We know physical activity and nutrition are very important for managing chronic pain in arthritis, but did you know there is evidence for cognitive behavioural therapy? In this article, we look at what it is and how it works. Later this month we have expert, Professor Louise Sharpe joining us from the University of Sydney to present a webinar on the Role of CBT in Chronic Pain & Arthritis.
What is CBT?
CBT combines cognitive and behavioural therapies for the treatment of mood and anxiety disorders – so why is it relevant to Arthritis?
CBT is a therapeutic approach that focuses on the relationship between thoughts, emotions, and behaviours. Arthritis is no doubt a physically painful condition – it can cause you to worry about the future, it can make you feel upset about having to live with pain, it can make you feel scared to exercise and engage in the activities you once use to love – it can be psychologically taxing.
CBT aims to identify and modify these negative or unhelpful thinking patterns and behaviours associated with chronic pain to alter the way you experience pain.
CBT involves:
- Rationalising the thoughts and behaviours contributing to the distressing emotions
- Encourages objectivity in the reflection of how situations, thoughts, behaviours and moods can influence emotions & challenges them.
- Improves feelings and emotions by changing dysfunctional patterns of thinking and behaviour.
How can CBT help?
Handling emotional difficulties
Arthritis can often trigger emotional difficulties such as depression, anxiety, and frustration. CBT equips individuals with arthritis with effective tools to manage these emotional challenges. Through cognitive restructuring, individuals learn to challenge negative thoughts and replace them with more positive and realistic ones. CBT can also help regulate emotions and navigate stressful situations, promoting emotional well-being and resilience.
For example:
(Client) No matter what I do, my osteoarthritis is going to get worse, I can’t control It – I can’t even do my Pilates anymore it has ruined my life.
(Therapist) You can’t control osteoarthritis, but you can control how you are going to manage it. If you love Pilates, and you know movement is good for your joints, ask your doctor if you can still do it, your doctor will likely tell you it will be good for you.
Behavioural adaptation
Arthritis can lead reduced activity levels, avoidance of certain tasks, and overall reduce enjoyment and fulfillment. CBT puts you in the driver’s seat of your treatment. By working with a trained professional to set achievable goals, gradually increase activity levels, you may be able to regain a sense of purpose. CBT aims to achieve a balance between rest and exercise to try break the cycle of inactivity and regain a sense of control over your life.
Improving Communication Skills
CBT also emphasizes the importance of effective communication with the doctors, family members, and support networks. It aims to help with articulating needs, expressing concerns, and engaging in collaborative decision-making regarding arthritis management. Enhanced communication skills facilitate a more productive and supportive relationship with healthcare providers and ensure that individuals receive the appropriate care and support they require.
Pain & The Brain
Central sensitization refers to a phenomenon in which the central nervous system becomes hypersensitive to stimulus and can amplify pain signals which can result in an increased perception of pain.
When you have a condition like osteoarthritis, there will be some degree of tissue damage in the joint that causes an acute pain response. In addition to the damaged tissue, there is now an understanding of the alterations that can occur in the central nervous system, particularly the neurons, that can cause widespread pain, at a greater intensity and make your body more sensitive to pain. This is why sometimes pain can feel like it’s worsening, even though there is no additional tissue damage.
One crucial part of addressing this, involves addressing the mental contributors to the pain experience like any false beliefs around the pain.
For example, if you think that your shoulder or your hip is never going to get better, or if you think the pain is going to get worse from exercise, they are mental contributors.
Some people respond well to breath work, other people respond better to CBT. In some cases, people may need medication, but the bottom line is, addressing the mental component is super important.
What you can expect in CBT?
CBT is typically conducted through a structured and collaborative approach involving the therapist and the individual experiencing pain. When you are acquainted with a therapist, you can be prepared for:
- A thorough initial assessment and lots of questions.
- Psychoeducation on the complex interaction between physical, psychological, and social factors in pain perception and management.
- Collaborative goal setting
- Cognitive Restructuring to help identify and challenge negative or unhelpful thoughts and beliefs related to pain.
- Behaviour Activation with a focus on identifying enjoyable activities, setting achievable goals, and developing strategies to gradually reintroduce or adapt activities to accommodate pain.
- Pain Coping Skills Training which includes using relaxation techniques, mindfulness meditation, deep breathing exercises, guided imagery, and distraction techniques to modulate pain and enhance control over the pain experience.
- Problem solving and adaptive thinking skills
- Relapse Prevention and Maintenance planning
CBT for pain is typically delivered in a structured format over several sessions, often ranging from 8 to 12 weeks. The frequency and duration of sessions may vary depending on individual needs and treatment goals. Therapists may also provide resources for self-guided practice between sessions, such as worksheets, recorded guided exercises, or mobile applications, to reinforce learning and promote ongoing skill development.
Cognitive change helps patients to develop a more optimistic but realistic attitude toward the illness and to manage other stresses in their lives.
If CBT is something you want to learn more about, be sure to watch the webinar coming up with Professor Louise Sharpe on Thursday 27 July 2023 or watch via the webinar recording.
Ismail, A., Moore, C., Alshishani, N., Yaseen, K., & Alshehri, M. A. (2017). Cognitive behavioural therapy and pain coping skills training for osteoarthritis knee pain management: a systematic review. Journal of physical therapy science, 29(12), 2228–2235. https://doi.org/10.1589/jpts.29.2228
Sharpe L. Psychosocial management of chronic pain in patients with rheumatoid arthritis: challenges and solutions. J Pain Res. 2016;9:137-146
https://doi.org/10.2147/JPR.S83653