Table 1.

Some of the components of cognitive behavioural treatment of chronic pain

Education

Teaching about pain and the importance of psychological and behavioural factors is essential as part of a program’s strategy to engage patients.

Goal setting

This may encompass targeting particular areas for all patients, for example, work or domestic duties, to individualized and iterative goal setting.

Relaxation and (or) biofeedback

These may be taught using a single technique, such as diaphragmatic breathing or progressive muscular relaxation or a set of different techniques to be applied across different settings.

Graded activity, exercise and fitness training, and activity pacing

This may range from written or verbal advice on posture, body mechanics, ergonomics, and recommended exercise routines through to specific exercises and techniques targeted at movement and exercise integrated with the patient’s physical strength and deficits and with their personal goals.

Operant principles

This requires a detailed functional analysis of the problem to identify the antecedents, for example, presence of others, type of social interaction, and place, where the behaviour is most likely to occur, and the identification of likely reinforcers.

Behavioural experiments

These are an integral part of mainstream cognitive therapy and the main vehicle for producing cognitive and behavioural change. Behavioural experiments are developed to test an individual’s beliefs about the consequences (emotional, behavioural, and cognitive) of either engaging or not engaging in particular behaviours.

Attention management

At the simplest level this consists of provision of advice on one or more methods, such as the use of distraction or imagery control techniques. Experiential methods should be used to teach the techniques.

Cognitive restructuring

This includes various methods aimed at changing both content and process of thinking.

Problem solving

This involves identification of the problem, generation of a range of possible solutions, prioritizing among those solutions according to opportunities, resources, and risks, and then attempting them.

Generalization and maintenance strategies

A thorough program will pay attention to generalizing treatment gains and developing maintenance strategies.