Cognitive Behavioural Therapy: How Challenging Negative Self-Talk Can Transform Chronic Pain

Changing negative self-talk can have dramatic effects on the pain you experience. We explain how.


My pain will get worse if I walk to the store.

My pain will never get better.

I am worthless for not being able to do everything I wanted to today.

These are examples of negative thoughts that may be present for those living with chronic pain. Where it concerns chronic pain, it is important to begin thinking about pain in a neutral, objective way to contribute to enhanced social, emotional, cognitive, and physical functioning. 

Chronic pain is most commonly defined as pain which lasts longer than the usual course of an acute injury or disease or the pain that recurs over time. Chronic pain can have a significant impact on one’s engagement in meaningful activities, relationships, occupations, and overall quality of life. Living with pain isn’t simple or easy. It can be a constant, nagging reminder of functional impairment. It can be a struggle to sleep or one may experience changes in appetite related to chronic pain. 

Our mental health is closely tied to our physical wellbeing. When physical pain is present, it is likely that we are more vulnerable to our emotions. We may be quicker to anger, or fearful of engaging in activities we previously enjoyed due to pain. The cycle of fear, avoidance, and inactivity can contribute to depression and anxiety, as well as other mental health conditions. 

Your mood plays a large role in the experience of pain and vice versa. In the Cognitive Behavioural Therapy (CBT) model, we endeavour to change the way that we think in order to ultimately change our emotional state. CBT examines our thoughts or cognitions, body sensations, emotions, and behaviours. Thoughts are the stream of consciousness, words, or images in our minds. Behaviours are the things that we do. Body sensations are physiological responses we experience. Emotions are the way that we feel. By catching, checking, and changing our thoughts or cognitions, it is possible to feel some relief from chronic pain.

The following is an example of how our thoughts, emotions, behaviours, and physical sensations are related:

  1. Thought: “This pain is too much for me to handle.”

  2. Emotions: Sad, Anxious, Angry

  3. Behaviours: Cry, sleep, yell at partner

  4. Physical sensations: Fatigue, decreased energy, decreased appetite, and more pain

Thoughts are so automatic that we may not even be aware of them. But it is possible to start evaluating and noticing our thoughts and making a concerted effort to change our thinking, which can reduce both pain flares and pain intensity, as we turn the volume down on our pain system.

How is this done?

Whether you receive the support of a therapist trained in CBT or explore methods for self-help independently, it is possible to retrain your brain to take a more balanced, healthy approach to your pain.

Step 1: Catch Your Thoughts

Ask yourself: What was I thinking the last time I experienced pain? What did I observe in my body and in my surroundings? What was the situation? What emotion was I feeling at the time and how would I rate its intensity on a scale of 0 (no pain) to 10 (extreme pain)?

Step 2: Check Your Thoughts

Ask yourself: Is the thought true? Some thoughts contain a kernel of truth and some do not. If it is true, ask yourself, is it helpful to continue thinking this way? Check out a list of cognitive distortions (widely available on the internet) if you want more information on how to do this step.

An example of a cognitive distortion is overgeneralization. One might think: “I can’t get out of bed today, therefore I can’t do anything at all.” Explore your thoughts and find out which ones are negative self-talk, untruthful, or unhelpful to continue thinking that way. If you can, take the thought “to court” and find out if there is evidence for or against the thought which supports it.

Step 3: Change Your Thoughts

Ask yourself: What is a more balanced way of thinking about this? What is a realistic way of viewing this situation? What would I tell a close friend? What is another way of looking at this? Choose a new, more helpful thought to repeat to yourself. Some examples of helpful coping statements or balanced, alternative thoughts could be “this too shall pass” or “just do one thing at a time” or “there is always something I can do.” Rate how much you believe the new thought on a scale of 0 (no believability) to 100 (I fully believe this statement).

Step 4: Evaluate the Results

Ask yourself: Did my emotion and/or its intensity decrease after examining my thoughts and engaging in the catch, check, and change exercise?

Writing this down in a journal entry or a thought diary can be supportive to mental health recovery and dealing with your pain. By journalling you can keep track of the work that you have done and reflect on common cognitive distortions that you may succumb to regularly, and have an arsenal of balanced thoughts to combat the negative thoughts.

Remember, it takes a number of weeks before we can begin to change our thinking. Our brains are wired towards a “negativity bias” and therefore it takes time and practice to start to chip away at these negative thought patterns which may have become habitual over many years. Make an effort to engage in self-compassion and use patience with yourself. Challenging our thoughts can build our resilience and ability to cope in the face of adversity. It can strengthen the mind-body connection in a positive way and provide us with a sense of control over something that we do in fact always have the capacity to control: our thoughts.

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