Chronic Pain

Cognitive Behaviour Therapy for Chronic Pain (CBT-CP)

What is the difference between chronic and acute pain?


  • Less than 3 months
  • Is a symptom
  • Identified cause, body’s response to injury
  • Diminishes with healing and responds to treatment

Chronic pain:

  • More than 3 months
  • Is a condition
  • May develop after incident, may have a known or unknown cause
  • Persists beyond expected healing time and/or despite treatment

Individuals with chronic pain often end up stuck in the pain cycle.  The pain hurts: we decrease our activity level in response.  This tends to decondition us.  When we reduce capacity we often develop negative emotions (feel worthless, grief our old activities, feel helpless), which perpetuates our avoidance/withdrawal from activities.  This can lead to further disability and distress, which actually increases our pain.  CBT for pain can help stop this cycle by re-programming the brain’s interpretation of pain and shifting the focus to what individuals are in control of.

Chronic pain is connected to numerous types of thoughts.  We often catastrophize our experience of pain (“this is so bad, I need help!” Or “I want this to stop”).  When we think this way, our attention remains on the experience of pain.  We also solicit attention from others when we are in pain, looking for social support in hopes that others can comfort us or reduce our pain.  By doing this we are again drawing our attention towards our experience of pain.  We avoid activities that might perpetuate our pain, thereby decreasing our capabilities, which can enhance our disability and pain response.  Rather than getting better, our help seeking behaviour sometimes worsens our condition.

We often seek out more and more help to try to find an answer to our pain response.  Rather than changing our perception of our experience of pain, these outward seeking behaviours enhance the experience of the problem and the pain can increase. 

The goals of CBT for Chronic Pain include: 

  • Helping clients gain a sense of control over their condition and the effect their pain has on their lives. 
  • Address maladaptive thought patterns and balance their views to improve mood. 
  • Improve reactions to experiences to reduce the reactions causing more pain or suffering. 
  • Engage in activities more that they are capable of engaging in. 

Therapists use a number of tools in CBT-CP including:

  • Relaxation training (breathing, progressive muscle relaxation, and guided imagery)
  • Reprogramming the brain through cognitive coping exercises (recognizing unhelpful thoughts and changing them). 
  • Behavioural activation (participating in more enjoyable physical activities that they are able to engage in)

The goal of this therapy is to help clients recognize what areas of their life they are in control of, shift their focus there, and improve their wellbeing.

If you want to learn more, book a free consultation with a CBT therapist at Island Clinical Counselling.

Written by Kathryn Atkinson