Coping with Chronic Pain
Week 1: Understanding chronic pain
Week 1 Action Plan
Week 2: Getting to know and understand your pain better
Understanding chronic pain and getting to know your symptoms
Thoughts, feelings and behaviours
A CBT model of chronic pain
The vicious cycle of chronic pain
The biopsychosocial model of pain
Setting goals for recovery
Skills for symptom monitoring and goal setting
Keeping a pain diary
Setting ‘SMART’ goals
Week 2 Action Plan
Week 3: Managing your stress and learning to relax
Stress management and relaxation
The stress response and chronic pain
Stress and worry in chronic pain
Ways to calm the stress response
Rest vs. relaxation – what’s the difference?
The benefits of planned relaxation
Relaxation for chronic pain
Mindfulness for chronic pain
Sleep and chronic pain
Skills for stress management and relaxation
Dealing with worry
Improving your sleep
Week 3 Action Plan
Week 4: Healthy thinking, healthy self
Healthy thinking for a healthy self
The role of thoughts in chronic pain
Common thoughts in chronic pain
A case example: Marge
Identifying your thoughts
Unhelpful thinking styles
The benefits of changing your thinking
Skills to help you identify and manage unhelpful thoughts
Using a thought diary
Examining the evidence
Is it a helpful thought?
Finding the positives
Week 4 Action Plan
Week 5: Balancing your activity patterns
Balancing your activity and reclaiming your life
Hurt vs. harm
Balancing your activity
Exercise and chronic pain
Skills to help you balance your activity and reclaim your life
Know your baseline
Grading your activities
Week 5 Action Plan
Week 6: Maintaining your gains and staying well
Introduction to relapse prevention
Look how far you’ve come!
Barriers to recovery
Lapses vs. relapses
When more help is needed
Skills to continue your progress and maintain your gains
Learning from your lapses
Replace worrying with problem solving
Create your own staying well plan
Week 6 Action Plan
About This Course
Learn evidence-based ways of coping with chronic pain
As you complete this six-week course, you’ll learn about chronic pain management. Specifically, learn evidence-based psychology skills to manage chronic pain.
Dr. Joseph and Dr. Sal, between them they have held positions as Psychiatrists and University Academics in several institutions across Australia. Epsychonline is their effort to bring low-cost access to mental health care globally. Lofty ambitions! If you want to get to know them, visit our YouTube Channel.
About this course
Learn evidence-based ways of coping with chronic pain
As you complete this six-week course, you’ll learn about chronic pain management. Specifically, learn evidence-based psychology skills to manage chronic pain. We are confident that with the right skills coping with chronic pain can become more manageable.
By taking this psychology course, you’ll develop a foundation or toolbox of chronic pain management skills. Week 1 is an introduction before we dive into more advanced topics. We will cover planned relaxation, dealing with worry, behavioural experiments, radical acceptance, unhelpful thinking styles, time-based pacing, and so much more.
Suppose you are struggling with chronic pain and want to learn about psychological chronic pain management. Read on to find out more.
Why we created this course
Chronic pain is a common condition, especially in the middle age and older cohorts. As a society, we don’t acknowledge it. We accept chronic pain as part of getting older, but it doesn’t have to be.
Global Burden of Disease Study 2016 stated that pain and pain-related diseases are the leading cause of disability and disease burden globally.
Millions of people suffer in silence, alone and struggle to get help. Misunderstood by friends, family and even health professionals, years of chronic pain can tear down someone’s life.
Coping with chronic pain or chronic pain management, we believe, can be taught. With the advances in technology, we now think it can effectively be taught online.
How this course is different
Each week of this course is divided into five parts:
- Educational lessons at the start
- Quiz to aid self-reflection
- Aided self-reflection questions to get you thinking more
- Tailored suggestions
- Action plans and worksheets
Depending on your quiz answers, you will get specific feedback and suggestions each week. The feedback and suggestions you take away from this course will be unique to you.
If two people were to do this course, the chances of getting the same feedback and suggestion would be over 1 in 100,000.
Our IT professionals and mental health experts have worked together to create a system that provides specific feedback and suggestions.
