Chronic pain is a prevalent and complex condition affecting millions worldwide. Defined as pain lasting more than three months, it often persists beyond the usual course of an acute illness or injury. The experience of chronic pain is not only physical but also deeply intertwined with our thoughts and beliefs. Understanding the cognitive aspect of chronic pain can provide valuable insights into managing and alleviating its impact on daily life.
What Is Chronic Pain?
Chronic pain is a persistent pain that can stem from various sources, including arthritis, back problems, neuropathy, and other medical conditions. Unlike acute pain, which serves as a warning signal for injury or illness, chronic pain persists over time and can exist without a clear underlying cause. It can lead to significant physical limitations, emotional distress, and reduced quality of life.
How Common Is Chronic Pain and What Are Its Consequences?
Chronic pain is a widespread issue, affecting approximately 20% of adults globally. Its consequences extend beyond the physical symptoms, often leading to psychological issues such as anxiety, depression, and sleep disturbances. People with chronic pain may also experience social isolation, relationship problems, and difficulty maintaining employment.
How Do Cognitive Beliefs Influence Chronic Pain?
The cognitive model of chronic pain emphasizes that our beliefs and thoughts about pain significantly influence our emotional and physical experience of it. Here are three common maladaptive beliefs related to chronic pain and how they can exacerbate the condition:
1. The Importance of Pain
Maladaptive Belief: “Pain is a sign of severe damage, and I must avoid all activities that cause pain.”
Adaptive Belief: “Pain doesn’t always mean damage. I can gradually increase my activity level and still be safe.”
Behavioral Change: People who believe pain is catastrophic may avoid physical activity, leading to muscle deconditioning and increased pain. In contrast, those who view pain as manageable are more likely to stay active, which can improve physical function and reduce pain.
2. Worrying About Pain
Maladaptive Belief: “I am constantly worried that my pain will get worse and never go away.”
Adaptive Belief: “I can learn strategies to manage my pain and reduce its impact on my life.”
Behavioral Change: Chronic worry about pain can lead to heightened stress and anxiety, worsening the perception of pain. Adopting a problem-solving mindset can empower individuals to seek out effective pain management techniques, reducing their overall stress and improving pain outcomes.
3. Pain and Shame
Maladaptive Belief: “I feel ashamed because of my pain; it makes me weak and less capable.”
Adaptive Belief: “Experiencing pain doesn’t define my worth or capabilities. I am still a strong and capable person.”
Behavioral Change: Feelings of shame can lead to social withdrawal and a reluctance to seek help, perpetuating isolation and suffering. Recognizing that pain does not diminish one’s value can encourage individuals to connect with others and seek appropriate support.
Case Example: Jane’s Journey with Chronic Pain
Jane, a 45-year-old accountant, developed chronic back pain following a car accident. She believed that her pain signaled severe damage and avoided physical activities, fearing further injury. Her belief that the pain would never improve led to constant worry, and she felt ashamed, perceiving herself as weak.
Through cognitive behavioral therapy (CBT), Jane began to challenge these maladaptive beliefs. She learned that pain does not necessarily mean damage and started engaging in gentle exercises. By focusing on problem-solving rather than worry, she explored different pain management strategies, such as mindfulness and physical therapy. Over time, Jane recognized that her pain did not define her worth, allowing her to reconnect with friends and family.
How Can Adaptive Thinking Help?
Adopting adaptive beliefs can transform the experience of chronic pain:
Maladaptive Belief: “My pain is unbearable and will never get better.”
Adaptive Belief: “I can find ways to manage my pain and improve my quality of life.”
Maladaptive Belief: “Avoiding all activities is the only way to prevent pain.”
Adaptive Belief: “Gradual activity can help me stay strong and manage my pain better.”
Maladaptive Belief: “I am alone in my suffering.”
Adaptive Belief: “Many people experience chronic pain, and I can find support and understanding.”
Conclusion
Understanding and addressing the cognitive aspects of chronic pain can significantly impact an individual’s experience and management of their condition. By challenging maladaptive beliefs and adopting adaptive ones, individuals can break the cycle of pain and distress, leading to improved physical and emotional well-being. If you or someone you know is struggling with chronic pain, consider exploring cognitive behavioral therapy as a valuable tool for managing pain and enhancing quality of life.
