Cognitive Behavioral Therapy for Chronic Pain
What is Cognitive Behavioral Therapy?
Cognitive behavioral therapy (CBT) is a process which involves helping one to figure out if there are any psychological variables that might be mediating your chronic pain. The idea is when people come to see a psychologist for a chronic pain condition, is that they might be receiving is, the pain is your head. The pain is 100% real. There may be psychological variables that are influencing your experience of pain. After an initial assessment, we may discover and underlying post-traumatic stress disorder. This can be very common attributing to your pelvic pain. So then we work on treating the trauma.
With cognitive behavioral therapy we like to take place in the present and not bring up specific trauma from the past unless we are talking about a specific trauma from the past. If the cause is about the pain in the here and now, we will work on the thinking process of that pain which can lessen the experience of pain. If people are avoiding a specific behavior because they’re worried it may increase the pain despite a doctor giving the all-clear, then we will work on decreasing those avoidance behaviors.
How does Cognitive Behavioral Therapy of Chronic Pain work?
One on One Virtual Therapy:
Cognitive behavioral therapy for chronic pain is offered online by Pelvic Rehabilitation Medicine. Online therapy involves an online video and talk conference call where we walk through the normal therapy guidelines. There is no difference in face-to-face therapy as we follow the same procedures and rules as an in-person meeting. We enjoy online therapy as it can be more accessible and makes it easier on the patient and doctor to be more flexible. When you are having an online session we believe it is best to find a place that is comfortable, private, and distraction-free.
There are multiple scenarios where one on one therapy isn’t feasible or the best option. We are also happy to offer 12-week closed-door group sessions. Depending on your need and location we will work to provide an option with rolling participation.
The group sessions are an outlet that many of our one on one patients progress into. When you contact us we will speak with you to find out which options best fits your needs.
Why CBT? What are some of the conditions or symptoms that see relief from CBT? Who tends to have the most success with CBT?
Cognitive Behavioral Therapy can help to manage chronic pain. The perception of pain is in your brain, so you can affect physical pain by addressing thoughts and behaviors that fuel it.
1. CBT can help change the thoughts, emotions, and behaviors related to pain, improve coping strategies, and put the discomfort in a better context.
2. CBT can help change the physiological response in the brain to pain. Pain causes a stress response which can amplify pain sensations via chemicals in the brain. CBT can help to reduce the stress response and thereby allow the body’s natural pain relief mechanisms to be more powerful.
Some areas where CBT helps and patients have great success include:
– Chronic pain conditions
– Post-traumatic stress disorder (PTSD)
– Obsessive Compulsive Disorders
How do you help your patients?
We work on creating a values-based life with the pain. We look at ways in which the pain might be interfering in a patient’s perceived ability to live a life that they value. Also, we focus on how we build a life that you value with this pain. This approach tends to aid in pain reduction in a manner of paradoxical intervention. Cognitive behavioral therapy is a collaborative process where there needs to be work done inside and outside of the therapy room.
Cognitive behavioral therapy tends to be a short term therapy modality. The goal is not to keep people in treatment for years and years. But it also does depend to some degree on how long the problems that you’re coming to therapy for have existed, and again, that’s something that we collaborate on.
We discuss, what were you thinking about how long you wanted to be in therapy for? And we check in regularly. So we might say, okay we’re going to try to meet X, Y, and Z goal in three months and have weekly check ins. But we use that three-month mark as a reassessment point and see how much longer do we think this is going to take.
How do you help people achieve their goals?
The first thing we like to do is start with a very thorough assessment and figure out what brings them to therapy, what’s keeping their problems going, and if they have any relevant past history. We also like to figure out what triggers these issues, what keeps it going, what thoughts and behaviors are keeping it going. We also want to know what’s getting in the way of you feeling a certain way so we work on changing those things.
When the triggers are sorted out we want to work on how to track and monitor progress outside of the therapy session. Self-monitoring and keeping track of the way that you think and the way that you feel are some easy ways to find triggers and what needs to be worked on.
Once we have a monitoring system we want to start to change the thoughts and behaviors that might actually be increasing your anxiety in that situation without you even being aware of it. Over time, changing those thought patterns, and changing those behavior patterns, the goal is for that to lead to meaningful change in your day to day experience of anxiety and chronic pain.
