Cognitive behavioral therapy or CBT is the term used to describe one form of modern psychotherapy is used to treat chronic pain patients. It is widely used to treat any number of emotional or mental problems, such as substance abuse, dependence and addiction, personality, eating or anxiety disorders and different psychoses.
CBT differs from other forms of psychotherapy in that it looks at conscious thinking (cognition) and behaviors (actions) that are not helpful and can cause problems for patients. It seeks to solve problems by changing thought processes and behaviors that are detrimental. It also acknowledges that all thoughts are not controllable or conscious. Pure psychoanalysis, for example, looks for the unconscious meanings behind troublesome thinking and behaviors that may have been formed early in life or through some traumatic event. Modern CBT acknowledges that both theories can be helpful when treating patients and looks to help patients address issues by using specific strategies to change thinking and behavior.
They are many types of CBT, some of which may be familiar to you, such as: exposure or aversion therapy, relaxation therapy, acceptance and commitment therapy, and mindfulness, to name a few. These therapies attempt to address cognitive distortions, such as catastrophizing, minimizing or denying positives, magnifying negatives, all-or-nothing thinking, etc., and to replace these with adaptive thinking skills and behaviors.
How does CBT work in practice? Dr. Robinson utilizes these four steps:
Step 1: Identify critical behaviors
Step 2: Determine whether critical behaviors are excesses or deficits
Step 3: Evaluate critical behaviors for frequency, duration, or intensity (obtain a baseline)
Step 4: If excess, attempt to decrease frequency, duration, or intensity of behaviors; if deficits, attempt to increase behaviors.
We help the patient to replace irrational, self-destructive thoughts and behaviors with those that are positive, rational, and action-oriented. Like most worthwhile pursuits, this takes practice and effort on the part of the patient. It is difficult to change years of negative thoughts and behaviors in one day or one week. However, for those patients who approach CBT seriously, they can successfully address negative behavior patterns and learn new ways of dealing with the stresses of chronic pain and everyday life.