Increasingly, evidence is pointing to the power of psychological practices and therapies such as mindfulness and CBT to improve chronic pain. But how does it work and what should you look for?
If you suffer from chronic pain, you know too well that the physical discomfort and limitations are only part of the experience. These are often accompanied by psychological pain and distress, which can manifest as frustration and despair (and in some cases, clinical depression), anxiety and painful emotional responses to the loss of ability to participate in or enjoy activities you once did. Indeed, many sufferers experience grief. Mental wellbeing can be further undermined by effects of pain such as insomnia.
This holistic view of chronic pain has inspired a large volume of research and evidence for an integrative treatment approach to chronic pain. It is now widely recognised that a multidisciplinary approach combining medical treatment, allied health treatments such as physiotherapy and psychological therapies and practices such as mindfulness and cognitive behavioral therapy (CBT) can produce better outcomes than standalone physical interventions. What’s more, self-help practices such as mindfulness and cognitive exercises prescribed by a psychologist may empower sufferers to take control of their pain experience as they can be called upon at will. So what are the best psychological interventions for pain?
Mindfulness has become a buzzword in recent years. Based on ancient Buddhist principles and practices, it is now backed by a wealth of scientific evidence as an effective tool in managing conditions from depression and anxiety to the effects of severe and chronic pain. Recent research suggests that mindfulness meditation–based interventions improve pain symptoms across a span of pain-related disorders including fibromyalgia, migraine, chronic pelvic pain, irritable bowel syndrome (IBS) and other conditions. What’s more, it can work quickly. Even a brief introduction to mindfulness can help people to manage and cope with physical pain and associated negative emotions, according to a study published in the journal Social, Cognitive and Affective Neuroscience.
Changing the way the brain responds to pain
It sounds like a wild claim, but mindfulness practice has actually been found to change the way the brain responds to inputs such as painful or uncomfortable stimuli. In fact, in the aforementioned research, brain imaging scans showed that when those who had practised mindfulness were exposed to high heat on their forearm, their brains responded in the same way as if they were exposed to a normal temperature. In other words, their brain didn’t register the pain it would be expected to. Evidence suggests that even a few minutes a day can assist with pain management.
Mindfulness in practice
Mindfulness is essentially awareness and acceptance of a situation without judgment. During mindfulness practice, one focuses on the present moment and tunes in to bodily sensations and emotional responses without either ‘following’ them or judging them. In a simplistic sense, this may include noticing a twinge or ache in a particular body part without progressing to a judgment such as ‘this pain is bad’. Or if negative thoughts or difficult feelings about pain arise (e.g. ‘I can’t stand this pain any longer’, ‘I will never be free of this pain’ or ‘I feel so hopeless’), mindfulness practice advocates merely noticing those. Importantly, the practice doesn’t minimise of invalidate pain or invite one to block it out. Rather, it may deactivate cognitive and emotional factors that amplify or perpetuate pain, reduce the stress response and simultaneously cause the brain to operate in a way that improves the experience of pain.
How do you do it? A psychologist can help you to tailor mindfulness practice to your personal needs and circumstances. However, common methodologies include reciting a mantra (e.g. ‘I am safe and at peace’), paying full attention to the breath or performing a body scan, whereby you attend in turn to the sensations in each part of the body without labelling or judging them or letting your thoughts spiral or run away. This is often done in an upwards sequence, from feeling your feet connecting with the floor to noticing the feel of your breath and even noticing whether your eyebrows are tense or relaxed.
Talk therapy for chronic pain
While mindfulness is a powerful DIY practice for those experiencing chronic pain, it doesn’t address unhelpful beliefs or emotional responses to pain. These aspects have been identified as integral to the pain experience and are targeted using certain psychotherapeutic paradigms. The two talk therapy frameworks with the greatest wealth of evidence in the context of chronic pain are cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT), which is a variation on CBT.
Cognitive Behavioral Therapy (CBT)
CBT is an evidence-based technique often used in the context of psychological talk therapy or ‘psychotherapy’ to improve symptoms and underlying factors in conditions including depression, anxiety and stress. It is now widely supported as a powerful component in management of chronic pain. It works to identify negative thought patterns and beliefs that may cause or perpetuate psychological and emotional discomfort. For chronic pain, this may mean identifying and replacing negative thoughts and beliefs and replacing them with more helpful ones, which may in turn disrupt processes that compound the pain experience. In other words, it may make physical pain feel more tolerable and positively alter pain perception. There is no standard timeframe for CBT. Depending on your needs and progress, sessions may be limited to a few (e.g. three to six) or ongoing.
Acceptance and Commitment Therapy (ACT)
Like CBT, ACT is a type of behavioral therapy. As the name suggests, it is heavily focused on helping to foster acceptance of factors that may otherwise inspire a mindset of ‘fighting’ or ‘resistance’. Why? Often, the negative thoughts and feelings involved in fighting a situation over which we have little or no control actually makes the experience (e.g. pain) feel more severe or unbearable. Part of the methodology includes promoting flexible thinking and relinquishing rigid, entrenched, unhelpful ways of thinking and related emotional reactions and behaviours). ACT also encourages clients to clarify personal values and commit (the ‘C’ bit) to actions based on these values to enhance life satisfaction. In the context of chronic pain, ACT may help to alleviate pain-related stress and anxiety and manage their experience of pain on a daily basis.
If you are experiencing chronic pain, consider consulting a psychologist, who can guide you in strategies to help manage the physical, mental and emotional effects of pain and help you to return to greater wellbeing and life satisfaction.