Cognitive Behavioral Therapy

One of the last things a person experiencing pain wants to hear is the phrase: “It’s all in your mind.” Pain is real to the person feeling it, and nothing can change that. But what if that person could gain a better understanding of their pain so that its effects were not as debilitating? Cognitive behavioral therapy seeks to help people change how they think to help them heal. It’s an incredibly powerful complementary therapy for those struggling with chronic pain. We’re proud to offer these services, as well as biofeedback and access to our weekly chronic pain support group, at Arizona Pain.

What is cognitive behavioral therapy (CBT)?

Cognitive behavioral therapy (CBT) is a type of psychosocial therapy useful for the treatment of many different chronic pain conditions. The idea behind CBT is simple: a distorted thought process causes negative behaviors and emotions. In people with chronic pain, these negative emotions can increase our perception of pain.

The goal of CBT is to make you aware of negative thoughts and emotions so that you can consciously change them. Healthy positive thoughts and emotions replace the negative ones. This has a powerful impact on your life and can decrease your pain.

Also, chronic pain and mental health conditions, like depression and anxiety, are inextricably linked. By working on one—like mental health concerns with CBT—you can help reduce the symptoms of the other. Treating both at the same time leads to better outcomes for patients.

There are a few specific tools we use for CBT. They may include the following, depending on the best approach for you.

Journal writing

Patients are asked to keep a daily journal of the day’s events along with feelings, emotions, and actions. They are asked to record the most stressful parts of their day and their related pain levels at that time. This can uncover patterns of thoughts and symptoms.


Conditioning uses positive or negative reinforcement to encourage helpful behaviors. This conditioning is verbal.

Systematic desensitization

This is frequently used for people with anxiety disorders. Patients imagine an uncomfortable or fearful situation, and the CBT therapist helps the patient to relax through it. Gradually the patient becomes desensitized to the fear-producing stimuli and instead associates relaxation with the stimuli.

This same technique can be applied to chronic pain. A CBT therapist walks you through various relaxation techniques to minimize the bodily response to pain. Over time, you will be able to do this yourself when pain flares. The more advanced version of this is biofeedback, a related process to identify bodily reactions to stimuli and uncover new ways to encourage the body to relax.

Cognitive rehearsal

You imagine a problematic circumstance, and the therapist helps you process it. This might be heading into a potentially stressful procedure, or even something like asking for a raise. You’ll identify fears and negative emotions, and think about the circumstance with a healthy frame of mind.

Together, these tools of cognitive behavioral therapy can help you reframe how you see pain (and other unrelated life challenges).

How can cognitive behavioral therapy help me?

Many patients who undergo cognitive behavioral therapy successfully learn how to replace their negative or unwanted thoughts and behaviors with healthier, more positive ones. These changes can improve quality of life and decrease pain symptoms for chronic sufferers. CBT is especially useful in conjunction with other pain treatments.

Many different disorders are treated successfully by CBT, including mood disorders, anxiety disorders, and chronic pain. The specific CBT methods used varies with each type of disorder, so it is important for the CBT therapist to be familiar with you and your goals for therapy.

Other conditions treated by cognitive behavioral therapy include:

  • Mental disorders
  • Personality disorders
  • Phobias
  • Eating disorders
  • Substance abuse
  • Post-traumatic stress disorder (PTSD)
  • Attention-deficit/hyperactivity disorder (ADHD)

Patients with sleep disorders may also find cognitive-behavioral therapy a useful treatment for insomnia. CBT for insomnia can improve sleep quality, reduce sleep aid use, and improve quality of life in patients with chronic sleep difficulties.

Cognitive behavioral therapy and chronic pain

Cognitive behavioral therapy can be very helpful for chronic pain. Research uncovers some of the following benefits on chronic pain, including:

In addition, these studies show an improved quality of life and overall reduction in average pain scores, all without side effects or additional medications.

Cognitive behavioral therapy and depression

Cognitive behavioral therapy’s effects on depression are closely related to the effects on chronic pain. CBT for depression involves changing two main contributing factors to depression: negative emotions and social withdrawal (the tendency to stop enjoyable activities).

Patients suffering from depression typically follow a pattern.

  • Depression comes on slowly with negative feelings present
  • The person tends to stop participating in pleasurable activities
  • Depression sufferers can become unable to function in their daily life

The goals of CBT are to change this negative pattern with depression and help patients to participate in gratifying activities.

People utilizing CBT for depression report feeling empowered and generally more positive overall. Other studies indicate that CBT is nearly as useful as antidepressant medication in treating depression but with no harmful side effects.

Cognitive behavioral therapy, whether delivered in a group setting or for individuals, also has long-lasting effectiveness against relapse into depression, even after therapy ends. This may be as a result of learned techniques that replace negative thoughts with positive ones. With CBT, patients suffering from depression learn how to rearrange negative thought patterns in order to influence their daily life activities. This is a skill that can last a lifetime.

Cognitive behavioral therapy and anxiety

Cognitive behavioral therapy is not just “thinking happy thoughts and all of your problems go away.” CBT helps people gain conscious control over unwanted thoughts or feelings that are typically associated with anxiety.

People with certain phobias benefit from a CBT method that uses exposure to what they fear. This brings about a gradual improvement of their reactions to the object or situation. Those who suffer from panic attacks, for example, become aware of their body’s negative responses and actions before and during these attacks. CBT helps them develop methods to counteract the reason for their panic attacks.

Finally, people who have obsessive-compulsive tendencies can expose themselves to what they fear. This helps them identify what they truly fear.

Each of these anxiety-based conditions require a different approach in CBT. It’s important to work with a provider who is able to provide an individualized, multi-pronged approach to treatment.

Learn more about pain management

The best pain management approach is one that treats the entire person—not just your symptoms. Arizona Pain takes a holistic view of pain management, offering a variety of individualized treatment options that are tailored to each patient. Since 2007, we have provided psychological evaluations, cognitive behavioral therapy, and biofeedback for our patients, and also host two support groups a week. If you’re suffering from pain and related mental health concerns, you are not alone.