Cognitive Behavioral Therapy Gains Popularity

From the Lund Report, July 14, 2010

On July 22, Debra Kirkman will celebrate an anniversary she’d rather forget: the day she was smashed between two cement trucks while working for Ross Island Sand and Gravel last year. “It literally smashed me, dropped me, and threw me,” she said.

Six ribs were fractured, and her lower lumbar, soft tissue and nerves around the area damaged. “I’ve never experienced as much pain in my life. I felt like I was dying.”

Kirkman engaged in physical therapy, pool therapy, saw a chiropractor, and began taking six different medications. Nothing worked. And she relied on her husband to perform the simplest of chores—including brushing her teeth, showering, and using the toilet. “I was basically a cripple.”

But Kirkman is approaching her accident’s first anniversary with a growing ability to manage and live with her pain because of a form of psychological therapy that teaches people how to deal with chronic pain.

It’s called cognitive behavioral therapy. Rather than cure someone of their chronic pain, people are taught skills and methods to manage and regain control of their lives. Methods can include physical and occupational therapy; self-management tools; stress management; self hypnosis; relaxation exercises; reading literature and reinforcing healthy behaviors.

The goal of cognitive behavioral therapy is to change the way a person thinks about their pain, enabling them to become more proactive and live a normal life.

“Cognitive behavioral therapy involves modifying negative thoughts related to pain,” explained Dr. Catriona Buist, clinical director of the pain management program at Progressive Rehabilitation Associates in Portland.

Frequently, people think their chronic pain will permanently disable them, and they’ll be unable to cope. Cognitive behavioral therapy changes that “narrative to be more hopeful or positive,” Buist said.

Chronic pain is defined as lasting longer than three months. Because of its duration, health professionals equate it with hypertension, diabetes and other chronic diseases. And, it frequently impacts a person’s emotional health.

People suffering from chronic pain can become irritable, depressed, or anxious. “It can be overwhelming for people,” Buist said. “A sense of helplessness sets in.”

Carol Ruby experienced that helplessness. Four years ago, she injured her hip and lower back when she lifted a heavy box while working as a cook. “My injury affected my thinking. It totally changed my personality,” said Ruby, who rarely left her bedroom, and became depressed.

She’s been part of Progressive Rehabilitation Associates’ pain management program for several weeks. Stretching, aerobic exercises, stress management classes and lectures have been particularly helpful to Ruby, who’s learning how to pace herself.

Now she hopes to use those skills to return to a “normal, everyday life, instead of having to lie down for hours at a time.”

Kirkman, meanwhile, has cut down on her medications as a result of the program, and is beginning to tolerate her pain. “I have good days and bad days,” she said.

Overall, Buist said cognitive behavioral therapy can provide a sense of empowerment. “People start to feel hopeful and take on a role of self-management as opposed to waiting for a fix from the pain.”

Kirkman and Ruby now recognize that, “the pain is never going away,” as the program at Progressive Rehabilitation Associates has taught them. But they’ve learned how to cope. “Your life is not always about the chronic pain,” Ruby said. “You have to live on.”