Cognitive Behavioral Therapy is a type of psychotherapy that acknowledges that our thoughts can shape our feelings, that often there is a pattern of distortion in our thinking that can increase our distress, and that we can learn to think about things differently to increase our happiness and ability to cope with stress.

Overview of CBT

Studies of CBT have shown it to be as effective as antidepressants, and long-term studies have shown a lower relapse rate after discontinuation. This makes sense – once someone learns these skills, they are theirs for a lifetime, whereas medications only work while you are taking them. It can be inexpensive as well: there are a number of studies showing bibliotherapy (i.e. buying and reading a book) to be as effective or almost as effective as seeing a therapist, and there is even a free website that will walk people through CBT. We recommend Feeling Good or The Feeling Good Handbook by David Burns.

In the field of Chronic Pain, there is also a wealth of data showing CBT to help with chronic pain management. Elements of CBT used in our pain program included:

1. Identifying thoughts and feelings

2. Identifying Irrational Beliefs and Cognitive Distortions, and then Countering them: We used the Daily Record of Automatic Thoughts to facilitate this. The Vertical Arrow is another personal favorite – I look at the worst-case scenario and when I realize I can survive that, whatever else happens seems manageable.

Old “Tapes”

The irrational beliefs and cognitive distortions described above are old “tapes” that we play from our early experience as children. They reflect the observed responses of our families, our teachers, and the society in which we develop. Loretta Laroche, a comedienne who teaches these principles through humor, conjures up the image of a big yellow school bus that each person drives through life. Various people get on and off, but some have a lifetime ticket. They may include parents, teachers, ex-lovers, friends, and mentors, both alive and dead. There’s always someone who thinks he or she knows the best way of getting where you’re going, and sometimes that person will be found in the driver’s seat. But this is your opportunity to decide who’s really driving your bus. To return to the “tapes” metaphor, it’s your opportunity to edit your old tapes and make some new ones.

There are different kinds of tapes, with different recurring themes. For example, you either assume all of the responsibility or none of it (“The pain is all my fault” or “The pain is all your fault). Or you expect a consistency in the world that doesn’t exist (“If I’m good, bad things won’t happen to me”). Or perhaps you feel that if you think negatively it will ward off bad fortune (“I’m feeling better this morning, but if I tell anyone the pain might get worse”). Thinking in restricted, unconscious patterns (the old tapes) often robs you of the flexibility needed to cope with the ever-changing world and your physical problems.

 3. Techniques to Promote Positive Thinking:

Gratitude, Pleasurable Activities

Affirmations 

4. Communication Skills

5. Forgiveness – using the work of Fred Luskin from the Stanford Forgiveness Project.

6. Time Management and Pacing/Adaptation/Delegation

7. Goal Setting and Effective Problem Solving