Types of Psychotherapy that Help with Pain

More research is connecting the emotional aspects of pain to pain response and treatment outcomes. Psychotherapy can help you work through the negative thoughts that often come with chronic pain and boost your pain-relief plan.

Don’t discount the emotional and mental component of pain. Psychological pain is a big part of chronic pain life, including anxiety about current and potential discomfort, insomnia, depression, suicidal thoughts, and grief. It is important to know that this is all normal. It’s also important to make sure you address these feelings.

Because chronic pain is very complex—it includes biological, psychological, and emotional component—all of these factors must be managed to treat your pain effectively. 

Your mental health is an important factor to chronic pain, and should not go ignored. (Image: iStockPhoto)

Why Your Pain Doc May Suggest Seeing a Psychologist

“When they are referred to see a psychologist, a patient may think that their provider believes their pain is in their head or that they are to blame for their pain, and this is not true,” explains David Cosio, PhD, ABPP, a clinical health psychologist at the Jesse Brown VA Medical Center in Chicago and an editorial advisor to PPM. “Providers do recognize that their patients’ pain is real,” he emphasizes.

“Referral to a psychologist is important because there are limits to what medical treatment can accomplish with chronic pain. Pain is not anyone’s fault,” adds Dr. Cosio. “However, there are many things patients can actively do to help their pain and emotional state. This does not mean that they have caused their pain or are in any way to blame.”

Individuals with a diagnosed chronic pain condition – that is, pain that lasts more than 3 months – may be referred to a psychologist by their primary care doctor or one of their other healthcare providers, but if your provider has not mentioned psychotherapy, you may want to ask about it. Any type of psychotherapy can be used in combination with medication and other pain management strategies or as an alternative to medication. In fact, current pain management approaches and experts encourage a multidisciplinary, integrated care approach.

Psychotherapy itself is not a job title or degree. Therapists who provide psychotherapy services include psychiatrists, psychologists, and licensed professionals with training and certification in mental health, such as counselors, social workers, marriage and family therapists, and psychiatric nurses.

Before choosing a psychotherapist, be sure he or she meets your state’s certification and licensing requirements for their specialty. Patients can find a licensed psychologist in their state using the psychologist locator search feature on the APA website (locator.apa.org). Don’t be afraid to try more than one therapist. An important part of successful psychotherapy for managing chronic pain is finding a therapist with whom you feel comfortable. In terms of cost, some types of psychotherapy are covered by insurance companies while others may be eligible for reimbursement with Flexible Spending Accounts, so check with your provider about your options.

Why Psychotherapy Should Be Part of Any Pain Management Plan

We know that being is constant pain can be depressing, so a certain level of depression, anger, anxiety, and other emotions are expected, points out Dr. Cosio. “Sometimes, these emotions may require additional treatment, such as education, psychotherapy, or medications. A psychologist can help connect patients to those services if needed.” 

In addition, more research has come out that connects emotional response to pain. If you have been hesitant to incorporate psychotherapy into your pain care plan in the past, consider that the stakes have changed and that psychotherapy offers a new opportunity to help improve your day-to-day. “We now understand pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage,” explains Dr. Cosio. “Individuals who do not address unpleasant emotional experiences may in fact experience more physical pain.” A psychologist can help evaluate how well you are coping with your pain and help you add non-drug interventions to your overall treatment plan.

Psychotherapy, in particular, as part of a pain management plan can help patients with any thoughts, feelings, and behaviors related to their chronic pain, Dr. Cosio says. “For example, individuals who are inactive may find their pain is increasing because they are becoming deconditioned. They may find behavioral strategies, such as relaxation, activity pacing, pleasant activities scheduling, goal-setting, and exposure to avoided activities, to be helpful,” he explains. “Those who engage in catastrophic thinking may benefit from cognitive strategies, such as cognitive restructuring, identifying core beliefs, and problem-solving.”

For those living with chronic pain, four types of psychotherapy may be beneficial, including CBT, ACT, mindfulness, and biofeedback. (Image: Christian Joudrey - Unsplash)

Four Types of Psychotherapy that Help with Pain

There are four common types of psychotherapy used to help manage chronic pain:

  • Cognitive behavioral therapy (CBT) 
  • Acceptance and commitment therapy (ACT)
  • Mindfulness/relaxation
  • Biofeedback.