Chronic Pain and Cognitive Beliefs Quiz
Chronic Pain and Cognitive Beliefs: Test Your Knowledge
What percentage of adults globally are affected by chronic pain?
How can maladaptive beliefs about pain affect physical activity?
What is a key benefit of adopting adaptive beliefs about chronic pain?
Pain disorders, often classified under chronic pain syndromes, involve persistent pain that goes beyond the typical healing time of an injury or illness. This pain can affect any part of the body and may not have a clear physical cause. Common types include fibromyalgia, chronic back pain, and tension headaches. Pain disorders can severely impact a person’s quality of life, affecting their physical, emotional, and social well-being.
How Common Are Pain Disorders and What Are Their Consequences?
Chronic pain affects approximately 20% of adults worldwide. The consequences of living with chronic pain are extensive. Physically, it can lead to decreased mobility, muscle atrophy, and additional health problems. Psychologically, it often results in anxiety, depression, and a reduced ability to participate in everyday activities. Socially, individuals may withdraw from social interactions, leading to isolation and strained relationships.
How Do Pain Disorders Relate to Cognitive Models?
From a cognitive perspective, the way individuals think about their pain significantly influences their emotional and physical experiences. The cognitive model posits that maladaptive beliefs about pain can exacerbate the suffering and disability associated with pain disorders. Conversely, adopting adaptive beliefs can mitigate the psychological impact and improve functioning.
How Do Beliefs Influence Emotions and Behaviors in Pain Disorders?
Maladaptive Beliefs
Catastrophizing: “This pain will ruin my life.”
Leads to feelings of hopelessness and increased perception of pain.
Example Behavior: Avoiding physical activities, leading to further physical decline.
Overgeneralization: “Because I have pain now, I will always have pain.”
Results in chronic anxiety and fear of future pain.
Example Behavior: Avoiding social activities, resulting in isolation.
Low Self-Efficacy: “I can’t cope with this pain.”
Causes feelings of helplessness and dependence on others.
Example Behavior: Reliance on pain medications, which may lead to addiction.
Adaptive Beliefs
Pain Acceptance: “I can live a meaningful life despite the pain.”
Promotes resilience and emotional stability.
Example Behavior: Engaging in enjoyable activities, enhancing quality of life.
Mindfulness: “I can observe my pain without judging it.”
Reduces stress and emotional reactivity to pain.
Example Behavior: Practicing meditation, leading to reduced pain perception.
Self-Efficacy: “I have the skills to manage my pain.”
Increases confidence and proactive coping strategies.
Example Behavior: Implementing physical therapy exercises, improving mobility.
Case Example: Jane’s Journey with Chronic Pain
Jane, a 45-year-old woman, developed chronic back pain after a car accident. Initially, she believed, “This pain will never go away,” leading to feelings of despair and frequent days spent in bed. Over time, her social life dwindled, and she became increasingly isolated.
Upon beginning cognitive-behavioral therapy (CBT), Jane worked on changing her maladaptive beliefs. She started to adopt the belief, “I can find ways to manage my pain and still enjoy life.” With this new mindset, Jane began to engage in light physical activity and resumed hobbies she loved, such as painting. Gradually, her emotional well-being improved, and her perception of pain decreased. Jane’s story illustrates how shifting from maladaptive to adaptive beliefs can positively impact both emotional and physical health.
Questions to Guide Your Cognitive Approach to Pain
What thoughts do I have about my pain? Identifying automatic thoughts about pain can help you recognize maladaptive patterns.
How do these thoughts make me feel? Understanding the emotional impact of your thoughts can reveal how they influence your pain experience.
What alternative thoughts can I adopt? Challenging maladaptive beliefs and replacing them with adaptive ones can lead to healthier emotional and physical outcomes.
