People dealing with chronic pain from arthritis, sometimes seek psychotherapy to learn how to live with the pain. Often, these patients receive cognitive behavioral therapy or CBT. CBT is a type of "talk therapy," developed by Aaron T. Beck, M.D., in the 1970s. Therapists practicing CBT teach clients to identify and confront incorrect thoughts. Each irrational thought is challenged by the therapist, who teaches the client to replace these thoughts with more productive, reality-based thinking.
Gate Control Theory
CBT practitioners sometimes use the gate control theory of pain to explain why physical pain can be managed through psychological means. The idea behind this theory is that your brain has a gate-type of mechanism controlling transmission of pain signals from the site of the injury to your brain. If the gate is open, you will experience pain. The intensity of your pain will be mediated by how wide the gate is opened. Higher brain centers such as those that govern thinking and reasoning play a role in controlling this gate to determine how much pain you feel and how much your pain stops you from pursuing a full and complete life. Practitioners of CBT believe you can be trained to exert more conscious control over your gate mechanism.
CBT for Arthritis
Psychological approaches, such as CBT, help a patient manage the psychological and social aspects of her arthritis. According to a December 2006 review article published in the "Arthritis Research & Therapy,” a typical CBT program to treat arthritis includes having her learn how to control her pain through diverting her attention, practicing relaxation techniques, changing her distorted and limited thinking patterns and focusing on enjoyable pursuits. Group or individual classes, typically conducted over a number of weeks involve having patients complete homework assignments to learn self-management techniques.
Return to Active Lifestyle
A person living with arthritis sometimes avoids physical activities because he does not want to endure any additional pain. A study published in the January 2003 edition of the ”Archives of Disease in Childhood,” found that CBT can be used effectively to help a patient enjoy a more active lifestyle, despite their arthritis. During the study, 57 adolescents aged 11 to 18 years old with chronic arthritis received treatment with CBT for three weeks. Prior to the treatment, each adolescent’s avoidance of activities was assessed using the Functional Disability Inventory or FDI. During treatment, one goal of CBT was to have the teens return to their regular activities, despite their pain. The CBT treatment appeared successful in achieving this goal because there was a significant decrease in level of disability as measured by the FDI following the treatment. The adolescents could also complete functional tasks at a higher level following the treatment, providing evidence the results were objective as well as subjective. This level of improvement was maintained at the three month follow-up.
Reduction in Pain
Learning to manage your life more effectively with CBT can decrease your level of arthritic pain, according to an August 2009 study published in the “Journal of Sleep Medicine.” In this study, 23 people suffering from both arthritis and insomnia, completed a CBT course focusing on the treatment of insomnia. Results were compared to a group of matched controls who received attention control treatment. At the end of the treatment, subjects receiving CBT reported significant improvements in both sleep and pain, as compared to the controls, who did not manifest significant improvement in either sleep or arthritis pain.
References
- "Archives of Disease in Childhood"; Chronic Pain In Adolescents: Evaluation of a Programme of Interdisciplinary Cognitive Behaviour Therapy; C. Eccleston, et al.; January 2003 (PDF)
- Academy of Cognitive Therapy: Cognitive Therapy for Relationship Distress; Frank M. Dattilio, Ph.D., A.B.P.P.
- National Association of Cognitive Behavioral Therapists; Cognitive-Behavioral Therapy
- "Arthritis Research & Therapy"; Psychosocial Aspects in the Management of Arthritis Pain; Catherine L. Backman; December 2006 (PDF)
- "Rheumatic Disease Clinics of North America"; Psychological Interventions and Lifestyle Modifications for Arthritis Pain Management; Francis J. Keefe, Ph.D, et al., 2008
- "Journal of Clinical Sleep Medicine"; Cognitive Behavioral Therapy for Insomnia Improves Sleep and Decreases Pain in Older Adults with Co-Morbid Insomnia and Osteoarthritis; Michael V. Vitiello, Ph.D, et al.; August 2009
