Cognitive Behavioral Therapy Evidence, Scope and the CBT Triangle

Alison presents CBT as a structured framework from psychology that gives physical therapists something to hold onto when conversations become emotional. Cochrane reviews show it has the largest evidence base among psychological approaches for pain, with small effects on pain, disability, function and distress that tend to last after treatment ends. A trial of almost 400 people with subacute or chronic low back pain found that six group CBT sessions from a psychologist, added to guideline-based care, improved disability and pain for 12 months and beyond, at about half the cost of competing treatments. Therapists use a cognitive behavioral approach, not therapy itself, and keep conversations on pain and its distress. Severe anxiety or depression affecting daily function, such as panic attacks or being unable to get out of bed, calls for referral, and the DASS can help decide. The CBT triangle links thoughts, emotions and behavior. Beliefs about damage hold back behavior change, as in fear avoidance. A burnt toast example shows how different thoughts about one event lead to indifference, hopelessness, anxiety or anger.