Conclusion
Pain disorders are complex and multifaceted, involving both physical and psychological components. By understanding and modifying the cognitive patterns that contribute to the experience of pain, individuals can improve their emotional well-being and overall quality of life. Cognitive-behavioral strategies offer a powerful tool for managing chronic pain and fostering resilience, leading to a more fulfilling and active life despite the presence of pain.
Pain Disorders Quiz
Pain Disorders: Test Your Knowledge
Which of the following is NOT a common type of pain disorder?
Which cognitive strategy can help reduce stress and emotional reactivity to pain?
Which maladaptive belief is characterized by the thought “This pain will ruin my life”?
Chronic pain is a debilitating condition that affects millions of people worldwide, significantly impacting their quality of life. It can lead to physical limitations, emotional distress, and social isolation. While there are various approaches to managing chronic pain, Cognitive Behavioral Therapy (CBT) has emerged as an effective treatment option. CBT focuses on the relationship between thoughts, feelings, and behaviors, and how they contribute to the experience of pain.
In this article, we’ll explore how certain maladaptive thinking patterns can hinder pain management and coping. By understanding these patterns and learning how to address them through CBT techniques, individuals can improve their ability to manage chronic pain and enhance their overall well-being.
The Connection Between Thoughts and Pain
Our thoughts have a powerful influence on our perception of pain. When we engage in negative or maladaptive thinking patterns, we may inadvertently amplify our pain experience and limit our ability to cope effectively. These patterns can lead to increased emotional distress, reduced activity levels, and a sense of helplessness.
It’s important to recognize that while pain itself is a very real and challenging experience, our thoughts about pain can significantly shape our overall experience. By learning to identify and modify maladaptive thinking patterns, we can develop a more balanced and adaptive perspective, ultimately improving our ability to manage pain and maintain a better quality of life.
In the following sections, we’ll discuss some of the most common maladaptive thinking patterns related to pain and explore how CBT can help address these patterns, promoting more effective coping strategies and improved outcomes.
Common Maladaptive Thinking Patterns Related to Pain
When dealing with chronic pain, it’s not uncommon to fall into certain patterns of thinking that can actually worsen our experience and hinder our ability to cope. Let’s take a closer look at some of these maladaptive thinking patterns.
Catastrophizing
Catastrophizing involves focusing on the worst possible outcome and magnifying the potential negative consequences of a situation. For example, someone with chronic back pain might think, “This pain is never going to go away, and I’ll end up completely disabled.” This type of thinking can amplify the perception of pain and lead to increased emotional distress, making it more difficult to engage in activities that could actually help manage pain.
All-or-Nothing Thinking
All-or-nothing thinking, also known as black-and-white thinking, involves seeing things in extremes. In the context of chronic pain, this might look like, “If I can’t do everything I used to do, I might as well not do anything at all.” This type of thinking can lead to a cycle of inactivity and discouragement, as individuals may feel that there’s no point in engaging in activities unless they can do them perfectly or without any pain.
Overgeneralization
Overgeneralization involves drawing broad conclusions based on a single event or experience. For instance, if an individual with chronic pain has a bad day, they might think, “I’ll never be able to manage this pain.” This type of thinking can contribute to feelings of hopelessness and helplessness, making it difficult to maintain motivation and engage in self-care activities.
Mental Filtering
Mental filtering involves focusing exclusively on the negative aspects of a situation while ignoring or minimizing the positive. In the case of chronic pain, this might involve dwelling on the pain and its limitations while overlooking any progress made or moments of relief. This type of thinking can make it difficult to maintain a balanced perspective and can contribute to feelings of depression and anxiety.
Recognizing these maladaptive thinking patterns is an essential first step in learning to manage them. In the next section, we’ll explore how CBT can help address these patterns and promote more adaptive coping strategies.
The Role of CBT in Addressing Maladaptive Thinking Patterns
Cognitive Behavioral Therapy (CBT) is a well-established and effective approach to helping individuals manage chronic pain. A key component of CBT is addressing the maladaptive thinking patterns that can contribute to increased pain perception and emotional distress.
