David Kannerstein, Ph.D.  

Changing Thoughts and Beliefs about Pain

pain managemantOne of the most important areas where people with chronic pain can benefit from psychological help is in changing negative thoughts and beliefs which help prevent more effective coping.  These thoughts and beliefs can also worsen the pain and suffering the person with pain experiences by reinforcing and deepening negative emotional states including anxiety, depression, and anger.  Examples of negative thoughts related to pain would be “I am useless,” “I am worthless,” “I can’t do anything to control this pain,” “no one believes I am in this much pain,” etc.  In turn, these thoughts reflect underlying beliefs such as “I’m only valuable as a person if I am working,” “I am no good if I have to depend on others for help,” and so on.  In our society, which emphasizes financial gain, work productivity, and individual autonomy, these are very common beliefs.  However, while they may be functional to a point by inspiring us to work hard and achieve what we can, they become serious liabilities if we become disabled. 

Changing dysfunctional thoughts and beliefs is part of what is known as Cognitive Behavioral Therapy or CBT.  CBT emphasizes the connection between our thoughts, behaviors, and emotions.  If we feel bad—anxious, depressed, or angry—we can often help this by adjusting our thinking or changing our behavior.  An example of changing a negative thought would be replacing “I am useless” to “I put out a lot of energy just getting through the day with my pain and therefore deserve a lot of credit, especially from myself.”  An example of changing one’s behavior would be scheduling (writing down in a schedule book or calendar) positive activities which one is able to do.
Often the two go together.  For example, many people with pain reduce or even eliminate exercise because it appears to worsen the pain.  Some of the time, however, this is temporary, and the exercise may actually improve the situation over time.  Challenging the negative thoughts about exercise (“This will worsen my pain”) may permit increasing activity and exercise (with, of course, the guidance by a physician, trainer, physical therapist or other qualified professional) and, in time, lower the pain. 

In my experience, CBT is most effective when combined with mind-body approaches such hypnosis, mindfulness meditation, visualization or guided imagery, and progressive muscle relaxation.