Why do we do this?
People are unique. We want to give you answers, feedback, and solutions that best suit you.
The reasons why you and someone else might struggle with chronic pain will be different. The same tips and suggestions aren’t going to work for everyone, which is why we have gone to the extent of providing tailored chronic pain management suggestions.
Key aspects of this course
Coping with chronic pain skills such as; radical self-acceptance, a DBT skill, self-compassion, managing flare-ups, time-based pacing, alternative thoughts and others. Troubleshoot the common roadblocks to chronic pain management.
We also cover chronic pain and mental health, self-monitoring activity diaries, dealing with worry and other psychology skills. The course ends with early warning signs, stay well plans and how to manage setbacks.
Is this course will help you with your chronic pain. Form part of your chronic pain treatment plan and be a tool alongside other professional and informal supports you get. We want to get you thinking, understanding and questioning your chronic pain. Our hope is for you to experience lasting change when it comes to your well-being.
Good News! We have opened access to Week 1 of the learning material
Topics Covered in this section
Introduction to this course
Welcome to the Epsychonline Coping with Chronic Pain Course. This is a six-week, self-help program for people struggling with chronic or persistent pain.
Do you suffer from persistent pain, which hasn’t improved over time? Has your pain lasted well beyond the injury or illness which triggered it? Does pain seem to rule your life, interfere with your enjoyment, and impact your ability to function? Does it impact your mood and lead to feelings of depression, fatigue and anxiety? Does your pain make it difficult to get a good night’s sleep? Have you struggled to find a solution to your pain?
If you answered yes to any of these questions, you may be suffering from chronic pain. Chronic pain is a serious condition, which is undoubtedly holding you back from reaching your full potential and living the life you want. Don’t worry, you’ve come to the right place! Whether you suffer from mild symptoms or severe and debilitating pain, there are sources of support and effective treatment options available to you.
This course is a great place to start, and we applaud you on making it this far in your journey towards freedom from chronic pain. All you need to get started with this course are basic reading skills and access to the internet. A good dose of motivation and an open mind will also go a long way. For anyone under the age of 18 years, we suggest a trusted adult be present to guide you through the content. Some of this content might trigger distress, so it is helpful to have support close by.
What to expect from this course?
This course will guide you through an evidence-based information and skills package to help you manage your chronic pain. The aims of this course are to help you:
- Better understand chronic pain and how it impacts you
- Set some realistic goals for your improvement
- Get to know and understand your symptoms
- Learn about and manage stress more effectively
- Learn about and change unhelpful thoughts and activity patterns
- Make a plan to maintain your gains and recover from setbacks
The course runs for 6-weeks in total, with each week broken down into three sections:
- Section 1 provides educational content to help boost your knowledge of chronic pain and get you thinking about how the information applies to you. It also includes activities, or ‘action plans’, to help you put the principles you’ve learned into practice.
- Section 2 guides you through an aided self-reflection in the form of multiple-choice questions and tailored feedback. This builds on Section 1 by helping you develop deeper insight into the nature of your difficulties.
Section 3 uses your responses from Section 2 to provide you with additional self-help recommendations and resources that are targeted to your unique needs.
How to get the most out of this course
Having a vision for life changing improvement is great, but it is also important to have realistic expectations for this course. Learning the skills in this course will take time and practice. The more effort you put in, the more you will get out of the course. You are likely to start noticing benefits as you make changes in your life, however, your difficulties are unlikely to disappear completely or be ‘cured’ overnight. To get long lasting benefits, you will need to continue your hard work well into the future.
When addressing complex health issues, it is not uncommon for things to get worse before they get better. Growing as a person means stepping outside your comfort zone. With that said, feeling uncomfortable is often a sign of progress. We encourage you to redefine your view of success. Down the track, success might look like being able to manage your pain easily. But right now, success might look like simply engaging with the course content each week and making a series of small changes in the way you think about and relate to your pain. You may not immediately feel better, but we encourage you not to make this your aim.
