Types of psychological therapy

What is Pain Psychology?

Living with long-term pain can be very difficult and have a significant impact on your emotional wellbeing. Science and research suggest that emotions and physical pain are closely linked and can influence one another. For example, persistent pain can lead to problems with emotional wellbeing, which can influence your ability to manage persistent pain.

Pain psychology cannot make your pain go away, but it can increase your understanding of the relationship between pain and mood. We aim to help you develop tools to manage difficult thoughts and feelings which you might experience when living with pain, and explore how you respond to the pain. We encourage you to work towards doing things which are important to you in life, alongside pain.

We know that people living with pain can sometimes experience emotions such as anxiety, low mood, frustration, anger, and guilt. We also know that sometimes our pain and emotions can be linked to difficult events which have happened in the past. We draw upon different therapy approaches which are tailored to your personal experience and circumstances. However, the two main approaches are:

• Acceptance and Commitment Therapy (ACT), and
• Trauma focused therapies including Eye Movement Desensitisation and Reprocessing (EMDR), Trauma Focused Cognitive Behavioural Therapy (TF-CBT) and Trauma-Focused ACT (TF-ACT).

Acceptance and Commitment Therapy (ACT)

ACT (pronounced as the word ‘act’) gets its name from one of its core messages: to develop ways to accept what is out of your personal control, while committing to take action that will improve your quality of life.

ACT takes the view that most psychological suffering is caused by avoidance, i.e. by attempting to avoid, escape, or get rid of unwanted internal experiences (such as unpleasant thoughts, feelings, sensations, urges and memories).

Our efforts to avoid might work in the short term, but not in the longer term, and in the process, they create more distress and take us further away from living life as we would like.

ACT helps people to change their relationship with painful thoughts and feelings (emotions and physical sensations) to develop awareness of their experiences and to live in the present, and take action, guided by what is important to them, to create a rich and meaningful life.

ACT does this by:

• Teaching psychological skills, such as present moment awareness skills, to deal with your painful thoughts and feelings in ways so they have much less impact and influence over you.
• Helping to clarify what is truly important and meaningful to you, i.e. your values, to guide and motivate you to take action that helps change your life for the better.

• It can also help you engage more fully in other pain management strategies, such as pacing and activity management.

Acceptance is not the same as giving up or losing hope, but making a decision to engage fully with life, including the pain and suffering that comes alongside it.

Research suggests that ACT is a helpful treatment in pain management. ACT is recommended by NICE (2021) as a treatment for persistent pain, to help improve quality of life and address pain related distress. We offer ACT on a 1:1 basis and in group formats, as a standalone therapy group.

Trauma Focused Therapies

We recognise that sometimes pain and the difficult thoughts and feelings that come with it can be related to very stressful, frightening, or distressing events from the past (trauma). We may be able to offer trauma-focussed therapy to individuals where there is a clear link between trauma and their pain. If you have experienced traumatic events in the past, and they are not directly related to your pain, we may recommend referral to other local services who also offer trauma focused therapy as the most appropriate treatment pathway. The main approaches we use for trauma are EMDR, TF-CBT and TF-ACT (ACT treatment as described above can also be adapted to include a trauma focus should this be indicated).

Sometimes when we experience a trauma we can feel overwhelmed with different emotions. This means the memory isn’t processed in the usual way, which can leave us with difficult emotions, thoughts and body sensations that reoccur regularly and interfere with living our daily lives. This can impact our ability to manage pain.

Trauma focused therapies involve recalling the traumatic incident in a safe environment with your therapist, having first built some skills to manage emotional distress. During EMDR whilst you recall, you might be asked to make side-to-side eye movements, or your therapist might use a device such as moving lights or alternating sounds or handheld buzzers. It is thought these side-to-side movements help to process the memory and reduce the intensity of the emotions associated with it, so it does not interfere so much with daily life. In TF-CBT the focus will also be on reprocessing the memories, along with working with the meaning of the event for you and helping you to reappraise the beliefs about yourself, others and your pain which may have arisen from the traumatic event.

Research suggests that EMDR and TF-CBT can be a helpful treatment for trauma related to pain. Both EMDR and TF-CBT are recommended by NICE (2018) in the treatment of PTSD in Adults. We offer trauma focused therapies on a 1:1 basis.