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Psychological therapies for long-term pain

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a term used for a wide range of psychological approaches designed either to manage symptoms of mental or physical health problems or to change behaviour so that your ability to function on a day-to-day basis is improved.

All forms of CBT are based on the idea that our thoughts, beliefs, feelings, behaviour and the situations we’re in interact with each other. CBT includes assessing and understanding how these interactions create problems and then altering these interactions so that the problems can be improved.

Within physical health, psychologists in particular often teach coping skills. This can include:

  • relaxation methods
  • methods for working with thoughts and beliefs
  • activity management methods (such as goal-setting and pacing methods)
  • methods for working with painful or discouraging moods.

These latter methods can include what is technically called ‘behavioural activation’ for depression and ‘exposure’ for anxiety or fear. These are highly effective ways to:

  • become more active when low mood is linked to withdrawal from activity
  • confront the sources of fear and anxiety one by one when these experiences have led to patterns of avoidance.

These descriptions may sound complicated but it’s important to know that CBT isn’t simply ‘having a chat’ or seeking advice, but a process of learning new skills so that you can handle challenges more effectively.

Studies of CBT for arthritis were done as early as the 1980s, so it’s a well-established approach that’s known to be effective for improving, mood, health and daily functioning.

Mindful meditation

Another approach that’s becoming more popular to treat both mental and physical health problems is called mindfulness or mindfulness meditation. This is a method for controlling your focus so that it’s more connected to the present moment – more aware and open – and leads to actions that are less ‘spur of the moment’ or driven by distress. Mindfulness is sometimes called paying attention, moment-to-moment, to experiences as they’re actually happening and not just your thoughts about experience.

Many psychologists and other professionals or trainers provide training in mindfulness to help people with health problems. It’s difficult to understand mindfulness just by its descriptions, but it might help to try a very simple mindfulness-type:

  1. Whatever you’re doing right now, pause.
  2. Now look around and notice five things you can see.
  3. Listen carefully and notice five things you can hear.
  4. Now focus on sensations on the surface of your body and notice five things you can feel.

You might find that you feel more focused and your mind seems less busy after you try this exercise.

This exercise is based on one described by Russ Harris, a physician and therapist in Australia. Russ and other professionals, including Tobias Lundgren, JoAnne Dahl and Steve Hayes, are researchers who’ve written quite a lot and produced books and workbooks you might find useful.

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