On the flip side, failure does not exist in this course. Every so-called failure provides you with useful information. You may learn something new about yourself, a situation, or a skill that you’re trying out. Remember, knowing what doesn’t work is just as valuable as knowing what does work. So, we encourage you to reframe setbacks as opportunities for learning. When things don’t work out as planned, reflect on what got in the way and make the necessary changes to improve next time. The most important thing is that you keep trying.
Understanding persistent or chronic pain
What is chronic pain?
Pain is a universal human experience; we all know that unpleasant sensation when we twist an ankle or break an arm. Despite the fact that it hurts, this type of pain is very useful. It stops us from using the body part and making the damage worse. This allows the damage to heal. As this healing takes place, the pain becomes less severe. For some people, however, their pain persists even after the injury heals. In some cases, there is no clear trigger for the pain at all. The first type of pain is called acute pain, whereas the second type is called chronic pain.
Acute pain usually occurs following an identifiable injury, where there is actual tissue damage to the body. This type of pain is useful, because it signals danger and the need for protection. The pain reduces as the body heals. Acute pain has the following features:
- It has a known cause
- It is a symptom of injury
- It is time-limited (less than 3 months)
- It improves as the body heals
- Needs to be cured
Chronic pain can occur following an injury or it can come on gradually for no obvious reason. Chronic pain persists for longer than 3 months and continues after the injury has healed. It is thought this occurs due to a misfiring of pain signals by the nervous system. As such, chronic pain is unhelpful and considered to be a chronic disease. Chronic pain has the following features:
- It may have a known or unknown cause
- It is a chronic disease or condition
- It persists beyond 3 months
- It doesn’t improve as the body heals
- Needs to be managed
Chronic pain can affect any part of your body. You may feel it in a specific area, or it could feel like the pain is everywhere. The pain may be there all the time, or it may come and go depending on your situation. Sometimes the pain can ‘flare up’, meaning it gets worse rapidly and without much warning. There are many different types of chronic pain, including back and neck pain, arthritis, headaches and so on. Some other types of chronic pain include:
- Postsurgical pain
- Cancer pain
- Nerve pain
- Joint pain
Chronic pain tends not to get better with medication, surgery or rest. Although these things can take the edge off, they do not fix the problem. Pain is meant to be like an alarm system in your brain, warning you not to cause yourself more harm. In chronic pain, that alarm system is faulty and continues to go off even after the danger of injury is gone. The reasons why some people develop this condition and others don’t are unclear. Chronic pain can be an incredibly stressful and debilitating condition that impacts all aspects of life.
Receiving a diagnosis of chronic pain
Chronic pain is not usually diagnosed until you have had regular pain for around 3 to 6 months. However, the process of diagnosing chronic pain is not always straightforward. Your doctor will probably try to determine the cause of your pain. Identifying the cause of pain can be a difficult and tedious process. Pain is subjective, meaning that only the person experiencing it can identify it and describe it. This makes it hard to detect and quantify on tests.
Your doctor may do a physical examination and order tests to gather more information. For example, they may request blood tests, imaging tests (e.g., MRI, X-rays), reflex and balance tests and more. They’ll also want to ask you a series of questions about your pain, including where it is located, what it feels like, how often it occurs, what helps or worsens it, and how much it impacts your life. In addition, you’ll likely be asked to provide information about your medical history, prior injuries and illnesses, and your current life circumstances (e.g., level of stress, anxiety, activity etc.).
It is important to know, however, that there is no strong relationship between a person’s reported pain intensity and the amount of detectable physical pathology via laboratory findings. In other words, someone who reports severe pain may show no signs of injury or illness on physical and medical tests. Whereas someone who reports little or no pain may show significant findings on imaging tests that would explain pain if it were present. As such, many people with chronic pain report feeling misheard or misunderstood by their doctors.
People with chronic pain can feel frustrated that they haven’t received conclusive answers about the causes of their pain. Furthermore, many are hoping for a cure and are dissatisfied with the level of pain relief provided by available treatments. In addition, people with chronic pain can feel like doctors have pushed medications on them, not taken their pain seriously, or believe that they’re “crazy”. Some people also report feeling like they’ve been unfairly labelled as “drug seeking” when they seek help for their pain.
