative thoughts and behavior. CBT is problem-focused and challenges the negative thoughts, beliefs, or concerns contributing to a patient’s mental health regarding their pain. It is more than a stereotypical therapy session that involves talking through a problem and focuses on “doing” things.
The science behind CBT says that individuals – not events or external stimulants – create their own experiences. This includes pain. People can train themselves to incorporate coping skills into their daily lives by changing awareness of pain and thought patterns. For patients with chronic pain, CBT helps patients break their pain cycles and improve their quality of life.
How is it used to Treat Chronic Pain?
Used to treat chronic pain, CBT is commonly used with other modalities of pain management. This may include massage therapy, medications, or physical therapy. CBT has minimal risk and side effects than medication or in extreme cases, surgery, making it an excellent treatment option.
Cognitive behavioral therapy can change a physical response in the brain that worsens pain. Pain causes stress which in turn affects the pain chemicals in the brain. CBT reduces the activity of those chemicals, making the body’s natural pain relief more effective.
The first step of CBT is education. When patients understand their diagnosis and how CBT can help, setting goals and getting in the correct mindset is easier. It also helps the patient identify triggers and behaviors that worsen their pain levels and allows them to learn adaptive behavior. The goal is to increase self-efficacy for managing and reducing chronic pain by correcting negative thoughts and beliefs. Cognitive behavioral therapy treats conditions caused by chronic pain, such as depression, anxiety, sleep disorders, and isolation.
What to Expect from CBT Sessions
CBT sessions vary depending on your provider and pain level, but the initial meeting may be used to normalize the patient’s experience. This involves normalizing their pain – they are not “crazy” or wrong for feeling their pain sensations. The pain is not “all in their head,” and they do not see a “shrink.” These are common concerns and worries of patients who suffer from chronic pain conditions.
There will be a clinical interview where patients are screened through a series of questions, self-reporting, and observations. This allows the doctor to provide feedback about their situation and allows them to educate them about how CBT can be used to help manage pain.
Paper material that use visuals to show the relationship of chronic pain and how it impacts feelings, behavior, thoughts, and their cycle of pain. When patients are able to understand and see these connections, it is easier to relate it to their lives. Visual materials also provide patients with assistance at home, promoting self-efficacy.
Cognitive behavioral therapy aids patients’ development of their own behavior. It “trains” them how to think, act, and feel regarding their pain. The sessions focus on teaching the importance of paced activities that increase function without overexerting yourself and how inactivity can worsen your pain. This trained development allows the patient to create specific, relevant, and achievable goals for themselves. It is often called SMART Goals: Specific, Measurable, Achievable, Relevant, Time-Limited goals.
By slowly incorporating activities into your daily routine, it takes away from the mindset of “My pain limits me” or “I can’t do this.” Once a mindset shift has been activated, any negative mood symptoms begin to dissolve.
CBT is often part of a comprehensive treatment plan, used in conjunction with interventional pain management techniques. The team at Progressive Pain Management works with your other healthcare providers to ensure you get the most out of your treatment plan and the highest quality of care possible.
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