Cognitive Behavioral Therapy

'Pain Relief By Controlling Your Brain'

What Is ‘CBT’?

Cognitive Behavioral Therapy is a method of achieving better physical outcomes (in our case reduced pain) by changing your perception of your surroundings and ultimately your own feelings.

According to Wikipedia, Cognitive behavioral therapy (also known as CBT) ‘focuses on challenging and changing unhelpful cognitive distortions (e.g. thoughts, beliefs, and attitudes) and behaviors, improving emotional regulation’

The success of the therapy itself revolves around being able to treat problems by altering your mindset around how you approach them. At the heart of all Cognitive Behavioral Therapy is the ability of your mind to take a huge problem and break it in to much segments, reduce their importance down individually and then conquer them one step at a time.

Four circles imitating the four pillars of cognitive behavioral therapy - that is thoughts, emotions, behaviors and physical response

Put more simply and without the ‘fluff’ – if you can convince yourself something is easy, it will actually seem easier and you’ll perform better in tackling it.

Your positive mindset and ability to see a mountain as just a series of steps one after another, actually makes the climb much easier. This works particularly well when tackling problems that are made worse by anxiety or stress.

Stress is great at making problems worse. In the case of pain, it makes sore muscles more tense, makes you consciously aware of the pain at all times and makes the part of your brain that processes nerve signals in to pain even more sensitive.

This means the same injury will cause different levels of pain to different people, partly based on how much stress/ anxiety they are suffering with.

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Cognitive Behavioral Therapy and Pain Management

Isn’t CBT all just in the mind? Yes of course it is – but so is pain to a certain extent.

I coined a saying on one of our other articles ‘no brain – no pain’ and then built it in to a cartoon as above.

Of course, in reality no brain equals death, but the point is true that it is the brain that ultimately takes the bodies nerve signals (transmissions) and turns them in to what we know as pain.

If you can train your brain to accept that a certain signal is not as bad as first thought, then the pain you feel will be noticeably less.

You are not altering the pain itself, but stopping how the brain ‘punishes’ your body.

As noted by Douglas Songer in Psychiatry MMC –

“Negative, inappropriate, catastrophic thoughts are often present in patients with pain disorders. Such thoughts are highly correlated to the intensity of pain complaints.”

There are in essence 3 basic channels to tackle pain –

1) Heal the cause of the pain/ injury that is forcing the nerves to send out what are effectively distress signals.

2) Block the transmission of the messages on their way through your body to your brain, so they either numb or cut off the signals before they reach the brain

3) Alter how your brain reacts when it receives those messages of pain.

Some very unfortunate people actually can’t feel pain at all because the brain can not process the pain messages. This is known as ‘congenital insensitivity to pain’ (CIP) and can be very dangerous, with sufferers unaware when they have hurt themselves.

Children with CIP for example, can suffer massive burns and not know to pull away or could easily bite off their own tongue in curiosity because it just doesn’t hurt when they bite it. Sufferers often don’t reach adulthood, because pain is vital to us in managing our responses to risks and danger.

Cognitive Behavioral Therapy exists in the third category – it is administered through discussion and a change of mindset. The objective it to change the way you think about pain, which in turn changes the way your brain thinks about pain and ultimately how it processes it.

Image of a man riding a brain to depict the objective of CBD that if you can change the brain, you can change the feeling of pain

Cognitive Behavioral Therapy Training

This really depends on how you choose to undergo cognitive behavioral therapy. You can learn it at home, either through a book or an online course – or you can attend a therapy session.

What works best is really up to you – the cognitive behavioral therapy training courses for home study will work out cheaper, but if you need to be face to face with someone to be motivated to learn, then that is also fine.

Cognitive behavioral therapy with a therapist

We will be covering home courses as soon as we enough members that have used a variety to put together a testing panel.

If you attend a cognitive behavioral therapy session in person, it is likely you will need between five and twenty sessions to achieve the start in altering your thinking and pick up enough knowledge to continue your therapy from home.

Each session will be focused on how to take what seems like a huge problem and break it down in to small sections such as what you think about it, how you feel about it and the physical actions that would be required to achieve success and sort out your problem.

Each section will then be broken down further to look at if your thoughts/ feelings and decide together if they are helpful or not and if they are even realistic in the first place. Once you have analysed these in depth, you will be in position to discuss what effect each feeling or behavior has on you and your problem.

