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

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

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.

The second level, mindset, is much deeper. Changing your mindset requires literally rewiring your brain - 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 CBT 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 - 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: Mindfulness-based stress reduction (MBSR), Acceptance and Commitment Therapy (ACT), and Compassion-focused Therapy (CFT).

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

Sword’s Strong Mind, Stronger Body Program

At Sword, we’re committed to giving our members comprehensive, clinical-grade care for their MSK conditions, and this means treating the mind as well as the body. To help our members strengthen their mental muscles, we’ve developed the Strong Mind, Stronger body program, a first of its kind structured CBT program that is offered to all our members as part of our holistic MSK care programs. This is an 8-week program designed by psychiatrists and psychologists specializing in CBT, which includes elements from all three techniques described above (MBSR, ACT and CFT), specifically formulated to address chronic MSK pain.

Through this 8-week program, members learn strategies and practices that will change the way they perceive pain, help them create new habits, and show them how to focus on what matters most in their lives. The program includes a series of short mindfulness meditations to help them connect with their emotions, thoughts and sensations, as well as exercises that help them live in and appreciate the moment.

To find out more about how Sword is helping thousands of members overcome chronic pain and live happier, healthier lives, contact us today.

About the author: Dr. Fernando Correia, M.D.

Dr. Fernando Correia is the Chief Medical Officer at Sword Health, where he leads clinical validation and medical affairs. He is a physician with a specialty in Neurology, and also holds an Executive Masters degree in Healthcare Management.

He co-founded Sword with the firm belief that technology can lead healthcare into a new era, one where high-quality, evidence-based medicine is available to everyone, not just a select few. He also believes that a more humanistic approach to healthcare is needed, and that technology and the human touch can go hand in hand and make each other better.

Fernando received his M.D. from the University of Coimbra and his Executive Masters from Católica Porto Business School. He trained in Portugal and in the UK (National Hospital for Neurology and Neurosurgery and Great Ormond Street Hospital for Children). He lives in Porto, Portugal with his family, where he enjoys playing tennis, reading all kinds of books and savoring a good glass of wine.