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Psychological TherapiesPsychological Therapies

Within pain management, psychological therapy is used both in addressing faulty ways of thinking and behaving when in pain, but also to address other underlying psychological problems such as anxiety, depression, anger or perhaps a traumatic response to the incident which caused the initial injury and which may be contributing to the person’s experience of pain.

Where psychological factors are recognised as contributing to the person’s experience of pain, this does not mean that the pain is not real or genuine. All pain experienced is very real to the sufferer, but the way we feel can make our experience of pain worse.

Psychological therapies used in pain management typically focus upon cognitive behavioural approaches, where the way we think, feel and behave when in pain can impact not only upon our mental state and our quality of lives but also the extent of pain we experience.

Other therapies are also recognised to be very useful in helping alleviate pain, such as Eye Movement Desensitisation and Reprocessing (EMDR), where special protocols in managing pain have been developed.

More recent approaches use Acceptance and Commitment Therapies (ACT), which focuses upon coming to terms with the presence of pain in our lives and learning to live with it.

In accepting pain and finding ways to enhance the quality of our lives, this enables us to take back a sense of control of the pain rather than living a life where the pain feels in control of us. This allows us to feel better, happier, enhances our sense of well-being and allows us to be more active even though the pain may well still be there.

Further information about the above psychological approaches is provided below.


What is CBT?

The basis of CBT recognises that how people think affects how they feel and also how they behave. During times of mental distress the way the person sees and judges themselves and the things that happen to them alters. This can worsen how the person feels and causes them to act in ways that prolongs their distress. CBT practitioners work jointly with the client to help them identify and change unhelpful thinking patterns and behaviour.

There is considerable research which demonstrates that CBT is effective in treating a wide range of problems such as: Depression; Adjustment Disorders, PTSD; Anxiety Disorders; and pain related problems.

How does it work?

CBT is a collaborative approach between therapist and client. Together, they identify the precise problems or symptoms that are causing difficulties, and agree what the goals of the therapy will be. The therapist then helps the client to identify how negative thinking patterns are affecting feelings and behaviour, and also how some behaviour such as avoidance, may be prolonging their symptoms. This process is called “psycho-education”. It may involve the client keeping diaries of what they think, feel and do, to help understand how this all works.

Once client and therapist have a clear understanding of the problems, the goals of therapy are broken down into smaller manageable stages, and the client is set “homework” tasks. The exact nature of these tasks varies, with each client’s therapy being very much individually tailored to their particular needs.

In pain management, CBT often focuses upon the client’s negative thoughts about the pain, the impact it has upon the client’s mood, personality and sense of self. It helps the client to look at their behaviour changes associated with pain, for example avoiding activities for fear of this triggering a worsening of pain, and helping them to establish a more  realistic and valued quality of life through engaging in, changing and/or regulating activities. It also focuses upon the impact of pain upon client’s relationships and social supports, encouraging clients to re-engage in social situations that have perhaps previously been avoided and communicating better with others, so as to enhance the client’s supportive network.

CBT is not ‘rocket science’ but a practical, easy to understand, step by step approach to managing psychological problems and enables clients to feel back in control of their lives, their emotions and their pain.

How long does it take?

Each therapy session lasts for about 45 to 60 minutes. The number of sessions varies with the nature and severity of the problem. However, CBT is not designed to be a long term treatment approach, and the range is normally between 6 and 20 sessions.


What is EMDR?

EMDR is a therapy typically designed to reduce the distressing memories associated with a traumatic event. It is not normally used as a stand-alone therapy, but is an effective additional therapeutic technique to address traumatic “re-experience” symptoms such as flashbacks and nightmares. However, it is also very effectively used to address many other psychological problems, including problems with pain.

How does it work?

During an EMDR session the client is typically asked to focus on emotionally distressing memories or thoughts (targets). At the same time they are asked to follow an alternating stimulus. This is commonly the therapist’s hand moving from side to side, but can also sometimes be sounds alternating from ear to ear, or tapping on alternate hands. It is recognised that this restarts the natural processing of the distressing memories that have previously been blocked, and allows the level of distress associated with such memories to subside.

There are three main phases in EMDR. Firstly the traumatic memories are processed. Next the processing shifts to any current circumstances that elicit distress. Lastly the processing shifts to working on imagined future events, to assist the client in acquiring the skills needed to function better in the future.

The EMDR protocol can be used to promote more successful management of pain, and can change pain sensations. Targets also include the impact of the pain on life situation.

How long does it take?

Sessions of EMDR tend to be longer than normal, lasting up to two hours. This is because it is important to allow time for the full processing of a set of memories before the end of the session, and the time taken for this to occur can be unpredictable.  There have been quite dramatic results with even a single session producing significant symptom relief in some cases, but normally 4-8 EMDR sessions are used in combination with additional sessions of CBT.


What is ACT?

ACT is a form of mindfulness based therapy, theorising that greater well-being can be attained by overcoming negative thoughts and feelings. Essentially, ACT looks at a client’s character traits and behaviours to assist in reducing avoidant coping styles. ACT also addresses the individual’s commitment to making changes, and what to do about it when they get ‘stuck’ and can not manage to work toward their goals.

ACT is recognised as an effective form of therapy in working with pain management as often clients can get ‘stuck’ in addressing their problems through straight forward CBT techniques alone. ACT enables clients to have a greater understanding of the barriers that seem to be preventing them from moving forward and works directly with the client in the ‘here and now’ to take control over the change process.

How does it work?

ACT focuses on three areas:
Acceptance of client’s reactions and the present
Choosing and being committed toward a valued direction of change and
Taking action to achieve change

Whether it be a situation the client cannot control, a personality trait that is hard to change or an emotion that overwhelms, accepting it can allow clients to move forward. Obsessing, worrying and playing things over and over causes clients to remain stuck. ACT invites clients to accept the reality and work with what they have.

Strategies include:

  1. Letting feelings or thoughts happen without the impulse to act on them.
  2. Observing weaknesses but taking note of strengths.
  3. Giving permission to not be good at everything.
  4. Acknowledging the difficulty in life without escaping from it or avoiding it.
  5. Realising that they can be in control of how they react, think and feel.

How long does it take?

Like CBT, sessions typically last for about 45 to 60 minutes and the number of sessions will vary with the nature and severity of the problem, usually around 6 to 8. It is also often used in combination with other approaches, such as CBT.