Before starting talking therapy at the pain clinic, you will have an assessment with our service. If your clinician thinks that this type of support might help, they will refer you directly.
Your first appointment is to talk about your main difficulties. Together, we’ll decide whether to continue working with our therapy team or suggest another service that may be more suitable for your mental health needs. Appointments usually last 50 minutes, and if helpful, we may offer up to 12 sessions.
CBT is a type of talking therapy that helps you understand how your thoughts, feelings, and actions are connected — and how they can affect your pain and fatigue. CBT has been shown to help people manage anxiety, depression, poor sleep, and the emotional effects of trauma, all of which can make pain and fatigue feel worse. Although it doesn’t offer a cure, it can help you build skills to manage your symptoms and move forwards in your life.
Living with pain and fatigue can feel like being stuck in a vicious cycle, where your thoughts, emotions and how you respond can start to maintain and even contribute to the problem. Making a change in one area affects all the other areas.
Working together with a therapist you can become aware of this process and build the skills you need to break in to the cycle, get unstuck, and feel better now and in the future. Together we’ll think about your current situation, identify the main difficulties you experience with pain and fatigue, and look at ways this could be different. We might also talk about your earlier life experiences and see how they affect what’s happening today.
CBT treatment focuses on you learning skills and making changes that really matter to you. We’ll talk about your values and set a goal. You will be encouraged to try out new ways of coping in-between sessions, and we can work through any barriers you face.
CBT helps you explore the thoughts and beliefs that come up automatically when you’re in pain. These thoughts can be powerful and upsetting, and they often bring fear or other difficult emotions. In your sessions, you’ll work with your therapist to notice these thoughts and try out new ways of thinking or responding.
Sometimes, the way we think or the “rules” we live by can get in the way of managing pain. These rules or beliefs may have been helpful in the past — for example, “If I work harder, I will succeed.” But when it comes to living with long-term pain, some of these beliefs can make things harder.
For example, you might notice you always put others first or push through activity and pay later with increased pain. These actions may be driven by beliefs that were formed from your earlier expereinces. They may be deeply held beliefs like “I’m not good enough” or “People will reject me.” These powerful beliefs can stop you from using helpful strategies like pacing your activity, taking breaks or other self care strategies — and can lead to cycles of overdoing things and crashing afterward.
CBT helps you spot these patterns and gently challenge them. By making your thinking and the rules you live by more flexible, you can feel more in control, manage pain more effectively, and live a fuller life.
We are all creatures of habit. We often do things without really thinking about them. That’s why considering our pain behaviour is a good place to begin. When we understand how our actions link to our thoughts, feelings, and how our body feels, we can make small changes that really help.
Setting goals gives you a focus and helps you see your progress. Goals can be short-term (like something you want to do today or this week) or longer-term (something you want to build up to over time). When you’re living with pain or fatigue, setting goals gives you a sense of moving forwards with pain and fatigue and can be motivating. Even if things don’t go exactly to plan, having a goal gives you something to work towards and adjust as needed.
To set a goal that matters to you, we’ll start by thinking about what’s important in your life — your values. These could be things like spending time with friends or family, staying active, looking after your health, or feeling part of a team at work or in education. Together, we’ll choose an area to focus on and create a plan. Big goals can be broken down into small, achievable steps. We’ll review your progress, make changes if needed, and keep a record to help you stay motivated and spot any challenges early on.
Find your why: Values based living
Looking after your body is an important part of CBT for pain and fatigue. It can help to learn soothing strategies, like breathing techniques, grounding skills, or using your senses to feel more settled and safe.
Your brain listens to signals from your body. When you push too hard or force yourself to keep going, your body may feel unsafe—even if you don’t notice it right away. This can make pain and fatigue worse over time.
Instead, learning to pace your activity, change posture, and move your body gently can help. Gently building up strength, fitness and flexibility over time can also improve your symptoms and support your overall wellbeing.
Cognitive Behavioural Therapy (CBT) is at the core of many psychological appraoches. In the pain clinic, we use a flexible approach. This means we can also include other therapies that have been shown to help with pain and fatigue. Your therapist will talk to you about what might work best for you.
See below for a short summary of some of the other approaches we use, including Acceptance and Commitment Therapy, Compassion Focused Therapy, EMDR, and DNA-V:
In an assessment appointment we can discuss your specific issues and agree together if there is anything you’d like support with. We can also discuss approaches, and what working together will involve before you agree to talking therapy sessions.
Cognitive Behavioural Therapists and Psychologists work with people with long term pain and fatigue. Training in Psychological therapy means studying at post graduate level and being assessed over many clinical hours. Cognitive Behavioural Therapists and Psychologists need to maintain registration and have regular supervision to uphold high standards of care. They may be trained in a range of psychological models which have strong research evidence to support their use in long term health conditions.
We work with people 1:1 providing a more tailored approach and also work in the group programmes for pain and fatigue, teaching skills that can improve life, and address common barriers along the way.
We’ll meet initially and talk about your issues, and if we agree to work together, then sessions are usually offered fortnightly, either in person, by video, or telephone. We usually book a few sessions at a time, and you can expect between 6-12 sessions of 50 minutes each.
Each session we will set an agenda, talk about your experience between sessions and agree some things for you to work on before the next session. You may wish to keep notes, record activity, thoughts, or emotions so a notebook is useful. There may be some education as part of sessions. There will be skills to learn too, so you’ll need to find time to practice these.
We can work with you in the service if you are struggling to cope with the impact of pain or fatigue in your life, and are not accessing talking therapy under other services.
We have a focus on pain and fatigue related issues, and if we feel that your issues fall outside of this we can signpost you or refer you to a different specialist service.
You will need to consider if this is the right time to have some therapy. Do you have time to commit to this? Is it a current priority? Be honest with yourself and your therapist, ask questions, commit to attend, and complete homework, try and keep an open mind, and tell your therapist if you are finding it too challenging.
Therapy can be hard initially, and you need to think about whether it is the right time for you. If we pace the work well and you are honest about the challenges you’re facing, we can make changes, even small ones that can help. You should start to feel the benefits quickly too as we balance dealing with difficulty with building resilience skills and soothing strategies.
Having talking therapy will not impact upon other treatments you may be accessing within the pathway.
We will begin to space appointments out towards the end of therapy, to help you feel more confident in your new skills, and during sessions we will plan for how you are feeling when therapy ends.
You will continue to have an open appointment with the service.
Its common to feel very low at times when you live with long term health condition. We are not able to offer crisis support so here are some good contacts if your mood begins to deteriorate.
GP, or mental health team
NHS 111 Option 2 for Crisis Team, or 0808 196 3779
Check your mental health symptoms – NHS 111
Samaritans 116 123
NottAlone website will offer mental health signposting for people of all ages across Nottingham and Nottinghamshire https://nottalone.org.uk
Nottinghamshire Crisis Sanctuaries for crisis support 0330 822 4100 or by texting SHOUT to 85258
If you feel unsafe call 999, or attend ED
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