Some people notice that they are better able to manage their pain after a few psychotherapy sessions. However, if you are also suffering from depression or long-term degenerative conditions, you may benefit from a longer period of treatment.

Cognitive Behavioral Therapy: Change Your Perspective, Ease Your Pain

CBT is a psychological technique used for a variety of conditions including depression, anxiety, and sleep disorders as well as coping with stress and managing chronic physical symptoms, including pain. As part of CBT, patients meet regularly with a therapist in a structured office setting to identify patterns of negative thinking and negative behavior so that you can develop healthier ways to respond to and think about pain.

CBT is goal-oriented and patient “homework” may include recommended reading or activities that build on issues related to pain that you discuss during therapy sessions. Some patients find that their pain improves after only a few sessions of CBT, but those who have depression or degenerative chronic medical conditions may find benefit from ongoing treatment.

CBT can also help with pain-related insomnia.

Acceptance and Commitment Therapy: Moving Forward

ACT is a type of behavioral therapy that encourages patients to commit to taking actions based on their personal values as a way to help enrich their lives. In ACT, patients learn strategies to accept the presence of pain and to set goals to move forward and find satisfaction with their lives. ACT can help pain patients relieve stress and anxiety, manage symptoms, and improve problem-solving skills.

ACT may involve a psychotherapist using metaphors such as thinking of pain as a beach ball that simply floats on the surface of the water instead of trying to push it under the water, which takes much more energy. ACT promotes flexible thinking and letting go of old behaviors, thoughts, and emotions to make room for new ones that include accepting the presence of pain sensations while finding value in life.

How to practice CBT and ACT at home.

Mindfulness: Being in the Moment

With mindfulness approaches, psychotherapists can help individuals living with pain learn meditation techniques to keep stress levels under control, which in turn may help manage chronic pain. Mindfulness means focusing the mind and body on the present moment without judging the feelings and sensations that arise, including negative or stressful thoughts about pain, and a growing body of research supports the value of mindfulness as part of a pain management plan.

Some strategies to practice mindfulness include reciting a mantra to oneself, such as “I am at peace,” focusing on the breath, or performing a simple, comfortable yoga move. Mindfulness can also involve learning to acknowledge pain without judgment. There is no single treatment protocol for how often people should practice mindfulness or types of meditation, but research suggests that even a few minutes a day can help with pain management.

Biofeedback: Getting Technical

Some psychologists and other healthcare providers use an approach called biofeedback, which teaches individuals how to increase control over their body’s stress responses.

In biofeedback, sensors are attached to the skin to measure heart rate, blood pressure, and sometimes brain waves in order to measure your stress response. When you are stressed (because of pain, anxiety, or other reasons) your heart rate speeds up, muscles tense, and blood pressure rises. Therapists teach you strategies to relax your brain and muscles—you can see the changes on a monitor and identify the strategies that are most effective for you.

In addition, relaxation exercises used in biofeedback sessions can include mindfulness, deep breathing, and progressive muscle relaxation. Most biofeedback sessions last for 60 to 90 minutes. Some people see improvements in a few sessions, while others may need additional sessions. Ultimately, patients learn to recognize the techniques that help lower their heart rate and relax their muscles so they can employ these techniques anytime, without a monitor.

How one clinician used biofeedback and neurofeedback for low back pain and more.

Get More Out of Your Psychotherapy

In addition to therapy with a professional, the American Psychological Association recommends a few other ways to manage chronic pain on your own time:

  • Stay positive. Try not to let pain take over your life by filling it with things you enjoy and remaining active. Exercise and physical activity can be key to staying positive—develop a plan that keeps you moving at a level you can handle and enjoy.
  • Stay connected. According to the APA, research supports the value of social connections in building resilience and reducing depression and anxiety. A social network can help support and enhance the pain management progress made in therapy.
  • Stay on track. If you are taking medications, follow your doctor’s directions. If you are having trouble staying on top of your prescribed schedule, tell your therapist, and he or she may be able to help you address any problem areas.
Updated on: 07/01/20
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CBT and ACT Therapy for Chronic Pain: How Does Psychotherapy Help?