All of these factors can act as barriers to someone seeking help. Over time, people can become distrustful or lose hope in the health system altogether. This distress simply adds to the already heavy burden of chronic pain. As such, it is important to receive the correct diagnosis and treatment for your chronic pain as quickly as possible. This will require you to work closely with your doctor and other health care providers. It is important to find a doctor who you trust and who understands chronic pain.
Common signs and symptoms of chronic pain
The exact signs and symptoms of chronic pain will differ from person to person. As we mentioned, chronic pain can be experienced in any part of the body. There are different types of chronic pain (e.g., back pain, headaches) and chronic pain can also be associated with other conditions, like fibromyalgia, arthritis and cancer. Chronic pain takes a toll on both your physical and mental health. Symptoms related directly to the pain can include:
- Joint pain
- Muscle aches
- Burning pain
- Shooting pain
- Stabbing pain
Chronic pain impacts all aspects of a person’s life and therefore has other physical and emotional consequences. Pain commonly stops people from doing the things they want and need to do. It can take a toll on self-esteem, as well as evoking difficult emotions like guilt, anger and frustration. The link between chronic pain and your emotions is important to understand and we will cover more in this later in the course. Other symptoms commonly associated with chronic pain include things like:
- Fatigue and weakness
- Poor sleep
- Poor memory and concentration
- Loss of endurance and flexibility
- Mood disturbance (including depression and anxiety)
- Loss of interest in sex
- Problems with work and/or relationships
- Drug or alcohol problems
Not everyone with chronic pain will have all of these symptoms. However, when present, additional symptoms can make chronic pain more severe. Chronic pain can range from mild to severe, depending on the intensity of the pain and the degree of distress and disability it causes. In extremely severe cases, people with chronic pain may be confined to bed and dependent on help from others for daily activities. As such, some people with chronic pain are unable to work, study, socialise or function properly in the community.
Causes of chronic pain
Chronic pain may have no known cause or be caused by illness, injury or disease. For example, it may be triggered by a muscle or joint condition, acute injury, degenerative disease, or surgery. Chronic illnesses like migraines, arthritis and cancer can also be a cause. There is also a link between pain and conditions like anxiety, depression and stress. Studies have found that up to 85% of people with chronic pain also have depression. Whilst mental health conditions may not cause chronic pain, they can definitely complicate the picture and worsen symptoms.
Potential causes of chronic pain:
- Sports injuries
- Muscle injuries
- Damaged nerves
- Certain conditions like endometriosis, fibromyalgia, inflammatory bowel disease, diabetes, cancer, arthritis, obesity etc.
Acute pain can turn into chronic pain if left unmanaged. The longer the pain remains untreated, the more likely it is to turn into chronic pain. Usually, when you’re injured, nerves signal to your brain that there’s a problem (acute pain). The brain reads these signals as pain and responds accordingly. However, in chronic pain, the nerves or the brain behave abnormally. The nerves may be more sensitive than normal or the brain may misread signals as pain. Either way, you experience pain in the absence of physical injury.
In chronic pain with no identifiable cause, it is possible that certain brain chemicals stopped working the way they’re supposed to. The exact reasons for this remain unknown. There are some factors that can increase a person’s chance of developing chronic pain. These include physical, lifestyle, and psychological factors. For example, people who have poor nutrition and mental health, a history of injuries or surgery, high rates of smoking and drinking alcohol, and more physical jobs are at a higher risk. Women and older people are also at greater risk.
It’s not ‘all in your head’
As we mentioned earlier, there is no definitive test for chronic pain and there may be no outward signs of an injury. In fact, medical tests may show no evidence of disease and provide no explanation for the pain. In some ways, this makes chronic pain an ‘invisible illness’. The challenges of an invisible illness can be complex and highly distressing. Some people with chronic pain believe others think they’re making up symptoms or that the pain is ‘all in their head’. This can leave the sufferer feeling misunderstood, frustrated and alone.
