Breaking the Cycle of Chronic Pain: A CBT Approach
Chronic pain is more than just a physical sensation—it’s a complex interaction between the body, mind, and emotions. Over time, pain can create a reinforcing cycle that worsens pain, increases stress, and decreases function. Cognitive Behavioral Therapy (CBT) for chronic pain helps patients break this cycle by addressing unhelpful thoughts and behaviors that contribute to suffering.
In this post, we’ll explore the cycle of chronic pain and provide two actionable self-management strategies grounded in CBT.
Understanding the Cycle of Chronic Pain
Chronic pain is often maintained by a cycle of pain, negative thoughts, emotional distress, and maladaptive behaviors (Turk & Monarch, 2002).
Here’s how this cycle typically unfolds:
Pain → A person experiences persistent pain, which may be due to an injury, illness, or an unknown cause.
Negative Thoughts → Thoughts like “This will never get better” or “I’m broken” increase feelings of helplessness and fear (Jensen et al., 2011).
Emotional Distress → Increased anxiety, frustration, or depression can heighten pain perception due to the brain’s role in processing pain signals (Linton & Shaw, 2011).
Avoidance & Decreased Activity → To prevent pain, individuals often withdraw from activities they enjoy or stop engaging in physical movement. Over time, this leads to deconditioning, increased disability, and more pain.
Reinforcement of Pain Signals → The nervous system becomes more sensitized to pain, making it easier for pain to persist, even when the initial cause has healed.
This cycle of chronic pain can feel overwhelming, but CBT-based strategies can help disrupt it.
Two Self-Management Strategies to Break the Cycle
(1) Cognitive reframing
Challenge Unhelpful Thoughts
One of the core principles of CBT is identifying and reframing negative thought patterns. Think of it like “changing the channel” on your mindset TV. When pain flares up, it's common to think the worst (e.g., “This is unbearable” or “I’ll never be able to do what I love again”).
instead, try this:
Write down a distressing thought related to your pain.
Ask yourself: “Is this thought 100% true? What would I tell a friend who had this thought?”
Replace the thought with a more balanced statement, such as, “This pain is difficult, but I’ve managed it before and can do so again.”
(2) Pacing
Gradually Increasing Your Activity
Avoiding movement because of pain is totally normal. It’s common for folks managing chronic pain to worry that movement or exercise will lead to a flare. Which makes sense, if the same activities have caused a flare in the past. But unfortunately, avoiding activity can lead to physical deconditioning and weakness, which then makes even small activities feel overwhelming and painful. Pacing is about breaking activities into manageable parts to prevent overexertion while still maintaining consistent movement.
instead, try this:
Choose an activity you’ve been avoiding (e.g., a short walk).
Set a realistic, time-limited goal (e.g., walking for just a few steps or minutes).
Gradually increase time or intensity over several days or weeks, rather than pushing through pain and risking a setback.
Final Thoughts
Chronic pain is not just a physical experience—it is influenced by thoughts, emotions, and behaviors. By understanding the cycle of chronic pain and applying CBT-based strategies like cognitive reframing and time-based pacing, you can begin to take back control. While these self-management tools are helpful, a little extra support can get you even faster on the right track—if you’re curious to learn more about how to work with a pain psychologist for personalized guidance, I offer free consultations to learn more. Schedule yours today!
Learn more about other treatment modalities offered at Alcove Mental Health to support adults managing chronic pain and other complex medical conditions via online therapy.
Alcove Mental Health provides psychological evaluations and online therapy for chronic pain, health-related stress and individuals coping with complex medical conditions in over 40 states, including Alabama, Arizona, Arkansas, Colorado, Commonwealth of the Northern Mariana Islands, Connecticut, Delaware, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
If you’re ready to explore how online therapy for chronic pain can make a difference, I invite you to schedule a free 15-minute consultation. It’s a chance to ask questions, get a feel for how I work, and see if therapy might be a helpful next step. (No pressure. Just an open door.)