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Cognitive Behavior Therapy - Distorted Thinking and Chronic Back Pain

Distorted Thinking and Chronic Back Pain

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Updated July 31, 2012

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Pain is often not the only thing with which people who have neck or back issues have to cope. It can be an added complication to pre-existing stress, depression or anxiety. Or it can trigger relationship issues - with a spouse or other family member, with friends or even with an employer.

If any of this rings true for you, you may find that a few sessions with a pain psychologist - particularly one who specializes in cognitive behavior therapy - greatly improves your ability to cope. A pain psychologist can help you deal with the transitions that generally accompany a back problem, as well as help you more effectively manage the way you feel day to day.

In a podcast entitled “Best Practices in the Co-Management of Chronic Musculoskeletal Pain”, Dr. Steven Stanos, DO, medical director of the Center for Pain Management at the Rehabilitation Institute of Chicago and assistant professor in the Department of Physical Medicine and Rehabilitation in the Feinberg School of Medicine at Northwestern University recommends cognitive behavioral therapy for patients with chronic musculoskeletal pain. (This includes people with neck and back pain.)

Medication can only do so much," Santos says. "A good cognitive behavioral therapist can help."

Related: Choose an Effective Pain Medication for Your Back.

Distorted Thoughts and Cognitions - The Symptoms Cognitive Behavioral Therapy Treats

In cognitive behavioral therapy, distorted thoughts are considered symptoms. The therapist identifies these symptoms by noticing an “activating event”, which is simply the stimuli that leads you into an emotional reaction. Generally the activating event is a combination of perceived (i.e. .not necessarily true ) and confirmable (i.e. factual and provable) realities.

So what exactly are these “distorted cognitions” or “distorted thoughts” that lead to an activating event? In other words, what types of thoughts and behaviors are fodder for a session of cognitive behavior therapy when you are trying to manage chronic back pain?

Dr. Aaron Beck, a Yale trained psychiatrist generally credited for founding and developing cognitive behavioral therapy, has put forth a number of distortions CBT therapists address in their sessions. They include but are not limited to:

  • Arbitrary inference, which, in my opinion, is a fancy way of saying you’ve jumped to a conclusion. The technical definition is making a conclusion based on limited data. An example of arbitrary influence might be if your co-worker brushes by you in the hallway without saying “excuse me”, and perhaps without even looking at you. After this encounter you feel sad, and you believe that your co-worker no longer likes you.
  • Amplification or overgeneralization, or, as I see it, “making a mountain out of a molehill”. An example of amplification might be, I can no longer bend over without pain, therefore everyone in my life has to take turns taking care of me. I need to depend on others for my independence.
  • Minimizing or maximizing. Minimizing is equivalent to playing down the positive aspects of your life, relationships, possibilities, experience, etc., while maximizing is playing up the negative side of things. An example of minimizing is not being able to take a compliment. If someone says, “I like your hair” and you respond by saying “You’re just saying that because you feel sorry for me because you know I have pain”, you are using a minimization strategy.
  • Selective abstraction is when you focus on one situation to the exclusion of an entire relationship. For example, in an otherwise happy marriage, if your husband has a habit of leaving the yard work to you, even though you’ve informed him numerous times that it makes your back worse, your contemplating a divorce based on this one problem could be selective abstraction.
  • Dichotomous thinking is characterized by the use of words such as always and never. For example, if you believe your pain is always at the bottom of disagreements you have with your family members, you may be engaging in dichotomous thinking. Or, returning to the amplification example (above) you might believe that because you can no longer bend over without pain, you'll never be independent again.
  • Personalization is taking responsibility for behavior on the part of another person that resulted in your activating event or otherwise feeling bad. For example – back to the encounter with your co-worker - if she brushes by you and doesn’t acknowledge you, after which you feel sad or dejected, if you are personalizing you might ask “what did I do to my co-worker to make her make me feel this way?”

Catastrophizing - The Mother of All Cognitive Distortions in People with Chronic Pain

But for people with chronic back or neck pain, the cognitive distortion CBT therapists treat the most often, says Dr. Melissa Rowland, psychologist at the MidAmerican Psychological Institute in Joliet, Illinois, is catastrophizing. Catastrophizing is similar to both dichotomous thinking and amplification, but also includes a "woe is me" element. Examples of things people say when they catastrophize are: "I am in so much pain, I can't do anything" or "I’ll never have a happy life because of my pain."

The good news is that cognitive behavioral therapy may help you reduce or eliminate the catastrophizing habit. The goal of the treatment is not only to help you identify distorted thoughts, but to help you correct them, as well, Rowland informs me.

Along with tackling distorted thoughts, a pain psychologist can help you learn to relax. Using techniques such as deep breathing and imagery may help you address any pre-existing stress or anxiety. "These are the things that patients seem to like the best," Stanos admits.

Related: Ways to Relax Your Back

'With chronic pain, you have to think more on the management side," Santos concludes.

Sources

“Best Practices in the Co-Management of Chronic Musculoskeletal Pain”, Dr. Steven Stanos, DO, medical director of the Center for Pain Management at the Rehabilitation Institute of Chicago and assistant professor in the Department of Physical Medicine and Rehabilitation in the Feinberg School of Medicine at Northwestern University.

Phone Interview. Dr. Melissa Rowland, Psy D. MidAmerican Psycological Institute, Joliet, IL. July 2012.

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