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When your brain helps the pain: Cognitive therapy in action

Written by: Joanne Zeis
Published: Tuesday, July 26, 2011
Reviewed by: Synne Wing, MSW, October 2015

When your brain helps the pain: Cognitive therapy in action

As they say, the only guarantees in life are death and taxes.

But what about pain? We all have that, too – although some feel it more than others. And some people with chronic pain conditions have a 24/7 pain problem that can be ruthless. How do they handle it?

Medication isn’t the only answer: A person’s brain can also help to handle the pain.

The impact of pain

There’s more to pain than being hurt. Every time you feel pain, your brain also kicks in with its own ideas about what just happened. Some of these thoughts may be helpful, like “Next time I’ll need to hold the board more tightly before I start hammering.” But if bad memories or feelings about past injuries get in the way, then unhelpful, negative thoughts could take over instead. For example, your brain could start to scold, saying, “I’ll never be as good a carpenter as my Dad. I shouldn’t even try.”

Believe it or not, these types of negative thoughts can affect how much pain you feel: It doesn’t matter whether you’ve had a recent injury, or you’re dealing with chronic, neuropathic pain. Experts know that a person’s thoughts, emotions, and past experiences can make a painful situation feel much worse than it is… or much better. Your thoughts can also affect how you choose to deal with your pain, now and in the future.

That’s where therapy can make a difference.

Cognitive therapy

Doctors often suggest cognitive therapy for people with chronic pain conditions – not because they think that their patients’ pain is “all in their head,” but because it will help their patients to learn new ways to handle (and reduce) their pain. Cognitive therapy is often the treatment of choice. Simply put, it means using your mind to help manage your symptoms. The therapist is usually a psychologist or another mental health provider.

For most people with chronic pain, cognitive therapy is meant to be a short-term treatment. “Booster” sessions may follow, to check on the person’s progress and results.

What happens in a cognitive therapy session?

Everyone begins therapy with their own beliefs about the pain that they’re in, about its impact on their lives, on the people around them, and on their futures. In treatment, the therapist helps the client to identify, understand, and change any of those beliefs that are unrealistic and/or self-defeating. That’s because those negative beliefs may lead to feelings of low self-worth – which can lead to stronger feelings of pain. Let’s look at a couple of examples:

"It’s all my fault!”:

Some people personalize problems by taking the blame, even if they had no responsibility for what went wrong. Take the case of Sarah, a 24-year-old woman with CRPS (complex regional pain syndrome). Twice a week Sarah’s husband had been picking her up from work and driving her to physical therapy; the therapist was trying to help reduce the pain that Sarah felt in both of her legs. It was raining hard during one of their drives, and when Sarah’s husband hit the brakes, their car spun around and went into a ditch. Neither of them was hurt, but they had to call a tow truck

“My legs wreck everything!” Sarah cried.”If I didn’t have all of this pain, we’d still have a car to drive. It’s all my fault!” Sarah didn’t want to hear about wet roads or old tires on the car.

A cognitive therapist might help Sarah grasp that this type of thinking is unrealistic and maladaptive: There are other ways to explain the car accident. Sarah can’t control the rain, the brakes, or the road conditions. She needs to focus instead on the things in her life that she is able to control.

“Our lives are ruined!”:

Someone who catastrophizes makes a problem seem much worse than it is. John’s story is a good example. John had worked for years as a mechanic at a national car dealership. He liked the job: Even though John had chronic lower back pain, his boss was understanding about taking breaks, seeing doctors, and having to take pain medication.

At home one night, John tried to lift a box that he thought was almost empty – but there were some heavy books in the bottom. He wrenched his back and could barely move. “I’ll never be able to work again!" he thought. “We won’t have any money to pay the bills…we’ll be out on the street.” John decided to call his boss and resign, before he got fired for not being able to work.

A cognitive therapist might help John understand other ways to think about this problem, before making drastic choices. John could ask himself: 

  • Am I over-reacting?
  • Have there been other times when I've hurt my back, and been able to go back to work?
  • What's the most likely thing that could happen?

 

But wait, there's more

Personalizing and catastrophizing are just two out of ten common “errors of thinking” that are addressed during cognitive therapy. Cognitive therapists also teach other pain management skills, such as deep breathing and muscle relaxation, and help clients to develop better problem-solving skills. By learning skills like how to communicate better, how to be assertive, and how to set realistic goals, people with chronic pain have the tools to lead healthier lives, with reduced pain.


References

MedlinePlus.gov
http://www.medlineplus.gov (Search on “cognitive therapy AND pain”)

National Association of Cognitive-Behavioral Therapists
http://nacbt.org (Search on “What is CBT?”)

Academy of Cognitive Therapy
http://www.academyofct.org (Search on “chronic pain”)

MedPage Today
http://www.medpagetoday.com (Search on “cognitive therapy AND pain”)