What Cognitive Behavioral Therapy Is and Why It Fits Our Scope

A 2013 Cochrane review of about 35 studies found small to moderate effects of CBT on mood, catastrophizing, pain and disability in chronic pain, though gains faded beyond 12 months. A UK trial of six group CBT sessions for subacute and chronic low back pain improved disability and pain at 12 months, kept the disability benefit at about 34 months, and cost less than half of competing interventions. Alison suggests clinicians use the approach inside everyday conversation during treatment and exercise, helping patients reach their own conclusions about pain rather than being told. Reframing a patient's understanding of pain is within scope, while significant anxiety, depression or post-traumatic stress call for referral. The CBT model links thoughts, emotions and behavior. Emotions are hard to change directly, so work targets thoughts and behavior. A burnt toast example shows how one situation leads to very different feelings and actions depending on the thought behind it.