For some, seeing a behavioral health provider may seem like an odd way to treat pain. After all, the pain is in your body – your back, your neck, your joints – not all in your head. But studies have shown that incorporating a psychologist into a multidisciplinary pain treatment plan can actually result in much better outcomes than just seeing a doctor. So the question remains: How does psychology, a science focused on the human mind, help improve pain, a condition of the body? For many, the answer lies in a type of therapy know as cognitive behavioral therapy, or CBT.
Overview of CBT
CBT is based on the cognitive model, an idea that the way we mentally frame our experiences affects the way we feel and act. The goal of CBT is to identify distorted thinking (negative or erroneous thought patterns) and begin to challenge them and replace them with more realistic – and positive – thoughts. Unlike Freudian psychoanalysis, which explores childhood experiences to get to the core of issues, CBT focuses on thoughts in an attempt to improve mood, behavior and even pain levels.
For example, according to APM licensed psychologist Mary Papandria, pain sufferers may think such distorted thoughts as “I can’t live with this,” “This is too much,” “I’m being punished” or “I’ll never be happy again.” Being able to identify these thoughts when they occur and utilize effective methods to overcome them is the goal of CBT.
CBT typically takes less time than other behavioral therapies, with most patients receiving treatment for roughly 8-10 sessions, according to Dr. Papandria. The first session is similar to an initial doctor’s visit in that the provider will evaluate a patient’s history of pain and other medical issues. They will also delve into social and educational history and will evaluate the patient’s current psychological condition and coping strategies.
“During this evaluation, I often get a good sense of how the person deals and copes with their pain, their viewpoint on life and illness and how well they have adjusted to their pain,” says Dr. Papandria.
Recognizing and Challenging
Once the provider has a good grasp of the patient’s thought processes and cognitive distortions, he or she can provide exercises that allow the patient to identify these episodes on their own. Dr. Papandria uses a set of steps called Challenging Cognitive Distortions. This process allows individuals to identify erroneous or destructive thinking patterns, evaluate the proof for and against it, then begin to replace these thoughts with more realistic ones.
Dr. Papandria gives the example of “I can’t live with this pain,” a common thought among pain sufferers. When going through the Challenging Cognitive Distortions steps, a patient would provide proof against this idea, like that they have lived with this pain for a while, that they do take steps to minimize the pain, that they have had happy moments even with the pain and that they are actually adjusting to life with pain. Over time, doing this makes it easier for people to recognize – and refute – their negative thought patterns.
“For patients who use this exercise daily,” says Dr. Papandria, “they have less depression, rate their pain at a lower level and feel they are in control of how they feel both physically and psychologically.
Utilizing CBT can also lead to a plethora of other benefits, including helping you improve communication with loved ones and co-workers, allowing you to become more active, helping you re-engage in hobbies and improving your mood, sleep, appetite and overall ability to cope with pain. After CBT, says Dr. Papandria, patients “begin to believe that they are in control of their lives and that pain is not in the driver’s seat.
By combining interventional treatments with cognitive ones, multidisciplinary providers are able to address pain on multiple fronts, helping patients achieve a higher level of relief and function.