CBT for Pain Management in Children:
A Brief Overview

CBT is short for cognitive-behavioral therapy. The goal is for you and your child to learn strategies to manage the physical and emotional symptoms interfering with life and increase functioning at home and school. The cognitive part means learning to use the thinking part of the brain to help cope with pain and any other stresses s/he may be experiencing. Identifying and changing unhelpful thought patterns into more balanced and helpful ones leads to better coping skills for pain, and for life in general. The behavior part means modifying activities to build up stamina and teaching relaxation and imagery to help counteract the physiological effect of pain on the body. Relaxation strategies are tools that can help decrease the body's sensitivity to pain and physical sensations. Your child will be able to help his/her body change its bad habit of responding to pain and start learning the good habit of responding to relaxing, good feelings.

In order to take what is learned in the office to the home/school environment, between-session "homework" is assigned, aimed at practicing the skills and strategies taught in session. Parents are involved at various times throughout the therapy sessions so they can support their child's recovery and improved coping skills. Generally, each meeting includes a brief check-in with the parents.

CBT for pain management lasts, on average, about 10 sessions, but can be shorter or longer, depending on the specific situation. The typical format and content for each session is listed below.

1. Initial assessment
   • Meet with the parents and child to gather background information and history
2. Relaxation and pain management strategies
   • Meet with your child individually to get to know each other better
   • Education about the condition and the factors that affect it
   • Education about CBT
   • Begin relaxation training with deep breathing
   • Talk with parents about strategies to help their child and reinforce skill-building
3. Relaxation and pain management strategies
   • Progressive muscle relaxation training
   • Identify behaviors that may exacerbate or improve condition
   • Talk with parents about strategies to help their child and reinforce skill-building
4. Relaxation, pain management strategies, and introduce CBT strategies
   • Imagery relaxation training
   • Introduce feelings identification
5. CBT strategies
   • Feelings identification & expression
   • Identifying thoughts
   • Reinforcing pain management skills
6. CBT strategies
   • Identifying helpful and unhelpful patterns of thinking
7. CBT strategies
   • Learning how to modify unhelpful thinking into more balanced thinking
8. CBT strategies
   • Review use of CBT and pain management strategies
   • Introduce additional coping strategies
9. Review and Relapse Prevention
10. Review and Relapse Prevention