From here, you would start agreeing with your therapist, which thoughts/ actions and behaviors have no benefit to you or the problem at hand. By rationalizing them and bringing them in to the open, your therapist can then help you to get rid of those thoughts/ actions or behaviors that are not helpful.

Once you leave each session, you should have agreed a number of small changes that you can take in to your life and implement. By making changes in small batches, they should be easier to stick to. 

The end result being an increased ability to break down, rationalize and overcome seemingly impossible problems. This includes overcoming the uphill battle of managing with chronic pain

Cognitive Behavioral Therapy Techniques – What They Can Teach You…

Cognitive behavioral therapy courses, whether taken at home or via a therapist, should focus on developing certain key skills.  Having successfully finished a course of cognitive behavioral therapy you should be able to –

  1. Understand how your previous experiences have shaped your personal view of likely outcomes.
  2. Develop more constructive ways of viewing situations and problems.
  3. Have a good awareness of the destructive, irrational thoughts that can subconsciously ruin your chances of achieving anything.
  4. Identify what problems you face and recognise how to break them down in to smaller, more achievable tasks.
  5. Distinguish between what is a real problem and what is actually just perceived as a problem
  6. Create achievable tasks to help you reach your desired outcome.
  7. Clearly recognise your own assumptions of how you see your environment and the challenges you face.
  8. Not to automatically assume the worst from every problem.
  9. Develop greater awareness of other peoples actions and what might lie behind them.
  10. Stop blaming yourself for things that are out of your direct control.
  11. Face anxieties and tackle them head-on.
  12. Focus on today and how to change things
  13. Manage your own moods before they start to dictate your surroundings
  14. Understand that every situation has different perspectives and how successful you re depends on which perspective you choose to accept.
  15. Avoid sweeping ‘big cloud’ generalisations.

Pro and Cons of Cognitive Behavioral Therapy

Cognitive behavioral therapy can be highly effective, even where other medications have not worked as successfully – but much like any treatment it will not work for everybody and it can not achieve every outcome.

Fundamentally the advantages and disadvantages of cognitive behavioral therapy can be summed up as –

Advantages

Flexibility. Cognitive behavioral therapy is a highly organised process that be applied by following general rules to almost any problem. This means that while CBT practioners are available, it can just as easily be learnt in the comfort of your home, around current commitments.

Strategic Planning. Once learned, the ability to break down large tasks in to small chunks, rationalise what will help and what wont, before getting rid of those negative chunks and starting work on the building blocks – is a skill that can help your entire life. The methods of planning you’ll learn can be applied to anything from essay writing to property development – not just pain management.

Easy To Try. There are no side effects if it doesn’t work and you don’t have to stop all pain medication just to try cognitive behavioural therapy. If you’re trying a new medication, you often have to either stop or reduce the dose of other meds to allow for safe use.

No Side Effects. Because CBT is a ‘talking therapy’ there is no chemical consideration that has to be put first, so you can try it without fear of increased side effects or medicinal clashes. If it doesn’t work for you (nothing works for everyone), you haven’t actually suffered at all.

A Different Strategy. Sometimes medication just doesn’t work (or your body builds up a tolerance to it). Trying a completely different strategy can have surprising results.

Timescale. Compared to some ‘talking therapies’, cognitive behavioral therapy doesn’t have to be strung out over months and months. If you follow the processes and implement small changes, you could be seeing an improvement in a matter of weeks.

Disadvantages

Commitment. Cognitive behavioral therapy only works if you are genuinely committed to the entire process and BELIEVE in it’s effectiveness. While a therapist can help you follow the steps correctly and may be able to add extra reassurance, it is only you that can alter your brain’s thought patterns. This is of course true of all the mindful therapies, but is none the less significant.

Emotion-Led. CBT ultimately involves altering your emotional balance to change the way you think about problems and life in general. This however means tackling anxieties and may not be easy in the short run as successful cognitive behavioral therapy will bring to the surface the irrational fears that you most need tot tackle in order to move forward.

Self-Focused. Cognitive behavioral therapy is great at getting you to change your inputs – but it ignores any outside influence. In the case of pain management for example, you may try to alter the way you think about your back pain, but if your family are constantly ‘over-treating’ your pain and convincing you of all the things you ‘cant’ do – then it very likely that your brain will keep kicking back to the default of assuming your back pain SHOULD rule your life.