Unfortunately, this experience can also occur within the medical system. Whilst knowledge and awareness of chronic pain is growing, patients with this condition can still feel misunderstood by their doctors. As we mentioned above, some feel as though they are not taken seriously or are treated as “drug seekers”. When you’re feeling unwell, it can be extremely disheartening to be left without answers. Feelings of hopelessness and despair can set in at this point. As such, it’s extremely important to have a good relationship with your doctor.
Some people also become confused about why they are being referred for a psychological therapy like CBT. They may wonder how psychological approaches can help them and misinterpret it to mean that they’re “crazy”. Let us assure you, this is far from the truth. As you’re probably aware, chronic pain is a complex condition that comes with many social and emotional challenges. Rather than looking for a cure for pain, psychological therapies aim to help people cope better with it and improve their quality of life. A reduction in pain is often an added byproduct of this.
Remember, chronic pain is a very real disorder with serious implications for your health and happiness. While mental health plays a role in chronic pain and may worsen the symptoms, conditions like depression, anxiety and stress do not cause chronic pain. Chronic pain most certainly is not ‘all in your head’. Scientific evidence shows that chronic pain is not an imagined illness or a mental illness for that matter. Rather, it is a complex condition involving biological, psychological, and social factors.
Treatment options for chronic pain
There are several treatment options for chronic pain. As a first step, your doctor will likely try to identify and treat the primary cause of your pain. However, as we have mentioned, sometimes there is no identifiable cause. In this case, the aim of treatment will be to manage the pain. The type of treatment options available to you will depend on things like the nature of your pain, your age and overall health, and any other factors that may be worsening your condition. Without treatment, chronic pain doesn’t tend to go away on its own.
Treatment options commonly include medical, lifestyle, and therapeutic interventions. The best treatment plans often involve a combination of these factors to target different aspects of your pain. If you have other physical or mental health conditions, it is important that you seek treatment to manage these alongside your pain. Co-occuring conditions may interact with your pain to make it worse. For example, conditions like depression and obesity interfere with motivation, sleep and activity levels, and can intensify pain.
There are many prescription and non-prescription medications available to help with chronic pain. Medications can be effective but are not without side effects. Some options come in the form of creams or gels that are applied topically to the skin. These may contain pain relief, anti-inflammatory or other soothing agents. Other options come in the form of oral medications, such as:
- Ibuprofen & other nonsteroidal anti-inflammatory drugs
- Anticonvulsants for nerve pain (anti-seizure medications)
- Muscle relaxants
- Opioids (pain relief)
- Sedatives for anxiety or sleep problems
- Medical marijuana (legal in some parts of the world)
Doctors will often be wary of prescribing many of these medications, as there is a risk of dependence. Opioids and sedatives in particular can be addictive and people require more of these drugs over time to get the same effect. As such, many doctors will advise you to go with other treatments first. There are also a range of more invasive procedures available. For example, spinal cord stimulators, nerve blocks, epidural steroid injections and surgical procedures are offered in severe cases of chronic pain.
Lifestyle modifications are often suggested as an effective way of managing chronic pain. Health practitioners will often suggest strategies to improve 1) stress management, 2) exercise, 3) diet, and 4) sleep. Stress, inactivity, poor diet and poor quality sleep can all contribute to and worsen chronic pain. As such, learning ways to manage your stress (e.g., mindfulness practice), participating in regular low-intensity exercise (e.g., walking), improving your diet (e.g., eating anti-inflammatory foods) and getting better sleep (e.g., practicing good sleep hygiene) can all contribute to pain relief.
A range of therapies can help with chronic pain. Cognitive Behavioural Therapy (CBT) is one example, which forms the foundation for this course. Counselling and other talk therapies can also help you explore new ways of thinking about and managing your pain. Occupational therapy can teach people new ways of approaching everyday tasks, which may reduce pain and minimise their risk of injury. Physical therapy involves exercises which aim to stretch and strengthen areas of the body that are affected by pain. Lastly, massage therapy aims to treat muscle tension and induce relaxation.
