Can Cognitive Behavioural Therapy Help With Chronic Pain?

what is CBT?

CBT stands for cognitive behavioural therapy, it is a talking therapy in which people learn to challenge negative and limiting beliefs and ideas. Your therapist will teach you how to change those beliefs and ideas into more positive behaviours and attitudes. 

CBT works by teaching people how to understand your emotions the underlying issues that have been created from major events in your life. Together, you will learn all about the impact that those events are having on you, to be able to challenge them and build new, more positive beliefs. 

For example, if you hold the negative belief that nobody will ever love you, CBT will work with you to help you to find evidence to the contrary and challenging those beliefs, so that you can change this internal dialogue to be that you are in fact lovable. 

CBT is being studied for chronic pain conditions

Chronic (long term) pain is more likely to occur in people with mental health problems, particularly depression or anxiety. People with chronic pain are also more likely to experience mental health problems.1

If you have experienced short-term pain, you will know its impact on our ability to manage our day to day life. It can disrupt sleep and prevent us from coping with emotional challenges and stress. When pain is long term (chronic), many patients experience frustration, despair and depression. 

Chronic pain is a public health problem of pandemic proportions and is the most common presenting medical complaint in western countries.2 Physical and emotional pain are strongly associated and extremely difficult to separate.  

Your mood and psychological state are shown to affect the severity and duration of any pain you experience. Whilst short-term and long-term pain is often triggered by damage to a tissue or organ, without ongoing damage (i.e. from cancer) chronic pain is much more difficult for us to understand. 

Those pain sensations are made up of ongoing nerve signals and the stimulation of our brain and spinal cord pathways. These flood our emotional and sensory circuits that lead to us experiencing increased sensations of pain and difficulty switching those sensations off. 

Many of the emotionally-regulated neurotransmitters (brain chemicals) like dopamine and endorphins affect the pain pathways, so anxiety and depression can both be increased by and significantly increase our experience of pain.2 Depression can alter the structure an activity of the brain in the areas where it perceives pain, making you more likely to develop chronic pain.3

what about ‘pain catastrophizing’? 

Pain catastrophizing is a phrase that has been used for over 40 years to describe the reaction of some patients to their experience of pain with feelings of helplessness, magnification of their pain and continuously thinking of their pain. People can easily find themselves in extreme difficulty trying to cope with pain or if they are in a situation that may provoke pain. 

The term and behaviours were originally documented in patients with anxiety and depression who saw pain as a forecast of negative future events and hopelessness. They disproportionately magnified their experience of a pain situation, so that they were unable to think of anything else. Pain catastrophizing is much more likely to occur in those suffering from anxiety or depression. Patients who catastrophize a short-term (acute) episode of pain are much more likely to go on to develop chronic pain and physical disability. Catastrophizing is more commonly seen in women and certain genetic patterns (SNPs in the COMT gene).4

The fact is, that it isn’t something people can just get over – some people are simply wired or conditioned to be more likely to suffer from this, which is where CBT can help to reverse those catastrophic thought patterns.

how does CBT help people with chronic pain? 

The majority of studies show that CBT helps to reduce pain5 and studies show that cognitive behavioural therapy can significantly improve both the perception of pain and pain catastrophising.6

As it is extremely difficult to separate the emotional and physical aspects of pain, a decrease in pain can occur with improved perception and it is likely this is how CBT works. By focusing on identifying behaviour patterns, thoughts and beliefs that are contributing to the pain and situations that increase it, the impact of those things are lessened. By working on this and any underlying psychiatric conditions, treatment by CBT can improve pain.7 CBT is shown to also improve resilience, which improves peoples’ ability to cope with pain.8

what does CBT for chronic pain involve? 

 CBT can help you to understand how pain works, so it feels less overwhelming. This can help people to change their perspective on pain, so that they feel more in control and can better manage their symptoms and improve their ability to function.9 Treatment plans will vary, depending on the severity of the pain and any underlying issues, but weekly sessions can show people how to reduce their fear of pain, give them distraction and relaxation techniques and work through their  underlying beliefs of pain. This treatment methodology has been shown to benefit chronic pain conditions, like back pain.10

what other tools or techniques are recommended for people with chronic pain? 

Mindfulness is shown to be as effective as CBT to help chronic pain.10 There is also early research to show the influence of the gut-brain axis on chronic pain, which indicates that by working on gut health, you can potentially reduce chronic pain.11 The Natural Doctors provides free mindfulness classes as well as a wealth of information on inflammation (extremely important to consider if you have pain), nutrition, back and joint health, gut health, the gut-brain axis and tools to improve your brain function and mental health



  1. Velly AM, Mohit S. Epidemiology of pain and relation to psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2018 Dec 20;87(Pt B):159-167. doi: 10.1016/j.pnpbp.2017.05.012. Epub 2017 May 15. PMID: 28522289.
  2. Elman I, Zubieta JK, Borsook D. The missing p in psychiatric training: why it is important to teach pain to psychiatrists. Arch Gen Psychiatry. 2011 Jan;68(1):12-20. doi: 10.1001/archgenpsychiatry.2010.174. PMID: 21199962; PMCID: PMC3085192.
  3. Doan L, Manders T, Wang J. Neuroplasticity underlying the comorbidity of pain and depression. Neural Plast. 2015;2015:504691. doi: 10.1155/2015/504691. Epub 2015 Feb 25. PMID: 25810926; PMCID: PMC4355564.
  4. Leung L. Pain catastrophizing: an updated review. Indian J Psychol Med. 2012 Jul;34(3):204-17. doi: 10.4103/0253-7176.106012. PMID: 23441031; PMCID: PMC3573569.
  5. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioural therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014 Feb-Mar;69(2):153-66. doi: 10.1037/a0035747. PMID: 24547801.
  6. Malfliet A, Coppieters I, Van Wilgen P, Kregel J, De Pauw R, Dolphens M, Ickmans K. Brain changes associated with cognitive and emotional factors in chronic pain: A systematic review. Eur J Pain. 2017 May;21(5):769-786. doi: 10.1002/ejp.1003. Epub 2017 Feb 1. PMID: 28146315.
  7. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioural therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014 Feb-Mar;69(2):153-66. doi: 10.1037/a0035747. PMID: 24547801.
  8. Joyce S, Shand F, Tighe J, Laurent SJ, Bryant RA, Harvey SB. Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ Open. 2018 Jun 14;8(6):e017858. doi: 10.1136/bmjopen-2017-017858. PMID: 29903782; PMCID: PMC6009510.
  9. McCracken LM, Turk DC. Behavioural and cognitive-behavioural treatment for chronic pain: outcome, predictors of outcome, and treatment process. Spine (Phila Pa 1976). 2002 Nov 15;27(22):2564-73. doi: 10.1097/00007632-200211150-00033. PMID: 12435995.
  10. Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, Hansen KE, Turner JA. Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA. 2016 Mar 22-29;315(12):1240-9. doi: 10.1001/jama.2016.2323. PMID: 27002445; PMCID: PMC4914381.
  11. Russo R, Cristiano C, Avagliano C, De Caro C, La Rana G, Raso GM, Canani RB, Meli R, Calignano A. Gut-brain Axis: Role of Lipids in the Regulation of Inflammation, Pain and CNS Diseases. Curr Med Chem. 2018;25(32):3930-3952. doi: 10.2174/0929867324666170216113756. PMID: 28215162.


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