Cognitive behavioral therapy (CBT) is a type of therapy aimed at identifying negative thought patterns and behaviors and replacing them with positive ones.

CBT is based on the theory that internal thoughts (cognition), rather than outside circumstances, shape behavior so a person’s beliefs about pain can influence adjustments to the pain experience. Distorted thinking thus leads to damaging behavior. Unlike typical psychotherapy, CBT focuses on changing present and future attitudes and behaviors, rather than addressing past conflicts. CBT is usually structured and conducted over short-term periods, whereas other forms of psychotherapy are often conducted over longer periods of time.

CBT combines techniques used in behavioral therapy and cognitive therapy. The focus of behavioral therapy (also called behavior modification) is to replace undesirable behaviors with healthier ones. Techniques used in behavioral therapy include positive reinforcements (technique in which positive behavior is rewarded) and desensitization (technique by which patients confront situations that cause discomfort, fear or anxiety and overcome negative emotions).

Cognitive therapy involves identification of distorted patterns of thinking, which are called maladaptive schema (fundamental core beliefs or assumptions that are part of the perceptual filter used to view the world). These negative patterns are often responsible for maladaptive behaviors (unsuitable or counterproductive behaviors). Patients try to replace these negative patterns with more constructive ones (cognitive restructuring).

Some common patterns of negative thinking include:

• Catastrophizing. Anticipating the worst and exaggerating perceived failures and symptoms, especially of chronic pain.
  
  
• Filtering. Exaggerating the negative aspects of an experience and minimizing the positive ones.
  
  
• Personalizing. Automatically accepting blame when something bad happens.
  
  
• Generalizing. Viewing a troublesome event as the beginning of a never-ending cycle.
  
  
• Polarizing. Viewing situations as all good or all bad, black or white. Not recognizing the middle ground.

The medical community began using CBT in recent years after recognizing that pain is not simply a biological response to unpleasant stimuli. Rather, there are a number of biological, social and psychological factors that interact in complex ways to influence the experience of pain. Factors that can influence a patient’s experience with pain include previous pain experiences, genetics, depression and other mood disorders, pain beliefs and fears, pain threshold, pain tolerance level and coping methods.

In addition, pain patients often experience emotions such as anger, sadness and anxiety, and may respond better to CBT than medication or other types of treatments.

CBT helps relieve pain in some patients by helping them recognize that emotional responses to pain are influenced by thoughts that can be controlled. CBT can give patients more confidence in their ability to manage their symptoms and sometimes reduces the number of visits to healthcare providers.

CBT is sometimes used when patients do not respond to medications or other types of treatment. But it may also be used in conjunction with medication.