Time. If you do decide to attend face to face cognitive behavioral therapy meetings, then it is a considerable time commitment. Given the potential difference that successful therapy can make, you may consider that time as time well spent – but it is a cost none the less.

Suitability. If you have complex mental health issues or learning difficulties, then the ability to isolate and rationalise technical problems is likely to be a step too far.

CBT In Conjunction With Medication.

Cognitive behavioral therapy can work superbly well just as a stand-alone treatment without the need for any medication whatsoever.

However, in consultation with your local doctor, they will often suggest a dual treatment – medication and therapy together.

In such circumstances, the most common adjunctive treatment is for you to be given an anti-depressant to help lift your moods and improve the chances of a positive mindset finding solutions to your problems.

What Is The Evidence Behind Cognitive Behavioral Therapy?

CBT is very much an evidence-based therapy, meaning the case for it’s effectiveness on the whole has been proven time and time again.

Furthermore, it is so established as an effective therapy that there is a vast number of clinical trials backing up it’s efficacy in treating any number of conditions from asthma to back pain.

We look in more detail specifically at how CBT can help back pain in a separate article, but the case for it’s overall use even by doctors that are trained instinctively to prescribe instant impact medicines, shows how far it has come.

In the UK, this is further backed up by the recommendations from NICE (The National Institute For Health and Clinical Excellence) which started as recommendation for electronic training for patients with mild depression (a frequent consequence of chronic pain) and expanded it’s use to treat a huge range of conditions, while NHS guidelines themselves are littered with references to the effective use of CBT.

More globally any search for evidence around cognitive behavioral therapy only need go as far as google searching the ‘Cochrane collaboration’, widely considered a gold standard for clinical reviews, that contains a vast number of studies demonstrating it’s clinical efficacy in all sorts of ways.

The Final Word –

Learning cognitive behavioral therapy (CBT) is a pleasingly short process that can be very successful in helping to change your thought patterns. Despite being a ‘mindful’ technique it is remarkably problem-specific and the skills acquired are frequently used by respondents again and again.

The fundamental philosophy behind it is to teach your brain to break the bigger problems you face in life down in to a whole group of feelings/ emotions and actions. From there, you can analyse which parts will help you in achieving the goal and which will not.

Removing a lot of the irrational, negative thoughts and then focusing only on the positive steps/ actions required will not only help you feel more positive, but actually make you much more likely to succeed.

When this comes to pain management, this can be as simple as separating fears over how painful something might feel from the actual feelings of pain. By breaking the cycle of expectation, and then focusing on small outcomes, you are likely to find you find that half of your ‘pain’ actually originated from what you were expecting to feel, as much as what you actually did feel.

Furthermore, because cognitive behavioral therapy is safe to use and can be learnt in a variety of ways, ranging from traditional face to face sessions with a CBT practitioner to a whole range of home study courses, it makes it an almost risk-free therapy with a high success rate. What more could you ask for?

Frequently Asked Questions

CBT could be perfect if you suffer with a whole range of conditions, especially chronic pain. The big advantage is if you try it and really don’t get on with it – there are no side effects to just stopping and trying something else!

As above, CBT is entirely evidence-based.

No – the ‘humanistic approach’ was developed by Abraham Maslow (hierarchy of needs).

While there are a number of similarities, the key is that there are also a number of differences. CBT is much more science-based and seeks for you to change your mindset by working through a defined process yourself. 

The humanistic approach is more about interactions with others teaching you about yourself – so is more dependent on others to be successful.

If you want to pay for classes, then your best option is to search locally via google or your local doctor’s surgery for the names of people that offer cognitive behavioral therapy.

If you are more interested in trying it out from home, come back June 15th, when we will have completed a group review of CBT courses out there to see which rank best.

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References –

1. Wikipedia. https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy

2. NIH Technology Assessment Panel. ‘Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia.’ J Am Med Assoc. 1996;276:313–18. [PubMed[]

3. Douglas Songer (2005) Psychotherapeutic Approaches in the Treatment of Pain. Psychiatry MMC

4. https://www.nice.org.uk/news/article/offer-digital-cbt-to-young-people-with-mild-depression-nice-says
 
5. Jacobsen PB, Hann DM. (1990) ‘Cognitive behavioral interventions.’ Psycho-oncology.New York, NY
 
6. Thomas EM, Weiss SM. (2000) ‘Nonpharmacological interventions with chronic cancer pain in adults.’ Cancer Control. []

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