Unfortunately, there is no cure for chronic pain. However, chronic pain may resolve if you are able to identify and treat its cause. Chronic pain can also be managed effectively with the right combination of treatments. Many people with chronic pain learn to cope effectively and go on to live full and productive lives. However, it is important to be realistic about your recovery expectations. It is unlikely that you will get rid of your pain completely, rather research shows that current treatments tend to reduce chronic pain scores by about 30%. Chronic pain is a burden, but it doesn’t have to rule your life.
Myths about chronic pain
There are many widely held myths about chronic pain, some of which are harmful and add to stigma surrounding the condition. There are many misconceptions about chronic pain and its treatments. Below, we address some of the most common myths related to chronic pain.
Myth 1: People with chronic pain should avoid exercise
- Exercise can exacerbate pain if not done correctly. However, carefully planned, light exercise can be the key to a successful recovery. There are many benefits to exercise and many ways that it can help with chronic pain. For example, exercise can reduce stress, improve blood flow, and act as a powerful antidepressant. It is important to seek medical advice before starting any exercise program.
Myth 2: Lots of bed rest is good for chronic pain
- A period of bed rest may be a good thing for acute pain, but not so much for chronic pain. Medical advice suggests that complete bed rest is actually one of the worst things for chronic pain. Inactivity results in a loss of fitness and physical conditioning, which worsens pain in the long run. Excessive rest can keep you stuck in the pain cycle. Of course, limit your exercise when your pain is extreme, but try to do your usual activities as much as possible.
Myth 3: Dwelling on chronic pain is helpful
- Some people think that focussing on their pain will be helpful. Perhaps they’ll be more prepared to deal with a flare up or better able to prevent a catastrophe? The evidence tells us another story. Dwelling is not problem solving; and dwelling on our pain simply serves to intensify it. Not only do the physical sensations get worse, but the psychological suffering also grows.
Myth 4: Chronic pain is a natural part of ageing
- People of all ages experience chronic pain; it is not a condition of age. Of course, ageing is associated with greater wear and tear on the body. In some cases, this leads to more aches and pains. However, there is a difference between a few extra aches and pains and a full blown chronic pain condition. If you’re in pain everyday, don’t put it down to age, seek help from your doctor.
Myth 5: You just need to ‘deal with’ chronic pain
- This myth can act as a barrier to treatment and leave people feeling isolated in their suffering. You should never ignore your pain or resort to ‘toughing it out’. Firstly, this can have serious consequences and may lead to worse pain or health complications in the feature. Secondly, why put yourself through this when there are effective treatments available for everyone?
After reading these myths, were there any that you also believed in? Perhaps you still believe them. Either way, we encourage you to continue with this course and see if your understanding and opinions change as you learn more. The next section will help you apply what you’ve learned so far to yourself. We encourage you to think about the topics we have covered within the context of your own life and personal experiences.
Understanding chronic pain in your own life
We have talked a lot about chronic pain generally. In this section, we want you to apply what you’ve learned so far to yourself. Take a moment to think about how chronic pain impacts your own life. Below are some questions to get you started:
- How much does my chronic pain interfere with my life overall?
- In which areas of my life does chronic pain impact me the most?
- Does chronic pain impact my identity and self-esteem?
- How would my life be different if I no longer had chronic pain?
Great job on getting this far. We have covered a lot about chronic pain, and you’ve done well to stick with us! In the next section, we briefly discuss Cognitive Behavioural Therapy (CBT), which forms the foundation for the remainder of this course.
What is cognitive behavioural therapy (CBT)?
Cognitive behavioural therapy (CBT) is an evidence-based psychological treatment. CBT has been tested widely by researchers to ensure that it is a safe and effective therapy. Research has shown that CBT is one of the most effective treatments for a range of mental health concerns. There is also evidence for CBT as a helpful therapy for people with a range of chronic illnesses, including chronic pain.
The aim of CBT is to help you identify and challenge unhelpful ways of thinking and acting. CBT is based on the idea that your thoughts, feelings, physical sensations and actions are all connected. It assumes that negative patterns of thinking and acting can keep you stuck and feeling lousy. CBT helps you deal with problems by breaking them down and challenging the negative patterns that maintain them. By teaching you new and more helpful ways of thinking and acting, CBT can help improve the way you feel.
