MIRECC / CoE

Introduction

Sophie is a 28-year-old Veteran who started having neck pain about 5 years ago. She was in a car accident during active duty, though the pain was not bad at that time. Over the last few years, it's slowly gotten worse and affects her day-to-day life. She's no longer as active as she used to be and her sleep has been getting worse. The pain has also affected her mood — she's often on edge, which has hurt her relationship with her boyfriend. Sophie's doctor recommended CBT for Chronic Pain, an effective treatment he said could help improve her responses to pain and decrease the negative impact it has on her life. Although skeptical, Sophie was eager to regain control of her life, so she agreed to see a therapist to learn more.

Sessions 1-2 (Interview, Assessment, and Orientation to Treatment)

In looking at her life with her therapist (Julie), Sophie saw that pain was affecting the choices that she made every day. Instead of doing what she wanted, she was letting pain call the shots and suffering in many ways. Julie explained that there were many things that Sophie could do differently to give her back more control over her pain and her life. Sophie learned that pain is more than just physical, and is affected by our thoughts, emotions, and behaviors, which "turn up the volume" on chronic pain. Sophie liked the idea of learning how to take control of the dial.

Sessions 3-4 (Goals, Movement, Pacing)

Sophie and Julie discussed how avoiding activities to reduce her pain was understandable but actually was working against her. Sophie learned that avoiding activities and movement was weakening her muscles and lowering her energy level. Sophie and Julie developed a plan for Sophie to be more physically active, in a safe way. As part of this plan, Sophie would do enough every day to stay engaged and productive but not so much that she would have a pain flare.

Sessions 5-7 (Relaxation and Pleasant Activities)

Now that Sophie was having less physical ups and downs, Julie introduced ways for her to better control her body's physical responses to pain. She learned effective relaxation strategies to turn down her body's harm alarm. This helped to calm her nervous system and reduce her muscle tension. As a result, Sophie's neck pain and headaches felt better! Next, Sophie and Julie focused on finding more activities that she enjoyed to improve her mood. Since Sophie loved animals, she decided to volunteer at the local shelter. Working with the dogs and cats helped her as much as she helped them!

She even became good friends with a few of the other shelter volunteers. Having more to fill up her life, Sophie started to feel better and more confident.

Sessions 8-9 (Re-Thinking Pain)

Despite her progress, some days Sophie still had thoughts like, "My life is never going to be good with this pain." During the next couple of weeks, Julie helped her catch these unhelpful pain-related thoughts and see the impact they had on her mood (e.g., feeling down) and behaviors (e.g., staying at home alone). Sophie used tools Julie gave her to change these thoughts and take away their negative power. Yes, the pain would be there, but she would decide the effect it would have on her day.

Sessions 10-11 (Sleep and Discharge)

Sophie was now feeling like she had more control over her life, but she was still struggling with sleep. Most nights she tossed and turned awake and frustrated in bed, sleeping only about 4-5 hours per night. Sophie came to see that being sleepy during the day made her more sensitive to pain. Working with Julie, Sophie learned proven sleep skills that helped her sleep longer and better.

After 11 weeks in treatment, Sophie had made great progress. Although she still had pain, it no longer controlled her life. Sophie was more active, less irritable, sleeping better, and feeling less overwhelmed. Together with Julie, Sophie made a plan for how to use all of her new skills to minimize and manage setbacks in the future.

Session 12 (Booster Session)

Five weeks after treatment ended, Sophie checked back in with Julie. Sophie reported that she was doing much better than when she started treatment. She was exercising again, using relaxation as a way to calm her nervous system, and was hired part-time at the animal shelter. Sometimes old fears like, "My life will never be good," crept into her mind. Julie reminded her of other ways to look at pain. Sophie also reported having some pain flares when she "pushed through" to get her chores done. She and Julie revisited how pacing activities allowed her to do more in the long run, and they made a plan for how to pace more often. Sophie felt like she had come a long way and like she was in charge now, instead of the pain.