What is a critical difference between cognitive-behavioral therapy (CBT) and traditional pain relieving therapies, such as pharmacological interventions, in terms of patient participation?

From the Guidelines

A critical difference between cognitive-behavioral therapy (CBT) and more traditional pain relieving therapies is that it requires the patient to be an active participant in their treatment. This is evident from the CDC clinical practice guideline for prescribing opioids for pain, which highlights the importance of noninvasive nonpharmacologic approaches, including cognitive behavioral therapy, in improving pain and function without risk for serious harms 1. Unlike medication-based approaches where patients simply take prescribed drugs, CBT demands engagement, self-reflection, and the application of learned techniques in daily life. Patients undergoing CBT must actively identify negative thought patterns, challenge distorted beliefs about pain, and implement behavioral changes. They typically complete homework assignments between sessions, practice relaxation or mindfulness techniques, and gradually modify their responses to pain.

Some key aspects of CBT that necessitate active patient participation include:

• Identifying and challenging negative thought patterns
• Implementing behavioral changes
• Completing homework assignments between sessions
• Practicing relaxation or mindfulness techniques
• Gradually modifying responses to pain

The therapeutic benefits of CBT come not just from the sessions themselves but from the patient's ongoing application of cognitive and behavioral strategies in real-world situations, making their participation essential to the treatment's success. As noted in the guideline, active approaches that engage the patient, such as CBT, have somewhat more robust evidence for sustained improvements in pain and function than more passive treatments 1. Therefore, CBT's requirement for active patient participation is a critical component of its effectiveness in managing pain and improving function.

From the Research

Cognitive-Behavioral Therapy (CBT) Requirements

• The patient to be an active participant in their treatment: CBT is a type of psychotherapy that requires the patient to be actively involved in the treatment process, unlike traditional pain relieving therapies which may be more passive 2, 3, 4, 5.
• Key aspects of CBT include:
  • Decreasing patient catastrophizing and increasing patient self-efficacy for managing pain 3
  • Increasing mindfulness and pain acceptance 3, 4
  • Improving physical functioning and reducing pain intensity and distress in patients with chronic pain 4, 5
• Studies have shown that CBT, mindfulness-based stress reduction (MBSR), and behavior therapy (BT) produce similar effects on outcomes such as pain, physical function, mood, and sleep disturbance in people with chronic pain conditions 5.
• The specific techniques included in CBT, MBSR, and BT may be less important for producing benefits than people participating in any techniques rooted in these evidence-based psychosocial treatments for chronic pain 5.