CBT for Pain - Module 7 Summary

CBT for Pain: Coping With Negative Thoughts

Your thoughts play an important role in your view of pain and the way you feel it.

As you’ve learned in previous modules, there’s a connection between negative thoughts and how you experience pain. In this module, we’ll review some ways to challenge and overcome negative thoughts related to your pain.

As you continue to feel pain, your thoughts may become more negative over time. Negative thoughts may be automatic - you may not even be aware of them. But, they still have a major impact on your emotions and behavior.

When you have negative thoughts, you may also experience negative emotions like anger, fear, or frustration. Sometimes they happen before your negative thoughts. Because negative thoughts can become automatic and continued pain means more negative thoughts, chronic pain can lead to an increase in distorted negative thinking.

What negative thoughts do you have in response to pain, or when when you think about pain?

Now, how do these thoughts affect your behavior? For example: do you avoid movement or socializing?

Research shows that assuming the worst (catastrophizing) about your pain is linked to a higher sensitivity to pain, higher disability, and more stress. Thinking the worst, or catastrophizing, is one of many cognitive distortions you might have about your pain.

Cognitive Distortions

Cognitive distortions are irrational or untrue thought patterns that have a negative impact on our views and beliefs. They are automatic thoughts that are not based on facts, and are often extreme. Thinking about your cognitive distortions can help you be more mindful of your negative thinking.

Below are some more cognitive distortions that are common in those who have chronic pain:

Overgeneralizing: One or two negative events means I have failed Mental filtering: Negative events interfere with my judgment Minimizing: I downplay positive experiences Internalizing: I blame myself for negative events and situations

After taking a look at the list of cognitive distortions, have you noticed any that feel familiar? Do you have others that aren’t listed here?

Monitoring Your Thoughts

It takes effort and practice to become aware of your negative thoughts linked to your pain or negative mood. Remember: a lot of these thoughts happen without conscious awareness. In other words, you don’t even realize they’re happening. These thoughts that happen without your awareness are automatic negative thoughts. They may be triggered when you’re stressed or in pain.

To help bring awareness to your automatic negative thoughts and the feelings that follow, ask yourself:

  • What am I thinking before the feeling happens? 

  • What am I afraid of? 

  • What’s the worst thing that can happen? 

  • Is there a memory that comes up when I feel this way? 

  • How does this affect the decisions I make in the future?

Earlier, you identified negative thoughts linked to your pain. Now, it’s time to challenge and change these thoughts. It might take time to be more mindful of your thoughts. However, you can choose the way you think and react to your experiences.

Challenge Negative Thoughts

By challenging your thoughts, you can create alternate, believable thoughts. These are balanced and accurate ways of understanding your experiences. To challenge your thoughts, think about these questions:

  • Is this thought or feeling 100% true?

  • Can I view this situation a different way?

  • What advice would I give to someone else with the same thought or feeling?

  • Is this thought helpful in any way?

  • Did I consider the whole situation or leave out certain parts?

Think back to your negative thoughts from the last module. Choose one of them and ask yourself the questions above to challenge it. What thought are you challenging?

Positive Affirmations

Positive affirmations are another tool you can use when you when you feel pain or are in a negative mood (for example, when you feel sad, stressed, frustrated, etc). They help you replace unhealthy thoughts and stay calm. It’s best to find coping statements that are truly meaningful to you, and ones that are realistic

Neutral Statements

Sometimes, it can be hard to start with positive statements. If you feel that any positive statements you try feel untrue, it’s okay to start with neutral statements. A neutral statement might look like:

  • I feel pain, but no more harm is being done to my body

  • I am taking steps to manage my pain

  • I have more pain today, but it will fade

Here are some more pain-related coping statements:

  • I can manage my pain

  • I know how to lower my pain

  • Staying positive helps me cope with my pain

  • I’ve gotten through my pain on other days

  • I would tell a friend with pain…

  • Someone else with good coping skills would deal with their pain by…

  • I can choose to focus on something other than my pain

  • Although I have pain, I can live a full life

Take a moment to think of other coping statements you can use. Think about the ones that are the most meaningful to you. What’s one statement that feels meaningful for you?


  • Your thoughts play an important role in how you view pain and the way you feel pain.

  • Negative thoughts can be automatic - you may not even be aware of them. They may also be cognitive distortions - thoughts that are not true and often extreme.

  • Bringing awareness to the negative thoughts that are linked to your pain takes time and patience.

  • Positive coping statements help you replace unhealthy thoughts when you’re stressed.