Identifying and Challenging Negative Thoughts
One of the primary goals of CBT is to help individuals become more aware of their thoughts and how they influence their feelings and behaviors. By learning to identify negative or maladaptive thoughts, individuals can begin to challenge and reframe them in a more balanced and realistic way.
For example, if someone is catastrophizing about their pain, a CBT therapist might encourage them to examine the evidence for and against their negative thought. They might ask, “Is it true that your pain will never improve?” or “Have you ever had periods of improvement in the past?” By questioning the validity of negative thoughts, individuals can begin to develop a more accurate and balanced perspective.
Developing Adaptive Coping Strategies
In addition to challenging negative thoughts, CBT also focuses on helping individuals develop adaptive coping strategies. This might involve learning relaxation techniques, such as deep breathing or progressive muscle relaxation, to help manage pain and reduce stress.
CBT may also encourage individuals to engage in activities that promote a sense of accomplishment and pleasure, even if they need to be modified to accommodate pain limitations. By focusing on what they can do rather than what they can’t, individuals can begin to build a sense of self-efficacy and control over their pain experience.
Promoting a Balanced Perspective
Another key aspect of CBT is helping individuals maintain a balanced perspective on their pain and its impact on their lives. This involves acknowledging the reality of pain while also recognizing that it doesn’t have to define one’s entire existence.
A CBT therapist might encourage an individual to consider the various aspects of their life, such as relationships, hobbies, and personal strengths, rather than solely focusing on pain. By promoting a more balanced and comprehensive view of oneself, CBT can help reduce the emotional impact of chronic pain and improve overall well-being.
In the next section, we’ll delve into some specific CBT techniques that can be helpful in managing chronic pain.
CBT Techniques for Pain Management
Now that we’ve discussed the role of CBT in addressing maladaptive thinking patterns, let’s explore some specific techniques that can be helpful in managing chronic pain. These techniques focus on changing negative thought patterns and promoting adaptive coping strategies.
1. Thought Recording
One effective CBT technique is thought recording. This involves keeping a journal or log of negative thoughts related to pain, along with the situations that trigger them. By writing down these thoughts, individuals can become more aware of patterns and start to challenge them.
For example, if you find yourself thinking, “I can’t do anything because of my pain,” write down this thought and then consider alternative perspectives. You might write, “While my pain does limit some activities, there are still many things I can enjoy and accomplish.”
2. Helpful Self-Talk
Another helpful technique is practicing helpful self-talk. This involves consciously replacing negative thoughts with more helpful, supportive and realistic ones. Instead of thinking, “I’ll never get better,” try telling yourself, “I’m doing my best to manage my pain, and I’m making progress, even if it’s small.”
Positive self-talk can help counteract the negative impact of maladaptive thinking patterns and promote a more adaptive mindset.
3. Guided Imagery
Guided imagery is a relaxation technique that involves visualizing peaceful, calming scenes. This can help reduce stress and promote a sense of control over pain.
For example, you might imagine yourself in a beautiful, tranquil setting, such as a beach or a forest. Focus on the details of the scene, engaging all of your senses. This can help shift your focus away from pain and promote a more relaxed state of mind.
4. Behavioral Experiments
Behavioral experiments involve testing out negative thoughts or beliefs to see if they hold up to reality. For instance, if you believe that you can’t engage in any physical activity because of your pain, try setting a small, achievable goal, such as walking for five minutes.
If you’re able to accomplish this goal, it can help challenge the negative belief and promote a sense of self-efficacy. If the experiment is too challenging, you can adjust your goal and try again.
5. Cognitive Restructuring
Cognitive restructuring involves systematically challenging and replacing maladaptive thoughts with more balanced and realistic ones. This technique often involves examining the evidence for and against a negative thought, considering alternative perspectives, and generating more adaptive thoughts.
For example, if you find yourself thinking, “My pain is unbearable, and I can’t cope,” you might challenge this thought by considering times when you have effectively managed your pain in the past. You could then replace the thought with a more balanced one, such as, “While my pain is difficult, I have coped with it before, and I have strategies to help me manage it.”
By incorporating these CBT techniques into your pain management plan, you can begin to address maladaptive thinking patterns and develop more effective coping strategies. Remember, change takes time and practice, so be patient with yourself and celebrate your progress along the way.
