MSK CBT for Pain Module 1 Summary

CBT for Pain: Overview

Welcome to Goodpath’s Cognitive Behavioral Therapy for Pain.

This first module will introduce you to Cognitive Behavioral Therapy (CBT) and help you understand how your thoughts and emotions affect your pain.

What is Cognitive Behavioral Therapy (CBT) for Pain?

Cognitive Behavioral Therapy (CBT) is a type of therapy that explores the relationships between cognitions (thoughts), emotions (feelings), and behaviors (actions). It also:

  • Teaches you to think and act in new ways

  • Can help you feel less pain

  • Improves your ability to cope with stress, anxiety, and depression

There are many different types of CBT. This program focuses on helping you with chronic pain.

CBT for long-term or chronic pain is supported by research. It’s effective as a stand-alone treatment, and alongside other treatment methods for chronic pain.

The next modules will help you learn more about your pain and the thoughts, emotions, and behaviors that go along with it. Learning more about your pain can improve your view of pain. 

You’ll also find coping tools to help you manage your pain. Our CBT for pain is designed to:

  • Increase your understanding of pain

  • Change how you view pain

  • Add to your coping skills

  • Improve your ability to manage pain

Chronic pain and emotions

Did you know that chronic pain and emotional problems often go together? Look at the image below to see how chronic pain and your thoughts, behaviors, and emotions interact.

Think about your emotions when you have pain, including when your pain feels worse, and any emotions that come up. How do you feel?

For example: depressed, anxious, afraid, angry, etc, or a combination of emotions

What do you notice about your pain when you feel strong negative emotions?

Does your pain get worse? Does the sensation of the pain change?

Learning more about pain

You can think of pain as having four dimensions. They are: 

  • Sensory: Where do you feel the pain? What does the pain feel like? How much pain do you feel?

  • Emotional: How unpleasant is the pain? Does it trigger strong feelings?

  • Cognitive: How do you interpret the pain? Does it cause stress?

  • Behavioral: How do you respond to the pain?

There are two types of suffering due to pain: primary and secondary.

  • Primary suffering is related to the actual pain - the sensation and other symptoms of pain.

  • Secondary suffering is related to the problems you face while trying to avoid or control your pain, and how those problems impact you. Pain changes what you think, what you do, and how you feel.

CBT can help you with primary and secondary suffering due to pain. By changing how you view pain, it:

1. Lessens the sensation of pain (primary)

2. Reduces unhealthy actions, thoughts, and negative emotions associated with pain (secondary)

What is happening to you and your behavior when you have chronic pain?

When your body feels threatened, it sends an alarm as a survival mechanism. This message says “Get yourself out of danger.” This starts your body’s pain response.

The pain response and chronic pain

If you have chronic pain, your brain constantly receives danger messages. 

  1. Your brain signals your body to defend itself.

  2. As the brain receives more danger messages, the body builds more defenses.

  3. As this continues, your body more quickly recognizes danger messages. 

  4. The result is that your body’s alarm system becomes very sensitive.

When the pain doesn't go away

To feel less pain, you might decide to avoid movement.

  1. When you avoid movement, your bones, muscles, and other body tissues become weak and less flexible.

  2. The weakness causes even more danger signals and an even more sensitive alarm system, and then:

  3. The pain is constant.

What happens to my thoughts and mood?

Other reactions happen when you have chronic pain, including changes in thoughts (cognitions) and emotions (feelings).

Here’s an example:

  1. You bend down to pick something up and you experience pain.

  2. The pain causes a negative thought, and then another one, and so on.

  3. Your negative thoughts are followed by a negative mood.

The reactions that occur with your pain, thoughts, and mood changes are not the pain itself.

They are, in fact, secondary suffering, as mentioned above - thoughts, and then mood changes (or vice versa) are a result of pain.

How can CBT help?

CBT teaches you to notice thinking patterns due to your pain. CBT will help you become more aware of the associations between your behavior, thoughts, and feelings.

Track your Pain

In the Home screen of your app, you will find a Daily Check-In. You can fill this out to keep track of your pain levels over time.

Mind-Body Pain Relief

There are many ways to help reduce pain. You probably have your own methods, and it may be helpful to discuss them with your coach. Here are some of the mind-body strategies we offer for your use as well.


Using a journal provides a safe place to help you cope with your pain, as well as negative thoughts and emotions associated with it.

Yoga and Meditation

We offer several different types of live yoga classes and pre-recorded meditation videos/audios that can help relieve your pain. For example, your program may include:

  • Yoga

  • Guided imagery

  • Progressive muscle relaxation (PMR) 

Talk with your coach about the other mind-body strategies offered in your program.

Have you tried any mind-body techniques to relieve your pain? Which ones?


  • Cognitive Behavioral Therapy (CBT) is a type of therapy that explores the relationships between thoughts, feelings, and behaviors

  • The four dimensions of pain are sensory, emotional, cognitive, and behavioral

  • Primary suffering is the actual sensation of pain, and its other symptoms

  • Secondary suffering is related to to the problems you face while trying to avoid or control your pain