CBT for chronic pain, chronic low back pain, chronic headache, IBS and tinnitus

Domain II · Behavioural & cognitive · Fordyce, Turk, Meichenbaum · 1970

What it is

This is a family of protocols, not one therapy. They share one learning model and one toolkit, then add condition-specific modules. Two roots: Fordyce's operant approach (1970s), which treats pain behaviour as shaped by its consequences and rebuilds activity on time rather than pain, and the…

Format

• Core protocol: VA CBT-CP (individual, about 50 to 60 min, weekly)
• The manual's Part 1 places relaxation in sessions 5 and 6, but its contents list puts pleasant activities at 6. Follow the contents list and extend relaxation if needed.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Analysis without a concrete plan at the end.
• Device dependence. Fade the feedback over time.
• Long time in bed "resting" the pain, which fragments sleep.
• Statements the patient doesn't believe. Rewrite them until they do.
• Treating the first setback as failure. Pre-name setbacks as expected.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.