Cognitive behavioral therapy (CBT) may be conducted in one-on-one sessions between a patient and a mental health practitioner, such as a psychiatrist, psychologist or clinical social worker.

CBT may also be conducted in group sessions, which may include patients experiencing a wide variety of pain symptoms. Sessions typically last between 1.5 to 2 hours and are held over eight to 10 weeks.

CBT programs usually include education, skills acquisition and relapse/maintenance training to help patients retain the information and skills learned.

There are a number of skills that patients may be taught during CBT sessions. These may include:

• Keeping a diary. Patients record pain sensations three times a day at the same time. This type of pain assessment rates pain on a scale of 0 to 10, with 0 meaning no pain and 10 meaning the worst pain possible. Patients record physical pain and emotional pain (such as anxiety and anger). A diary helps patients identify negative patterns that may be reversed with CBT.
  
  
• Pacing activities. Patients identify daily activities that cause pain (e.g., sitting at a computer). They also monitor how long the activity is performed before pain is experienced and how long it takes before pain disappears. Patients time themselves while doing the activity to ensure it is discontinued before pain is experienced. Pacing activities help to relieve pain by reducing muscle fatigue, nerve irritation and frustration.
  
  
• Relaxation therapy. Techniques to elicit the relaxation response, which is a quieting response that can balance the physical and emotional effects of stress. Patients are sometimes taught breathing and relaxation techniques so they can be used to alleviate pain during stressful and painful diagnostic tests and therapeutic procedures. These techniques reinforce the connection between mind and body and give the patient more control in reacting to difficult procedures.
  
  
• Cognitive therapy. Techniques to help patients learn negative emotional responses and alter them. Patients keep track of emotional reactions to events, such as driving in traffic. Common reactions may be anger and frustration, which can lead to increased adrenalin, blood pressure, heart rate and pain.
  
  Patients also keep track of internal thoughts that occur during events, such as thinking, “This always happens to me when I want to get somewhere.” Patients identify patterns, assumptions and distortions in thought processes and try to reframe them with healthier ones, such as thinking, “There is not much I can do about the traffic jam, but I can practice my breathing exercises.” The goal of this technique is to learn to respond, and not react, to stressful situations. Other positives include ignoring pain and indicating acceptance of pain.

Patients being treated with CBT are sometimes required to perform activities outside of therapy sessions, such as behavioral homework assignments. During these, patients try out new responses to situations discussed during therapy.

Patients may be treated with CBT over a short period of time, such as a few weeks or months, or may be treated for longer periods of time.