Chronic pain: A reformulation of the cognitive-behavioural model
Abstract
The last few decades has seen psychological theories of chronic pain dominated by behavioural concepts and particularly, by the operant model as described by Fordyce et al. (1968: Fordyce, W., Fowler, R., & DeLateur, B. (1968) An application of behavior modification technique to a problem of chronic pain. Behaviour Research and Therapy, 6, 105-107, 1976: Fordyce, W.E. (1976) Behavioral methods for chronic pain and illness. St Louis, MO: C. V Moseby). More recently, cognitive constructs have been included, giving the impression that the operant theory of chronic pain has been replaced by a cognitive-behavioural theory (CBT). Given the fact that CBTs were introduced essentially to overcome some inherent problems with operant theory, it is notable that they are still very much based on operant theory and continue to be founded upon operant principles. Further, the extent to which CBTs (at this stage) have included contemporary cognitive research has been limited. This paper argues that it is of questionable validity to continue to include problematic concepts (e.g., operant principles) into a revised theory (e.g., CBT). Instead, consistent with research from other areas (particularly the anxiety disorders), chronic pain and the problems associated with it may be better explained by a reformulated cognitive-behavioural theory which although not ignoring the observable behaviours of pain patients and their associations with social reinforcers, interprets these phenomena from a cognitive perspective. Thus, a modified CBT is proffered, focusing more directly on patients' thoughts about, and appraisals of, their pain. Evidence in support of such a theory is provided, as are suggestions for further research and the implications such a theory has for treatment.
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Part of the problem with chronic pain patients arises from how they react to their pain.
“Part of the problem with chronic pain patients arises from how they react to their pain [11].”
From Behavior Modification Techniques on Patients with Chronic Pain in the Context of COVID-19 Telerehabilitation: An Umbrella Review (2022) · cites this paper as [11]
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- Authors
- Sharp, T. J.
- Corresponding author
- Sharp, Timothy J
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2001-07
- Volume
- 39
- Issue
- 7
- Pages
- 787-800
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W1994874583
- Cited by
- 356
- References
- 105
- Citations by year
- 2025: 4 · 2024: 5 · 2023: 5 · 2022: 12 · 2021: 3 · 2020: 10 · 2019: 16 · 2018: 14 · 2017: 13 · 2016: 19 · 2015: 35 · 2014: 23 · 2013: 12 · 2012: 11
- FWCI
- 11.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- chronic pain, cognitive-behavioral model, cognitive behavioral therapy, pain appraisal, social reinforcement, pain management
- MeSH terms
- Chronic Disease, Humans, Models, Psychological, Pain, Cognitive Science
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