Here is a table that outlines the main maladaptive thinking patterns related to pain and how they can hinder your ability to improve:
Maladaptive Thinking Pattern
Description
Impact on Improvement
Catastrophizing
Focusing on the worst possible outcome and magnifying the potential negative consequences
Amplifies pain perception, increases emotional distress, and reduces motivation to engage in activities that could help manage pain
All-or-Nothing Thinking
Seeing things in extremes, with no middle ground
Leads to a cycle of inactivity and discouragement, as individuals may feel there’s no point in engaging in activities unless they can do them perfectly or without any pain
Overgeneralization
Drawing broad conclusions based on a single event or experience
Contributes to feelings of hopelessness and helplessness, making it difficult to maintain motivation and engage in self-care activities
Mental Filtering
Focusing exclusively on the negative aspects of a situation while ignoring or minimizing the positive
Makes it difficult to maintain a balanced perspective and can contribute to feelings of depression and anxiety
Emotional Reasoning
Assuming that negative emotions reflect reality
Leads to a distorted perception of pain and its impact, making it difficult to challenge negative thoughts and beliefs
Labeling
Assigning global negative labels to oneself or one’s experiences
Promotes a sense of helplessness and reduces self-efficacy, making it harder to believe in one’s ability to manage pain effectively
Should Statements
Focusing on what one “should” or “must” do, rather than what is realistic or achievable
Creates unrealistic expectations and leads to feelings of guilt, frustration, and self-blame when these expectations are not met, hindering progress and self-compassion
Personalization
Taking excessive responsibility for negative events or outcomes
Leads to feelings of guilt and self-blame, making it difficult to maintain a balanced perspective and engage in effective problem-solving
Maladaptive thinking patterns related to pain
Benefits of CBT for Pain Management
Incorporating CBT techniques into your pain management plan can lead to numerous benefits. By addressing maladaptive thinking patterns and promoting adaptive coping strategies, CBT can help improve your overall quality of life and reduce the impact of chronic pain.
Improved Coping Skills
One of the primary benefits of CBT is the development of improved coping skills. By learning to identify and challenge negative thoughts, you can begin to approach pain and its challenges with a more balanced and adaptive mindset. This can help reduce the emotional distress associated with chronic pain and promote a greater sense of control over your experiences.
Additionally, CBT techniques such as relaxation training and behavioral activation can provide you with practical tools to manage pain and its impact on your daily life. These skills can help you maintain a more active and engaged lifestyle, even in the face of chronic pain.
Reduced Pain Intensity and Disability
Research has shown that CBT can be effective in reducing pain intensity and disability associated with chronic pain conditions. By addressing the cognitive and emotional factors that contribute to pain perception, CBT can help alter the way you experience pain.
Furthermore, by promoting adaptive coping strategies and encouraging engagement in meaningful activities, CBT can help reduce the functional limitations and disability that often accompany chronic pain.
Enhanced Emotional Well-Being
Chronic pain can take a significant toll on emotional well-being, often leading to feelings of depression, anxiety, and isolation. CBT can help address these emotional challenges by providing you with tools to manage stress, reframe negative thoughts, and maintain a more balanced perspective.
By improving emotional well-being, CBT can help you maintain a better quality of life and reduce the overall burden of chronic pain.
Increased Self-Efficacy and Sense of Control
One of the most challenging aspects of chronic pain is the sense of helplessness and lack of control it can engender. CBT can help combat these feelings by promoting a sense of self-efficacy and control.
Through techniques such as goal setting, problem-solving, and behavioral experiments, CBT can help you develop a greater sense of mastery over your pain and its management. This increased self-efficacy can foster a more positive outlook and improve your ability to cope with the challenges of chronic pain.
By embracing the benefits of CBT and incorporating its techniques into your pain management plan, you can work towards a more adaptive and fulfilling life, even in the face of chronic pain. Remember, you have the power to shape your experience and improve your well-being, one thought and one action at a time.
