| Abstract | Background
Chronic Pain is a debilitating condition affecting billions worldwide with devastating consequences for the individual with chronic pain and those around them. Chronic Pain can be experienced as part of an underlying condition such as cancer (chronic secondary pain) or as ‘a disease’ in its own right (chronic primary pain). With chronic pain being a dynamic interplay between biological, social, and psychological factors, it is imperative for psychological treatments to be adequate in meeting the psychological needs of individuals with chronic pain. To date, Cognitive Behavioural Therapy (CBT) is the most commonly offered form of psychological therapy for chronic pain. This thesis sought to investigate how CBT interventions making up CBT treatment packages for chronic pain were experienced by participants with chronic primary pain conditions.
Method
An Interpretative Phenomenological Analytical approach was chosen as the most suitable theoretical framework aligned to the aims of this thesis. Seven participants who were living with chronic primary pain conditions based on the ICD-11 classifications and had received CBT treatment for chronic pain were recruited for participation. Through semi-structured interviews, participants shared their experiences of each CBT intervention making up their course of treatment. In keeping with IPA methodology, a case-by-case idiographic analysis was conducted followed by cross cases analysis.
Findings
Five CBT interventions for chronic pain were identified within the data set. Participants shared their experiences of 1) Behavioural Activation, also known as activity scheduling, 2) Problem Solving, 3) Graded Exposure, 4) Thought Challenging and 5) Pacing. Five Group Experiential Themes (GETs) representing participants’ subjective experiences of these CBT interventions were developed. The first, ‘Regained Autonomy’ highlighted positive gains attributed to the CBT interventions graded exposure, problem solving and behavioural activation by participants. These gains include improvements to sense of agency, power of choice and independence. The second, ‘A changed Pain Mindset’ described participants’ experiences of thought challenging whilst the third GET, ‘The Pain in Pacing’ highlighted cognitive and emotional barriers to pacing as reported by participants. The fourth GET, ‘Indirect Interventions’ presented factors (therapist style and the support of loved ones) participants reported to have contributed to their experience of CBT interventions whilst the fifth GET, ‘CBT did not cure my Pain’ addressed participants’ views on labelling CBT as a treatment for chronic primary pain.
Conclusions
The results provide insights into how specific cognitive behavioural interventions are experienced by patients with chronic primary pain and why they were experienced in that manner. Participants’ experiences of CBT interventions highlighted an interplay between the meaning assigned to the doing encompassing each intervention and the personal fight to preserve self-identity not just pain. Participants favoured CBT interventions with procedures that were additive to their behavioural repertoire, with such interventions being experienced as allies in their fight to reclaim their self-identity. These insights are useful in both research and clinical spheres with the potential to improve patient clinical outcomes. |
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