iCBT Program for Chronic Pain

Module 2. Pain

Pain is subjective. That means everyone experiences it differently.

Over the course of this module, you will learn to understand the connection between your mind and your physical pain.

Mind and body connection

The connection between the mind and the body is related to how our thoughts can affect our behaviours.

Your thoughts control how you act every day. For example, the more negative your thoughts are, the more isolated your behaviours will be.

man is meditating

Pain and the relationship to CBT

When a person experiences pain, they will have an emotional response to it, and will experience certain thoughts and/or images during or immediately following the pain.

Similarly, thoughts and emotions that are activated in the brain may also affect pain. In other words, our thoughts, memories, and emotions can influence the physiological experience of pain.

CBT addresses the importance of realistic (healthy) beliefs, attitudes, and behaviours in reducing the emotional and physical suffering associated with pain.

CBT is geared toward identifying any emotional, cognitive, behavioural, physiological, and/or environmental (e.g., family, social, cultural, and societal) difficulties that might be influencing the experience of pain.

Although it is rare for clients to become pain-free, CBT teaches people how to reduce their pain, how to be less affected by pain, and how to enhance life functioning.

CBT is an effective form of treatment for people who suffer from chronic pain.

There is firm evidence that demonstrates that CBT is effective in reducing pain levels, the use of pain medications, negative thoughts, and extent of physical disability.

CBT can also enhance one’s pain control, emotions, physical functioning, overall health, and relationships with others.

The cognitive-behavioural approach has a positive effect when combined with active treatments such as medications, physical therapy, and other medical treatments for chronic pain patients in treating pain, thoughts about pain, and pain behaviour problems.


George, a chronic pain patient, experiences burning and numbing sensations in his lower back. He feels frustrated, and sad, and thinks: “This pain is horrible. I cannot handle it. This is so unbearable. I cannot go on like this.” Next, he imagines the pain taking over his whole body. His pain worsens. He becomes even more absorbed in his pain, frustration, and sadness. He decides to go back to sleep to escape from this pain.


Why is George feeling horrible? This isn’t simply because he is experiencing severe pain.

Write down on a piece of paper why you believe George’s pain is worse than it should be.

George is feeling horrible because of what he is telling himself about the pain—in other words, the meaning he has given his pain. He has told himself his pain is “uncontrollable” and “unmanageable.” He thinks of himself as a victim—powerless to control or stop his pain. His negative thoughts start taking on a life of their own.

Homework for Module 2

Pain Diary

Click here to download the Pain Diary

Please, print and complete the pain diary for 7 days as shown below:
T : Time you experienced the pain
P : Pain area on your body
A : Activity
T : 10:30am
P : Left shoulder
A : Brushing my teeth

Use what you have learned this week to control your negative thoughts while recalling your pain levels.

Exercises for Different Areas of Pain from Wilderman Medical Clinic

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