Hamilton Health Sciences
Intensive Pain Program (Fee For Service)

Cognitive Behavioral Therapy

The Intensive Program at the Michael G. DeGroote Pain Clinic utilizes cognitive behavioral therapy (CBT) as its core psychological therapy.

What is CBT?

CBT is a structured, problem focused and practical therapy approach. It is type of psychotherapy, “a talking treatment.” Unlike other types of therapy, it does not dwell on events in your past to gain insight about your emotional or mental state. Rather, it deals with “the here and now” and how your current thoughts and behaviors are affecting you. CBT is an active, directive therapy approach that teaches the skills necessary to cope with a clinical problem such as a chronic pain.

We will help you change certain problematic thoughts and behaviors so that you can function better with your chronic pain.

CBT is an integrated approach, made up of components of both cognitive and behavior. Cognitive processes are our thoughts which include our ideas, mental images, attitudes or beliefs. Cognitive therapy is based on the principle that certain ways of thinking can trigger or “fuel” certain health problems. Health professionals at the CPMU will help you understand your current thought patterns and how they relate to your pain experiences. In particular, they will help you identify any unhelpful, “false” or even harmful ideas or thoughts that you have – thoughts that can aggravate your pain condition.

The behavioral components of CBT utilize various techniques to reduce tension in the body – one of the consequences of pain. These techniques contribute to the well-being of patients with chronic pain and include relaxation techniques, biofeedback, and modification of activities related to pain aggravation.

Cognitive and behavioral strategies are often combined because how we behave often reflects how we think about certain things or situations.

There are several negative thoughts common to chronic pain sufferers. Examples are as follows:

• I can’t do that because of this pain I feel.
• If I increase my activity, I will re-injure myself.
• Things are really bad. I am going to have to see the doctor about this.
• I can’t stop thinking about this pain. I feel like a hypochondriac.

CBT is utilized in this Program through several modalities and all health professionals in the Intensive Program are trained in CBT. The group psychoeducational sessions utilize CBT strategies in discussion about issues such as Stress Management, The Meaning of Pain and Illness Behavior. There are also psychoeducational groups that more directly exemplify CBT such as Self Talk. Moreover, your case manager utilizes these clinical techniques in discussion about how to manage your pain and how accomplish your goals. More intensive CBT can be obtained on an individual basis with the Program psychologists. Where appropriate, individualized CBT treatment can be recommended following your treatment in the Intensive Program.

There is now considerable research evidence that patients with chronic pain who participate in CBT programs can significantly improve their psychological and physical functioning. A systematic review of several CBT pain management programs discovered that CBT produced significantly greater changes for patient’s pain experience, their cognitive coping, their use of positive coping strategies, and reduced behavioral expression of pain (illness behavior).

How does CBT compare to medication in terms of treatment effectiveness?

Some studies have shown CBT to be as effective as medication in treating clinical disorders, such as depression. Recent brain imaging research (PET scan research) revealed that medication and CBT actually impact different parts of the brain when treating depression. Research is still pending in terms of the comparative efficacy of CBT and medication in the treatment of chronic pain. Yet the research to date suggests that we can achieve the same clinical ends through different means and through different brain centers. The possibilities are exciting. Already, CBT has been proven to be a powerful technique designed to help patients work successfully with their thought processes and clinical syndromes such as depression, anxiety and chronic pain.

Hamilton Health Sciences • Hamilton, Ontario • 905.521.2100

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