Cognitive Behavioural Therapy (CBT) & Arthritis.
July 2023
We know physical activity and nutrition are very important for managing chronic pain in arthritis, but did you know there is evidence for
cognitive behavioural therapy?
In this article, we look at what it is and how it works.
What is CBT?
CBT combines cognitive and behavioural therapies for the treatment of mood and anxiety disorders – so why is it relevant to
Arthritis?
CBT is a therapeutic approach that focuses on the relationship between thoughts, emotions, and behaviours.
Arthritis is no doubt a physically painful condition - it can cause you to worry about the future, it can make you feel upset about having
to live with pain, it can make you feel scared to exercise and engage in the activities you once use to love - it can be psychologically
taxing.
CBT aims to identify and modify these negative or unhelpful thinking patterns and behaviours associated with chronic pain to alter the way
you experience pain.
CBT involves:
- Rationalising the thoughts and behaviours contributing to the distressing emotions.
-
Encourages objectivity in the reflection of how situations, thoughts, behaviours and moods can influence emotions and challenges them.
- Improves feelings and emotions by changing dysfunctional patterns of thinking and behaviour.
How can CBT help?
Arthritis can often trigger emotional difficulties such as depression, anxiety, and frustration.
CBT equips individuals with arthritis with effective tools to manage these emotional challenges.
Through cognitive restructuring, individuals learn to challenge negative thoughts and replace them with more positive and realistic
ones.
CBT can also help regulate emotions and navigate stressful situations, promoting emotional wellbeing and resilience.
For example:
(Client) No matter what I do, my osteoarthritis is going to get worse, I can't control It - I can't even do my Pilates anymore, it has
ruined my life.
(Therapist) You can't control osteoarthritis, but you can control how you are going to manage it. If you love Pilates, and you know
movement is good for your joints, ask your doctor if you can still do it, your doctor will likely tell you it will be good for you.
Behavioural Adaptation
Arthritis can lead reduced activity levels, avoidance of certain tasks, and overall reduce enjoyment and fulfillment. CBT puts you in the
driver’s seat of your treatment.
By working with a trained professional to set achievable goals, gradually increase activity levels, you may be able to regain a sense of
purpose.
CBT aims to achieve a balance between rest and exercise to try to break the cycle of inactivity, and regain a sense of control over your
life.
Improving Communication Skills
CBT also emphasises the importance of effective communication with the doctors, family members, and support networks.
CBT aims to help with articulating needs, expressing concerns, and engaging in collaborative decision-making regarding arthritis management.
Enhanced communication skills facilitate a more productive and supportive relationship with healthcare providers and ensure that
individuals receive the appropriate care and support they require.
Pain & the Brain
Central sensitisation refers to a phenomenon in which the central nervous system becomes hypersensitive to stimulus and can
increase pain signals which can result in an increased perception of pain.
When you have a condition like osteoarthritis, there will be some degree of tissue damage in the joint that causes an acute pain response.
In addition to the damaged tissue, there are going to be changes that can happen to your neurons, in the central nervous system, which
make your body more sensitive to pain.
This is why sometimes pain can feel like it's worsening, even though there hasn't been any additional tissue damage.
A crucial part of addressing this, involves addressing the mental contributors to the pain experience like any false beliefs around the
pain.
For example, if you think that your shoulder or your hip is never going to get better, or if you think the pain is going to get worse
from exercise, they are mental contributors.
Some people respond well to breath work, other people respond better to CBT. In some cases, people may need medication, but the bottom line
is, addressing the mental component is super important.
What can you expect in CBT?
CBT is typically conducted through a structured and collaborative approach involving the therapist and the person experiencing pain.
When you are acquainted with a therapist, you can be prepared for:
- A thorough initial assessment and lots of questions.
-
Psychoeducation on the complex interaction between physical, psychological, and social factors in pain perception and
management.
- Collaborative goal setting
- Cognitive Restructuring to help identify and challenge negative or unhelpful thoughts and beliefs related to pain.
-
Behaviour Activation with a focus on identifying enjoyable activities, setting achievable goals, and developing strategies to gradually
reintroduce or adapt activities to accommodate pain.
-
Pain Coping Skills Training which includes using relaxation techniques, mindfulness meditation, deep breathing exercises, guided imagery,
and distraction techniques to modulate pain and enhance control over the pain experience.
- Problem-solving and adaptive thinking skills
- Relapse Prevention and Maintenance planning
CBT for pain is typically delivered in a structured format over several sessions, often ranging from 8 to 12 weeks.
The frequency and duration of sessions may vary depending on individual needs and treatment goals.
Therapists may also provide resources for self-guided practice between sessions, such as worksheets, recorded guided exercises, or mobile
applications, to reinforce learning and promote ongoing skill development.
Cognitive change helps patients to develop a more optimistic but realistic attitude toward the illness and to manage other stresses in their lives.
If CBT is something you want to learn more about, be sure to watch the webinar coming up with Professor Louise Sharpe.
How Arthritis Queensland can help
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Talk with a peer-mentor in our free Arthritis
Assist service.
References
Ismail, A., Moore, C., Alshishani, N., Yaseen, K., & Alshehri, M. A. (2017). Cognitive behavioural therapy and pain coping skills
training for osteoarthritis knee pain management: a systematic review. Journal
of physical therapy science, 29(12),
2228–2235. https://doi.org/10.1589/jpts.29.2228
Sharpe L. Psychosocial management of chronic pain in patients with rheumatoid arthritis: challenges and solutions. J
Pain Res.
2016;9:137-146. https://doi.org/10.2147/JPR.S83653
