CBT for Pain - Module 3 Summary

CBT for Pain: The Mind-Body Connection

Pain and the Mind-Body Connection

Have you ever wondered why, after burning your hand, shaking it makes it feel better?

In this module, we’ll review some theories about how pain works. This will give you a better understanding of the connection between pain and your emotions. We’ll also look at some common thinking traps that can worsen your pain. Last, we’ll cover some strategies to identify those traps and improve your brain’s relationship with pain.

Let's go back to the example of shaking your hand to make it feel better.

The Gate Control Theory claims a “gate” of nerves in the brain controls the experience of pain. It can be opened (more pain) or closed (less pain). This theory also states that non-painful sensations (like shaking your hand) reach the brain faster and can distract from the pain.

On the other hand, it means that negative non-painful sensations (including stress and emotions), can make pain worse.

The Neuromatrix Model of Pain claims that a network of nerve cells in your brain creates pain from the patterns it receives. When these cells keep receiving these patterns long-term (in other words, when the pain is chronic), it causes problems with their ability to send normal signals. Things like emotional stress will trigger pain because the nerves can no longer tell the difference between it and physical harm.

Neuroplasticity is your brain’s ability to change in response to your experiences. This concept may apply to pain - changes in the brain may affect your sensitivity and adaptation to pain. You may be able to influence this consciously, improving your pain over time.

The chronic pain theories have a common element: individual differences. Though biological factors play a role in the sensations and distress caused by pain, it is your personal perception that ultimately determines how you cope with and experience pain.

Think about your pain. Do you think of it as a disease - a result of changes in your body tissue, perhaps found by your doctor? Or, do you think of your pain as an experience - in other words, you see it as your own personal experience of pain?

Thoughts (Cognitions)

Negative thoughts and beliefs about pain can make it harder to cope with your pain. These thoughts and beliefs can actually worsen your pain and distress, and can limit your ability to function. It’s important to know: these ways of thinking are normal. They have been encouraged in many ways by what we have been traditionally taught about injuries, pain, and recovery.


Catastrophizing means you assume the worst. This has a direct effect on your pain intensity, distress, and lack of willingness to use healthy coping methods. 

For example, you may think:

  • "This pain is never going to go away"

  • "There is nothing that can help my pain"

  • "I must have something very serious"

This can lead to mood changes, and another negative thought: “Why bother?”

Hurt Vs. Harm

If you tend to catastrophize, you may also have a way of thinking called harm thinking. This means you believe that your pain means that further damage has been done to your body. 

The opposite of this is hurt thinking: believing that the pain is an ongoing but stable problem that will eventually improve. This is a healthy way of coping, as the intensity of your pain is likely to be less with hurt thinking.

Here are some examples of harm thinking:

  • "I just twisted my back - I must have a muscle strain."

  • "My upper back hurts - it must be osteoporosis, just like my Mom."

And, here are some examples of hurt thinking:

  • “My back pain is worse today - I may have over-exercised yesterday. Rest should improve my pain.”

  • “My shoulder is bad today. I think I need to adjust my keyboard so I’m not so sore after working.”


You may doubt what your doctors tell you about your pain and you might continue to seek other opinions. This is called answer-seeking. Thinking this way can impact your ability to manage your pain. Instead of finding ways to manage your pain, you might be looking for a “cure”. While there might be a treatment for your condition, it’s often best to focus on pain management instead.

Here’s an example:

You saw your doctor a while ago for shoulder pain. Playing tennis had made it worse. She referred you for physical therapy and prescribed anti-inflammatory medication. She also recommended a break from tennis. You followed all of the instructions and your shoulder felt much better.

Last week, you started playing tennis again. On your first serve, your shoulder started to hurt. You stopped immediately and decided to go to urgent care, thinking you needed immediate care. You saw a nurse practitioner who recommended physical therapy, anti-inflammatory medication, and rest from tennis - exactly what your doctor said months ago.

You left, feeling angry, thinking "neither of them knows what they’re talking about. I’m going to call that orthopedist’s office I heard about."

This cycle continues, and your pain does not improve.

Emotions or Mood

Your negative mood and your pain have a complicated, back-and-forth relationship - you may have negative feelings because of your pain, and your negative feelings may increase the intensity of your pain.

Bringing awareness to the negative emotions you feel about your pain may help you process them. What emotions do you feel if your pain worsens?

Here are some examples: angry, anxious, depressed, discouraged, exhausted, hopeless, overwhelmed, sad.

Journal about your Pain

What contributes to your experience of chronic pain? Try writing in a blank page of your journal. If you need more guidance, consider:

  • What emotions do you feel when your pain is at its worst?

  • How do you rate your pain when you have positive emotions? 

  • How do you feel others view you when they learn about your experience with pain?

  • If your pain was better managed, how would this affect your emotions?

The Chronic Pain Cycle

Chronic pain can impact every part of your daily life, and the cycle is different for everyone. No one goes through the phases the exact same way.

Chronic pain may lead to lower activity levels and physical strength. The pain itself and less activity can lead to negative feelings. You might stop moving entirely. This can first trigger higher stress and disability, and then more pain.

However, when you’re more active, you often have positive thoughts and feelings. You’re likely to continue to do these enjoyable forms of movement. 

Stress and Chronic Pain

Stress is a biological, emotional, cognitive (thought-based) and behavioral reaction. It happens when you think you may not be able to cope with a situation.

Chronic pain triggers a stress reaction. This reaction can make your pain worse. Combined sources of stress (for example, relationship, financial, or work) can make your pain even worse.

Here’s what can happen:

  • Biological reaction: increased blood pressure, heart rate, breathing rate, and slowed digestion.

  • Emotional reaction: you might feel intense emotions that affect your mood.

  • Cognitive reaction: thoughts, mental images, and beliefs may change.

  • Behavioral reaction: you might act differently. For example, you may eat more or less than usual.

How does your pain affect your biological, emotional, cognitive, and behavioral reactions? What about other forms of stress in your life? How do they impact your pain?

A stress reaction doesn’t always come from the actual event, but from how you view the situation.

You could see a stressful event as:

  1. A challenge: when you see the event as a challenge, you might handle it better.

  2. A threat: when you view the event as a threat, you see the situation as harmful and feel less able to cope.

  3. A loss: when you view the situation as a loss, you believe you’ve already been harmed by it.

Choose a form of stress you have in your life (financial, work-related, family, etc.) Do you view this form of stress as a challenge, a threat, or a loss?

Feel free to repeat this with more forms of stress to get an overall feel for how you view stress.


  • Pain may be explained by different theories, but their overall theme is that your thoughts and emotions are linked to your pain.

  • Negative thoughts and beliefs can make it harder to cope with your pain.

  • Chronic pain usually leads to lower activity levels and physical strength.

  • Chronic pain triggers a stress reaction. This reaction can make your pain worse.

  • A stress reaction doesn’t always come from the actual event, but from how you view the situation.