CBT for Pain - Module 4 Summary

CBT for Pain: Exercise and Pacing

Think about your current relationship with movement. Do you move to improve your pain? Or, do you avoid it?

In this module, we will review how getting the right amount of movement will help relieve your pain. Avoiding movement entirely can make your pain worse, but overdoing it can have the same result.

In the last module, you read about catastrophizing and harm thinking.

To remind you, harm thinking is when you think the worst about your pain. You might think that more “harm” is happening to your body when you feel pain. The intensity of your pain is likely to be worse with harm-thinking.

On the other hand, hurt thinking is the belief that pain is an ongoing, yet stable problem that will eventually improve. In previous modules, you learned that positive thinking can improve your pain. Therefore, thinking this way can help you better manage your pain.

To explore this further: do you believe that any kind of physical activity will make your pain worse and cause harm to your body?

While this may be true for acute pain, it’s inaccurate for chronic pain. Remember: chronic pain is an ongoing condition where damage or harm is no longer happening, but your body is more sensitive to perceived threats.

Avoiding activity can worsen chronic pain over time. Here’s what happens, physically:

  • First, you become deconditioned, meaning your body changes in a way that makes it hard for you to perform daily tasks. You are weaker, less flexible, and tire more easily.

  • You are at greater risk for injuries, weight gain, negative feelings (such as sadness and frustration), and other problems.

Here’s what happens, mentally:

  • You may not feel the same positive feelings from doing activities you once enjoyed.

  • You may have a lack of motivation, increasing your avoidance and withdrawal from activities. The scientific term for this is kinesiophobia, or fear of movement.

Kinesiophobia can be part of a self-fulfilling cycle of fear and avoidance - in this case, when you are inactive because you fear activity will increase your pain, it actually results in more pain.

The negative effects of kinesiophobia make it harder to cope well. As you can see from the image of the fear-avoidance model, by decreasing fear and increasing activity, you are less likely to experience unhealthy thinking patterns that could lead to avoidance and lower moods.

Reflect on what you’ve learned and check in on your own feelings: Are there certain activities you avoid because you associate them with pain? Which ones?

To break the cycle, get moving again. It’s best to start slowly and gently increase how long and how hard you exercise. You’ll also want to choose something that matches your fitness level. For example, if you’ve been:

Inactive: try gentle stretching, range of motion exercises or light yoga, if safe.

Moderately active: try increasing the length of time or number of repetitions/sets or how often you do them.


If you're able, walking is a great choice for movement, since this can be done anytime and anywhere. It not only helps keep your joints healthy, but it is gentle enough to reduce pain. Research has shown that it can also slowly increase your flexibility and strength, as well as improve your mood.

Movement tips

  • Make movement a part of your day and include it in your plans.

  • Keep track of your activity - you can use our activity log. The goal is to make it a habit, like brushing your teeth or eating lunch.

Reach out to your Goodpath coach if you could use extra accountability and support for your movement goals.

When you have pain, it’s also possible that you push yourself too hard and to the point of pain. Are there any activities you tend to overdo? Make note of them here.

The Cycle of Overactivity

If you have chronic pain, you might use a “good” day to be more active. Unfortunately, you could have more pain as a result. You might hurt right away, or you might be sore the next day. This creates yet another chronic pain cycle: the cycle of overactivity.

Take a look at the image below:

When you do too much or are overactive, you can feel more pain and fatigue. Then, you may move less (rest) and feel frustrated because you want to do more. When resting, you’re likely to feel less pain. So, you return to activity - and possibly overactivity - because you feel better. The cycle continues.

The cycle of overactivity may worsen or intensify unhealthy emotions, increased stress, and negative thoughts. As you’ve learned, your mood and thoughts affect your behavior, so all of this makes you less likely to be active. 

So, how can you break this cycle? One way is pacing your everyday activities.

Pacing means balancing your activities by: 

  1. Breaking activities into more manageable tasks 

  2. Resting between tasks

  3. Planning the amount of activity

Being mindful of your physical activity through pacing will help you complete tasks, and getting things done can help you feel accomplished and improve your mood.

How to Pace Yourself

  • Plan tasks - Think about what you’re going to do and how you’ll do it before you start.

  • Set priorities - Instead of trying to do everything, choose a few things.

  • Take your time and move carefully.

  • Take regular, scheduled breaks. Don’t wait until you have to stop from pain or fatigue.

  • Break a task into smaller chunks instead of doing all of it at once.

  • Change positions - Avoid staying in one position for long periods of time.

  • Ask for help


  • Avoiding pain worsens your pain over time.

  • Being more active helps to break this cycle and can improve your pain.

  • Doing too much can also make your pain worse, so pacing yourself is key.

  • Pacing involves planning out activities and balancing the activities with rest.