CBT is traditionally delivered in structured, face to face settings with a trained therapist. However, access to this kind of therapy is not always convenient or available. Our online courses aim to make support more easily accessible and available to those who need it. There is growing evidence to suggest that CBT delivered in an online format is just as effective as face to face sessions. However, this course is not intended to be a substitute for therapy with a qualified health practitioner.
CBT is based on several key principles or assumptions, which are important to know and remember throughout this course. CBT involves learning skills to help reduce your unwanted symptoms. It helps you reduce unhealthy patterns of thinking and behaving, whilst teaching you new and more helpful strategies.
Here are some of the CBT principles:
- CBT is focussed on problems in the here and now, meaning it aims to solve current problems rather than delve into the past or find the origins of these problems.
- CBT requires goal setting to help guide the therapy and evaluate your progress. Goals should be realistic and related to the problems you are facing.
- CBT aims to be time-limited, meaning that you work towards overcoming your problems within a set time frame. This can help keep you on track towards your goals.
- CBT uses a variety of techniques to help you change your thoughts, actions, and mood.
- CBT encourages active participation in therapy and requires you to practice the skills between sessions. Skills practice is essential for achieving lasting change.
- CBT teaches you to become your own therapist, by involving you in the therapy process and ensuring that you understand how to manage unhelpful thoughts and behaviours. This is essential for preventing a return to old habits once therapy has finished.
Keep these principles in mind as you move through the course. Pay particular attention to the importance of active participation in CBT. We strongly encourage you to be an active participant in this course, so that you get the most out of it. Each week, we will give you an ‘action plan’ to complete before you return for the following week. The aim of the action plan is to guide your practice of the skills in your daily life.
CBT for chronic pain
As you’ll learn in this course, there are several factors that keep chronic pain going. Some factors are outside of your control, whilst others are changeable. For example, research has shown that your beliefs about pain and the way you manage your symptoms both play a role in how you experience chronic pain. This makes sense from a CBT perspective, which suggests that your thoughts and actions impact how you feel. It follows then, that by changing your unhelpful thoughts and actions, you can start to feel better.
CBT offers a useful framework for understanding chronic pain, which can be empowering in and of itself. The CBT model (covered in Week 2) helps to acknowledge the seriousness of your condition, whilst also giving you a clear pathway forward. CBT can help you explore and change the thoughts and actions that currently maintain or worsen your pain. It also offers you new ways of coping with pain, other symptoms and difficult emotions. Over time, CBT can help you to rebuild self-confidence and regain a sense of control and enjoyment in your life. CBT does this by reducing your pain-related difficulties and the intensity of your pain experience.
CBT skills for chronic pain include:
- Education on thoughts, feelings, actions, and chronic pain
- Self-monitoring techniques to help you understand your pain
- Stress management and relaxation skills to decrease tension
- Cognitive skills to help you address unhelpful thoughts and increase healthy thinking
- Behavioural strategies to help you better manage your pain and increase your engagement in meaningful activities
- Relapse prevention skills to help you maintain your gains and stay well into the future
The Epsychonline Coping with Chronic Pain Course is based on CBT principles. We hope that you find these skills helpful on your recovery journey. When practiced regularly, CBT skills can be life changing. Within the context of chronic pain, the skills you’ll learn in this course have the potential to free you from a life dictated by pain. However, as with any new skill, CBT requires effort and commitment. Each week, you will need to put what you learn into practice in your own life. The action plan tasks we provide will help you with this.
After a while, if things aren’t falling into place, you may consider speaking to a trained CBT therapist who can provide you with extra support. A trained therapist will be able to work closely with you to help you overcome any barriers to your treatment and recovery.
Making a commitment to change
It is well known that any type of behaviour change can be a challenge. As we have mentioned, the tasks in this course will be no different. CBT assumes that people must commit to practicing new skills if they are to achieve meaningful improvement. This section includes some exercises to help you think about and make your own commitment to change. These exercises are included as action plan tasks for this week. So, for now just read through, reflect on the information, and take in as much as you can.