You may not even be aware that you are holding your stress and anxiety in a specific area. To many, they may be holding their tension in a specific area. The first step is bringing awareness to the area. For many it is the pelvic floor and could lead to learning very specific targeted exercises, to becoming more aware, then to release that tension.
We want to learn what’s contributing to holding that tension. During your sessions, we want to discover certain things to avoid. For example, oftentimes people with different pelvic floor disorders, they may avoid going to public restrooms, or the opposite, they may be consumed with the idea of, I need to locate every single restroom in this area, so I know that I’m safe. We want to work on releasing that tension both physically and mentally.
Can one prepare for an online cognitive behavior therapy session? If so, how?
Online cognitive behavioral therapy involves an online video or talk conference call where we walk through the normal therapy guidelines. There is no difference in face-to-face therapy. We enjoy online therapy as it can be more accessible and makes it easier on the patient and doctor to be more flexible. Sometimes a concern if you’re meeting in your home, is your partner home? Are your children home? When you are having an online session we believe it is best to find a place that is comfortable, private, and distraction-free.
You want to try and take care of the online experience such as; make sure nobody else is using your wifi and close out all your tabs, so your experience can run smoothly.
For your first therapy session, come with an open mind. There are no expectations that you’re going to know or have to produce anything. For your first session we want you to feel as comfortable as possible so come with questions, whether it’s about our expertise, past experience, whatever it is, we are happy to answer any of those questions. We want our patients to feel as though they can ask those things, and get honest answers to them because this is their psychological care it’s important that our patients feel comfortable with the person who is providing it.
What is the process if someone would like to work with you?
You may request your initial consultation through our website or by giving us a call. After the initial consultation, and once we both agree to see each other, we will schedule the initial 90-minute consultation with you. Once we schedule an appointment we create an online portal for them, and then you will electronically sign a consent information form.
After the initial 90-minute consultation you will be seen once a week for 50 minutes. During that 50 minutes we will talk about your week, your “homework” that was given to you, work through your agenda and talk about your future “homework”. This is your time to talk and let us know what is going on. Although you spend 50 min with us once a week, a lot of the work and change goes outside of your appointment. We make sure to individualize each appointment and make it your own.
Are there maintenance or followup sessions? Additional scheduling?
Sometimes patients would like to check-in or feel the need for more short term therapy sessions after they’ve worked with the therapist through the initial course of sessions. This is normal, and in these instances, scheduling for maintenance, subsequent, or follow-up sessions are all done through the doctor, and not the practice.
Are there any other therapies you may suggest that are complementary to the talk therapy process?
There are several other therapies which may help our patients outside of talk therapy. Some of the therapies are more to try to bring relaxation, while others are to create movement and body awareness. These other therapies may include:
– Mindfulness Meditation
– Restorative Yoga
– Exercise, to the best of someone’s capabilities
– Movement to create body awareness
Are there any potential risks to having therapy?
Patients may initially feel worse once they begin talking about their unpleasant and uncomfortable emotional states. As time goes on, and you open up more while working on your “homework,” the process may become easier.
Do you take insurance for therapy sessions?
As of right now we do NOT work directly with insurance carriers. We urge people before our first session to talk with their insurance company about reimbursement. Oftentimes people are able to get a portion of their therapy reimbursed. If this is the case, then we can issue a Superbill for our clients to submit for reimbursement.
What is your cancellation / no-show policy?
We have a 24 hour cancellation policy. If the session appointment is rescheduled before 24 hours of the appointment time/date, you won’t be charged. If changes are made within 24 hours of the session you will be charged the whole fee. The same rules apply for appointment no-shows. We do realize there may be something going on and emergencies and try to be flexible by rescheduling.
Is tele-therapy available in my state?
Pelvic Rehabilitation Medicine’s chronic pain teletherapy is available in New York, Florida, Virginia, DC, and Maryland.
This remote therapy is coming soon to New Jersey.
How do I start?
To begin your journey to finding relief through cognitive behavior therapy, sign up for an appointment request through this website.
– Go to our Request an Appointment page
– Choose “Cognitive Behavior Therapy Consult” as a reason for visit
– Choose your desired consultation time and date
– Fill out the rest of the requested information
– Wait for a PRM Representative to call contact you to confirm your consult appointment