Chronic pain is recognised as a significant public health concern (Driscoll et al., 2021). According to the International Association for the Study of Pain (IASP), chronic pain is defined as prolonged or recurrent discomfort that persists beyond a period of three months (Scholz, 2019).
CBT for chronic pain
CBT focuses on targeting and altering catastrophising thought patterns about pain that contribute to feelings of distress and unhelpful behaviours such as withdrawal or isolation. Additionally, CBT aids in educating patients about their condition and encourages the development of coping strategies (e.g., relaxation) (Driscoll, 2021). Gaslander et al. (2022) conducted an experiment to evaluate the effectiveness of an online-based CBT treatment in reducing chronic pain and psychological distress. The participants were randomly assigned to either CBT or a waiting list control group. During the experiment, participants of the CBT group were instructed to access various online treatment materials. The waiting list group filled out online questionnaires instead of undergoing treatment. The findings demonstrated significantly larger improvements in pain, depression, pain acceptance, catastrophising and quality of life for participants of the CBT group compared to the control group. All changes were stable one year following the intervention (Gaslander et al., 2022).
The Fear-avoidance model
The fear-avoidance model suggests that individuals with chronic pain develop a fear of reinjury, which leads them to avoid certain movements. This avoidance behaviour and lack of physical activity contribute to increased pain and disability (Zale, 2015). Yang et al. (2022) conducted a systematic review to evaluate the effectiveness of CBT in improving fear avoidance, pain and self-efficacy in patients with chronic pain. Fifteen studies revealed CBT to have strong effects in reducing pain while sixteen articles found a significant reduction in disability. Five studies revealed a decrease in fear avoidance behaviours following CBT and this improvement was associated with a reduction in pain and disability. An additional five studies found that CBT was effective in helping patients develop a strong sense of self-efficacy which can help build resilience and adopt healthy behaviours when experiencing chronic pain (Yang et al., 2022).
ACT for Chronic Pain
ACT is a process-based approach with a primary goal of enhancing psychological flexibility. This is accomplished by fostering a greater sense of openness, engagement, and awareness of the present moment. Individuals are encouraged to accept their thoughts and emotions rather than try to control or avoid them (Harris 2019). ACT further aids in developing skills to effectively manage pain symptoms in a way that aligns with the patient’s personal goals and values (Hayes & Pierson, 2005). Lin et al. (2017) conducted an experiment to evaluate the efficacy of an online-based ACT intervention program (ACTonPain) in reducing chronic pain. The researchers compared a group of participants exposed to ACT with participants on a waiting list control group. Participants of the ACT group were exposed to interactive exercises and completed online self-assessments relating to pain interference, physical and emotional functioning, and satisfaction with the program. Clinical Psychologists guided patients through the process. The control group received no intervention during the experimental period. Participants were assessed immediately after treatment and at six months follow-up. The findings revealed that participants of the ACT group demonstrated significant pain improvement, higher pain acceptance and lower levels of depression at post-treatment and follow-up compared to the control group. All Participants reported high levels of satisfaction following their treatment. Online-based ACT was found to offer an effective solution for the management of chronic pain. Online-based ACT can be beneficial in shortening waiting times as patients receive treatment from the comfort of their homes without having to wait for in-person appointments. Hence access to therapy becomes easier (Lin et al, 2017).
In conclusion, psychological interventions such as CBT and ACT have demonstrated significant efficacy in managing chronic pain and its associated psychological distress. CBT effectively addresses and modifies maladaptive thought patterns, reduces fear-avoidance behaviours, and enhances the overall quality of life for individuals suffering from chronic pain. Meanwhile, ACT promotes psychological flexibility by encouraging acceptance of thoughts and feelings, leading to improved pain management and greater emotional well-being. Both approaches not only facilitate symptom relief but also empower patients to adopt healthier behaviours and coping strategies.
References
Driscoll, M. A., Edwards, R. R., Becker, W. C., Kaptchuk, T. J., & Kerns, R. D. (2021). Psychological interventions for the treatment of chronic pain in adults. Psychological Science in the Public Interest, 22(2), 52-95. https://journals.sagepub.com/doi/epub/10.1177/15291006211008157
Gasslander, N., Andersson, G., Boström, F., Brandelius, L., Pelling, L., Hamrin, L., Gordh, T., & Buhrman, M. (2022). Tailored internet-based cognitive behavioural therapy for individuals with chronic pain and comorbid psychological distress: a randomized controlled trial. Cognitive behaviour therapy, 51(5), 408–434. https://doi.org/10.1080/16506073.2022.2065528
Harris, R. (2019). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger Publications. https://books.google.co.uk/books?hl=en&lr=&id=C1aRDwAAQBAJ&oi=fnd&pg=PT13&dq=What+is+Acceptance+and+commitment+therapy%3F&ots=Y1NhPDHlVh&sig=1RUm6tyU8_8sWrGnk-HqpCp3Lss&redir_esc=y#v=onepage&q=What%20is%20Acceptance%20and%20commitment%20therapy%3F&f=false
Lin, J., Paganini, S., Sander, L., Lüking, M., Ebert, D. D., Buhrman, M., Andersson, G., & Baumeister, H. (2017). An Internet-Based Intervention for Chronic Pain. Deutsches Arzteblatt international, 114(41), 681–688. https://doi.org/10.3238/arztebl.2017.0681
Scholz, J., Finnerup, N. B., Attal, N., Aziz, Q., Baron, R., Bennett, M. I., Benoliel, R., Cohen, M., Cruccu, G., Davis, K. D., Evers, S., First, M., Giamberardino, M. A., Hansson, P., Kaasa, S., Korwisi, B., Kosek, E., Lavand'homme, P., Nicholas, M. & Nurmikko, T., (2019) The IASP classification of chronic pain for ICD-11: Chronic neuropathic pain. Classification Committee of the Neuropathic Pain Special Interest Group (NeuPSIG), 160(1), 53–59. https://doi.org/10.1097/j.pain.0000000000001365
Yang, J., Lo, W. L. A., Zheng, F., Cheng, X., Yu, Q., & Wang, C. (2022). Evaluation of Cognitive Behavioral Therapy on Improving Pain, Fear Avoidance, and Self-Efficacy in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Pain research & management, 2022, 4276175. https://doi.org/10.1155/2022/4276175
Zale, E. L., & Ditre, J. W. (2015). Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain. Current opinion in psychology, 5, 24–30. https://doi.org/10.1016/j.copsyc.2015.03.014