Our thoughts, feelings, actions and physical sensations are all quite intimately linked. In terms of chronic pain, it is common for depression, anxiety and/or fear of movement to correlate with pain; these psychological symptoms can: 1) exacerbate pain on a biochemical level, as the brain uses the same neurotransmitters and regions to process both stimuli; and 2) influence a person’s behavior in negative ways, such as encouraging avoidance of pain through a reduction in physical activity, which can lead to overall poorer health and make pain worse.
In cognitive behavioral therapy, patients work with a therapist to identify negative automatic thought patterns about their pain. This allows them to interrupt them and replace them with more positive, accurate and constructive cognitions (thoughts, feelings and judgments). Improved mental and physical health are likely results of this practice, and research has time and again attested to the effectiveness of CBT in helping patients manage their chronic pain conditions.
Less but increasingly studied in this vein are internet CBT programs; this option is ideal for patients who can’t access in-person therapy – so long as it is effective. Though the body of research into internet CBT is comparatively small, it is promising.
Perhaps the largest body of research is a meta-analysis in which researchers assessed results from 23 different trials into internet-based CBT. Overall, results were promising; improvements in both physical and mental well-being were seen, with the former being more significant. They found that more notable improvements for depression were observed when therapy was extended beyond six weeks (CBT is a short-course treatment, usually taking between six weeks and six months).
See more on the meta-analysis at www.jmir.org.
Two more recent studies also support the potential of online CBT for pain patients. In one, researchers compared the effects of in-person group CBT to individualized online therapy. At follow-up, participants in internet therapy had superior outcomes in coping, pain intensity, catastrophizing and some quality of life scores. Also, internet therapy was more cost-effective.
See more on this study at www.ncbi.nlm.nih.gov.
Finally, another small study of 52 patients compared the impacts of an individualized online CBT program on patients with those of a moderated online forum. Reductions in depression, anxiety and catastrophizing were all superior in the CBT group. Significantly, the researchers noted that these improvements were maintained at one year, suggesting potential long-term results from this short-term therapy.
See more on this last study at www.ncbi.nlm.nih.gov.
We can’t know for sure how internet-based CBT stacks up against individualized in-person treatment. However, for those who can’t access or afford the in-person variety, they may find it worthwhile to take the online route. One potential source is www.online-therapy.com, where patients can receive eight weeks of individualized treatment for $249, a price tag that pales in comparison to the cost of medications and co-pays.