Escaping the Pain Cycle: How CBT Can (and Can’t) Help with Chronic Pain, (or Fatigue, or Persistent Symptoms)

We are meaning making machines, living in biological bodies.

So, when our bodies send signals to our brain during our interactions with the world; we’re going to do our best to make sense of them. This is where the stories about our experiences begin. These stories have the power to be helpful or harmful; to upregulate or downregulate the pain (or other signals) from our body.

This is why cognitive behavioural therapy (CBT) is often recommended as part of a treatment approach for chronic pain, fatigue, and other persistent physical symptoms.

I want to share an overview of the vicious cycle that can arise with pain (or other persistent physical symptoms), and some of the ways CBT can help to interrupt that cycle.

Trigger

Let’s start with the trigger. Many things can cause pain, or other physical symptoms. You might have a medical diagnosis that helps you understand some of them, or you may not. A key part of CBT is monitoring your symptoms to build that understanding, helping you learn more about what makes it better or worse, and empowering you to problem-solve around managing those triggers.

Thoughts

Pain evolved to act as a warning sign to protect our bodies from danger. When that danger is not immediately obvious in our environment, our mind may continue to search for possible threats. You might think “there must be something seriously wrong with me”, “the doctors have missed something”. You may begin to worry what this means for you or your future: “It’s going to get worse” “I won’t be able to do the things I want to”, “I can’t cope”, “this is unbearable”. You may have anxious thoughts about how others perceive you at this time: “they don’t believe me”, “they don’t want to hear about it”. You might feel angry “this is unfair”.

CBT for pain management works by interrupting the cycle. Here we can interrupt by noticing and gently questioning some of these thoughts. Are they true? Are they helpful? After testing them out, you might decide to make a conscious effort to replace some of these thoughts with alternative, accurate, and helpful thoughts. If the original thoughts are true, we might problem solve how you can cope. Or you may choose simply to let some of them go.

Emotion & Body Response

As your brain searches for, or thinks about threats, your body automatically prepares to deal with them (unable to differentiate immediate threats in our environment from imagined possibilities in our mind). This means your “fight, flight, freeze” response is activated. Your body gets ready to fight or run away by increasing your heart rate, redirecting blood flow from your digestive systems to your muscles, and more. It even narrows your attention around whatever is threatening (in this case the pain or other physical symptoms, so you notice them more). This physical response from your body can generate more pain, more concern, or simply draw more attention to it.

CBT can help interrupt the cycle here by teaching you some relaxation skills. This can help activate your parasympathetic nervous system, sending signals of safety and calm from the body to the brain. This acts in opposition to, and turns down the fight, flight, freeze response. Relaxation skills can include slow, deep breathing, and progressive muscle relaxation.

More Thoughts (and behaviours)

You might have more thoughts about pain, or bodies, or health, or facing challenges, that shape how you have tried to deal with pain (or physical symptoms) so far. We all have a personal system of rules and beliefs that guide us through life, some of them may be conscious, others not; some of them helpful, some of them not.

You may have a belief that “I need to push myself on a good day to get more done”. This is a common belief that can lead to over exertion or injury, followed by a period of more pain.

You may have a belief that “There’s no point in a job half done”, leading to procrastination, inactivity and deconditioning as you wait to feel better.

You may have a belief that “I should be able to handle this on my own” leading to isolation and negative feelings towards yourself.

Our beliefs are shaped by our personal experiences and the cultures we live within. CBT can help you to notice some of your beliefs, then notice which ones are helpful, and which ones you want to test or change.

A note on what CBT can’t do

CBT (and most psychological therapies) can help increase your awareness about connections between your thoughts, feelings, behaviours, and environment. This can help you to notice what might be keeping you stuck or contributing to your pain and empower you to take action to change that.

When we’re talking about physical pain or other physical symptoms, it is important to recognise that CBT cannot help you identify all possible contributing factors. For this reason, it is advisable that if you are experiencing persistent physical symptoms, you consult with a medically trained professional, such as your GP to assess for any relevant underlying conditions.

CBT also cannot eliminate 100% of pain (or painful thoughts, or emotions). We are human, and these are all adaptive, functional, and often helpful experiences. CBT simply increases your ability to understand and manage them.

Further Reading

If you’d like to explore CBT informed self-help resources to help manage pain, two great sources to start with are: NHS Lothian's online resources and YouTube webinar series, or Curable’s Like Mind Like Body Podcast.

Looking for personalised CBT support for pain management or persistent physical symptoms?

We are all unique, and if you’re looking for a little more support to understand and work through your personal experience of pain or persistent physical symptoms, please feel free to reach out and discuss.

I can offer individual sessions in person in Elgin, or online for clients across the UK.

I can offer a free 15minute compatibility call to see if I feel like the right fit for you, or I am happy to answer any queries through email.