Cognitive behavioural therapy

Psychological approach addressing thoughts and behaviours; in persistent pain, it may support coping and activity strategies.

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Understanding the approach

Cognitive behavioural therapy, or CBT, is a structured psychological intervention. In persistent pain care, it helps people recognise relationships between thoughts, emotions and behaviour. The aim is to develop useful strategies for returning to activities, managing flare-ups and reducing the extent to which pain controls daily life, rather than promising complete symptom elimination.

Indications and assessment

The practitioner assesses practical difficulties such as fear of injury, movement avoidance, disrupted sleep or a sense of helplessness. Goals and exercises are then tailored to the individual. New pain or neurological signs still require an appropriate physical assessment; CBT does not replace investigation of a possible underlying condition or urgent medical care.

Benefits, limitations and precautions

WHO includes psychological interventions among options for chronic primary low back pain. A randomised trial found functional improvements with a CBT programme compared with usual care. This does not guarantee pain relief for every participant. Practice between sessions, access to care and a suitable programme format can affect participation and the ability to use new skills.

Place in the care pathway

CBT can accompany active rehabilitation and medical treatment when these are indicated. It should be offered by an appropriately qualified practitioner and reflect the patient's preferences. Assessment at TAGMED may lead to a suitable referral; this article does not identify psychotherapy as a service provided at the clinic or equate it with a physical treatment session.

Goals should be practical: walking farther, returning to a chosen activity or reducing symptoms that interfere with sleep. Improvement immediately after a session does not establish lasting benefit. Follow-up compares function with the starting point, records adverse effects and considers progress between appointments. An inadequate response should prompt a review of the clinical explanation or proposed approach, rather than an automatic extension of the same treatment.

Frequently asked questions

Does this mean everything is psychological?

No. CBT addresses how someone lives with real pain, regardless of its original cause.

What might exercises involve?

They may include gradually resuming activities, observing thoughts and practising coping strategies during a flare-up.

How many sessions are needed?

The format depends on the programme and individual needs; no universal number guarantees a result.

Can CBT accompany exercise?

Yes. Their goals may complement each other when care reflects the person's abilities and preferences.

What if the approach does not suit me?

Discussing this allows changes to the pace or goals, or consideration of another approach.

Educational information from The Spine Page. This entry does not replace an individual assessment. Documentary version: October 12, 2026. Sylvain Desforges, B.Sc., D.O., N.D., osteopath and naturopath.