Explained: The role of cognitive behavioral therapy in MSK care

If you’ve been following our posts, you’ll have learned that mental and physical health are inseparable, and that the brain is just as involved in physical pain as the body is. We’ve explored the causal links between pain, depression and anxiety, and we’ve discussed the impact of fear on your ability to heal.

That’s why in order to be truly effective, musculoskeletal (MSK) treatments need to address both body and mind.

At Sword, our holistic program combines therapeutic exercise to strengthen the body, with education and behavioral coaching to strengthen the mind.

They work together to help release members from the grip of pain. One of these tools is an 8-week Cognitive Behavioral Therapy (CBT) program called Strong Mind, Stronger Body.

Today, I’ll explain how CBT works and why it’s so effective for pain.

Change your brain, change your pain

“After 7 weeks, I feel like a new man.” Arthur, Sword member.

Many of our members say they feel changed after completing their Sword program. Physically, members regain their strength and mobility, and they’re able to do things they haven’t done in years. Mentally, their attitude towards pain and their body is different.

These transformations might seem fast, but they’re the result of many small, incremental changes. If you’ve ever lifted weights, you’ll know that if you start small and increase your weight gradually over time, you’ll end up lifting more than you ever thought possible. The same thing goes for the brain. Lots of small mental exercises can add up to big impact when applied consistently over time.

The first step is education - understanding what’s going on with your body. This is a vital step in the process, and is often more about understanding what’s not wrong with you than understanding what is.

Knowledge is important, but it’s only as good as your ability to act on it. There is often a disconnection between what we know we should do and what we actually do (believe me, I know this: I’m incapable of resisting chocolate). This is where behavior change comes in.

The two levels of behavior change needed for MSK care

In MSK care, behavioral changes need to happen on two levels: lifestyle and mindset.

Lifestyle changes build healthy habits

Let’s start with lifestyle. Our bodies were designed to be in constant motion, in all directions.

Today, we spend too much time sitting and making repetitive movements, and it’s causing our bodies and brains to short-circuit. Incorporating more movement into our daily life can be transformational, and it starts with tiny tweaks. As our PTs say, motion is lotion. Adding a variety of different movements into your day can be a balm for pain.

Our PTs give members tips and reminders to help them make movement a regular habit, and they progressively increase the difficulty and complexity of exercise programs as their members get stronger and more limber.

Developing a positive mindset helps to reduce pain

The second level, mindset, is much deeper. Changing your mindset requires literally rewiring your brain by making and strengthening new, healthier connections. Mindset shifts can take a variety of forms, from ‘I have a bad back’ (self-judgement) to ‘My back hurts, and I can manage it’ (self-acceptance).

One of the most common mindset shifts involved in pain management is the fear avoidance cycle. As we’ve learned, it’s common for us to want to avoid doing things that hurt.

The problem is, the more you avoid pain, the weaker your body becomes, and the more it’ll hurt. The first step to breaking this cycle is understanding what’s causing the pain and why you’re avoiding it. But knowledge alone won’t break the cycle.

You need to take that leap and start putting your body - safely - into the positions that cause pain. Easy, right?

How Cognitive Behavioral Therapy changes the brain

Cognitive Behavioral Therapy was specifically designed to help change the brain. At its core, CBT is based on a set of practices that teach you the mental tools you need to break the cycle and conquer pain. CBT has been around since the 1950s, and since then it’s gone through three generations of approaches.

The first and second generation programs were focused mostly on thoughts and re-training the person to change the way they think about their condition by substituting negative thoughts for positive ones. However, it soon became apparent that avoiding bad thoughts didn’t deliver sustained outcomes.

The third generation of CBT takes a different approach, one that’s centered around acceptance rather than avoidance.

There is a whole family of third-generation CBT techniques, and three of them are especially useful for chronic pain.

3 effective CBT techniques

These three techniques work together to help people rewire their pain brain, step by step.

1. Mindfulness-based stress reduction (MBSR): MBSR combines mindfulness meditation, body awareness, yoga and with an exploration of thoughts, feelings and behaviors. Over time, people learn to live in the present moment without judgement, and train themselves to observe their pain and other sensations as they rise, peak, and dissipate.
2. Acceptance and Commitment Therapy (ACT): ACT uses acceptance to build the psychological flexibility needed to improve function. By simply accepting that their pain is there and not judging it, they can move past it.
3. Compassion-focused Therapy (CFT): CFT uses compassionate mind training to help people develop and work with experiences of inner warmth, safeness and soothing, via compassion and self-compassion.

These therapeutic techniques have been proven to reduce depression and anxiety in multiple chronic pain conditions, and have been recommended by the CDC due to their ability to manage pain and improve function.

But healing the mind is only part of the equation. To unlock real, lasting relief, mental and physical health must work together.

The mind-body connection is movement-powered

Research shows that physical activity doesn’t just build strength and flexibility. It also reduces symptoms of depression and anxiety (in many cases, as effectively as medication). Movement enhances circulation, balances neurochemicals, and helps regulate the nervous system. When we move, we feel better, both mentally and physically.

At Sword, we recognize this powerful connection. That’s why we built Move, our full-body solution designed to help people increase physical activity, reduce sedentary behavior, and improve mental wellbeing. Sword Move combines data from wearable devices with the expertise of a dedicated Physical Health Specialist to deliver personalized movement plans.

What is Move?

Move is a digital, sensor-enabled program that helps members develop healthy movement habits for life. It combines weekly activity plans, real-time feedback through the Move Wearable, and expert guidance from certified Physical Health Specialists (each holds a Doctor of Physical Therapy). All care plans are delivered digitally with the help of smart AI technology through the Move app, so member can access and complete their exercises wherever and whenever they want.

• Each member receives a Move Kit that includes wearable technology and resistance bands.
• The Move Wearable tracks physical activity, sleep, heart rate, and more
• Weekly Move Plans outline classes and step goals customized to the individual’s needs.

Move is more than a fitness tracker. It's a clinical tool grounded in behavior change science. Members complete weekly assessments that monitor both physical and mental wellbeing, ensuring progress is measured, keeping accountability on progress and increasing engagement rates.

This regular physical activity develops positive movement habits, which as we know, helps people improve their mental health in the process.

Why Move improves both physical and mental health

The science behind Move is clear and the program delivers clinically-validated proven results:

• 74 percent of Move members report improved overall health quality
• 49 percent show reduced propensity for developing anxiety disorder

By combining personalized support, real-time feedback, and achievable daily activity goals, Move helps members consistently show up for their health, both physically and mentally.

Move provides a powerful complement to any mental health treatment. CBT builds psychological resilience, while Move creates the physiological foundation for emotional regulation. Together, they work to:

• Interrupt the pain-anxiety cycle
• Improve confidence and self-efficacy
• Build routines that support long-term recovery

And because members can access Sword Move from the comfort of their home without the barriers of traditional care models, there are no waiting rooms, no in-person conversations required, and no restrictions on access.

Move your body. Calm your mind.

Chronic pain is complex. Recovery shouldn’t be.

By addressing both the mental and physical drivers of MSK conditions, Sword empowers members to take back control of their health and their lives. Whether it’s strengthening the body, shifting the mindset, or creating sustainable habits, our holistic approach helps people move forward with less pain and more confidence.