What are my reasons for change?
To give yourself the best chance of success in this course, you will need to keep your motivation levels high. One way to maintain your motivation is to know your reasons for change. That is, be clear about the reasons why you want to change. Revisiting these reasons will give you the push you need when things get tough. So, take a moment to think about what you would like to change and what brought you to this course.
Below, we have provided you with some example reasons for wanting change. We also encourage you to come up with your own reasons, as these will be more meaningful to you. Many of you will likely report “feel less pain” as a reason for change. This is a valid reason, but we encourage you to go beyond this. Consider what you would be doing and how you would be feeling if you had less pain. These are also reasons for change that we hope will be well within your grasp.
Example reasons for change:
- I want to reduce the negative impact of chronic pain in my life
- I want to engage or reengage in certain activities
- I want to improve my physical functioning
- I want to improve my confidence and self-esteem
- I want to improve my mood and mental health
- I want to improve my concentration, memory etc.
- I want to feel more optimistic about the future
- I want to be able to socialise more
- I want to feel less stressed and worried
- I want to gain a sense of freedom and control in my life
Take a look at the pros and cons
Hopefully you have had a chance to think about your reasons for change. As a next step, we encourage you to think about the pros and cons of working towards change. Saying you want change is all well and good, but change often comes at a cost. Doing a pros and cons analysis can help you decide on the best course of action moving forward. We suggest you write your answers down on a sheet of paper, as this can help you lay out and clarify your thoughts.
In this exercise, you are aiming to compare the pros and cons of 1) trying the skills you’ll learn in this course, and 2) not trying the skills and staying the same. Once you have listed all of the pros and cons, you can weigh up each option to find out which one will get you closer to your goals. Remember to think about both short- and long-term pros and cons. Once you have chosen your option, you can come back to your pros and cons list as a reminder for why you chose that option. This can be particularly helpful for those times when your mind asks “what’s the point?”.
Self-contract and goal setting
If you’ve decided you’re ready to commit to change, congratulations! This is the first step on your journey towards a new relationship with chronic pain. We encourage you to formalise this commitment by making a contract with yourself. Signing a change contract means you are serious about this commitment and will be more likely to follow through with the necessary action. The self-contract will also prompt you to set some goals, which can be a great source of motivation.
When thinking about setting goals, it is important to make sure your expectations are realistic and achievable. We suggest that you don’t aim to get rid of your pain completely, as this is an unlikely outcome of any treatment option. Rather than focussing on what you don’t want (i.e., pain), think about what you do want or would be doing if you had less pain, and make this your goal. It is often more helpful and realistic to set goals that focus on something you are moving towards or trying to accomplish.
For example, instead of saying “I want to have less pain”, you could say “I want to start doing regular exercise again” or “I want to leave the house more often”. Once you have your goals, you’ll need to consider the steps required to achieve them and set a reward for when you follow through. You may also want to enlist the support of friends and family on this journey, as they can help keep you accountable and on track towards success. If you feel comfortable, let them be a witness to your change contract.
Big changes start with small steps
Let’s end with a small note on a big topic. Often, we have a vision of what we want to achieve, and we expect ourselves to get there in one big leap. This is not only unrealistic, but it is simply unfair. Throughout this course, we encourage you to acknowledge each small step you take towards your goals, no matter how insignificant it may seem. This is a tough journey, so break it down and be kind to yourself along the way.
This course is a big ask for anyone, let alone someone who’s constantly in pain. As such, a gentle and graded approach will serve you best. This course aims to help you, so don’t let it be an additional stressor in your life. We expect you to have breaks and make mistakes along the way, in fact, we encourage it. Finding the right pace and a strategy that works for you will be a process of trial and error. Continue to remind yourself of this as you move through each week of the course. Also remember to acknowledge the progress you are making simply by showing up.
Start right now by congratulating yourself on getting to the end of the Week 1 educational content. We think this is an accomplishment in itself that is worth celebrating, so see if you can set aside some time to reward yourself for your efforts.
Great job and see you next week!