Conclusion
Living with chronic pain can be an incredibly challenging experience, affecting every aspect of your life. The physical discomfort, emotional distress, and functional limitations associated with chronic pain can make it difficult to maintain a sense of well-being and control.
However, by understanding the role of maladaptive thinking patterns in the pain experience and learning to address them through Cognitive Behavioral Therapy (CBT) techniques, you can begin to take steps towards a more manageable and fulfilling life.
Throughout this article, we’ve explored some of the most common maladaptive thinking patterns related to pain, such as catastrophizing, all-or-nothing thinking, overgeneralization, and mental filtering. We’ve also discussed how CBT can help address these patterns by promoting more balanced and adaptive thoughts, feelings, and behaviors.
By incorporating CBT techniques such as thought recording, positive self-talk, guided imagery, behavioral experiments, and cognitive restructuring into your pain management plan, you can begin to develop a greater sense of control and self-efficacy in the face of chronic pain.
It’s important to remember that managing chronic pain is a process, and it may take time to see significant improvements. Be patient with yourself and celebrate the small victories along the way. Every step you take towards a more adaptive mindset and coping strategy is a step in the right direction.
If you find yourself struggling to manage your chronic pain and the associated maladaptive thinking patterns, don’t hesitate to seek professional help. A trained CBT therapist can provide you with personalized guidance and support as you work towards a more manageable and fulfilling life.
Remember, you have the power to shape your experience and improve your well-being. By embracing the principles of CBT and committing to the process of change, you can begin to take control of your pain and live the life you deserve.
Chronic pain is a complex and pervasive issue that affects millions of individuals worldwide. Unlike acute pain, which serves as a temporary and direct warning signal of injury or illness, chronic pain persists for months or years, often outlasting its original cause. It not only takes a toll on one’s physical health but also profoundly impacts emotional and psychological well-being. Common consequences of chronic pain include limitations on daily activities, reduced quality of life, depression, anxiety, and sleep disturbances.
Cognitive Models of Chronic Pain
From a cognitive perspective, chronic pain is not just a sensory experience but also deeply intertwined with thoughts, beliefs, and attitudes. Central to this viewpoint is the understanding that pain-related beliefs and thoughts can influence the intensity and persistence of pain, as well as the development and maintenance of pain-related disability. Cognitive models, such as the Fear-Avoidance Model of chronic pain, highlight how individuals’ interpretations of pain significantly affect their emotional and behavioral responses to it.
Maladaptive Beliefs and Examples
Pain-Related Belief in Change: “My pain will never get better.” This belief fosters a sense of hopelessness, contributing to the cycle of chronic pain by discouraging active engagement in pain management strategies.
Pain-Related Negative Beliefs about People: “Others think I’m exaggerating my pain.” Such beliefs can lead to social withdrawal, isolation, and a decreased support network, exacerbating feelings of loneliness and misunderstanding.
Adaptive Beliefs and Examples
Pain-Related Hope: “I can find ways to manage my pain and improve my quality of life.” Holding onto hope can motivate individuals to explore and adhere to pain management techniques, fostering resilience.
Pain-Related Thinking: “Pain is a part of my life, but it doesn’t define me.” This belief encourages a more balanced view of pain, helping individuals engage more fully in their lives despite discomfort.
Maladaptive Meta-Cognitive Beliefs and Examples
Pain-Related Intolerance of Uncertainty: “I can’t handle the uncertainty of my pain levels.” This leads to excessive worry about future pain episodes, increasing stress and potentially exacerbating pain sensations.
Pain Avoidance: “If I avoid activities that make my pain worse, I will be okay.” While avoidance may provide short-term relief, it contributes to long-term physical deconditioning and emotional distress.
Adaptive Meta-Cognitive Beliefs and Examples
Acceptance of Uncertainty: “Even though I can’t predict my pain levels, I can still manage them effectively.” Accepting uncertainty can reduce anxiety and promote engagement with coping strategies.
Balanced Engagement: “Engaging in meaningful activities, even if they might increase my pain temporarily, enriches my life.” This belief supports the idea that the benefits of engagement outweigh the risks of temporary discomfort, encouraging a more active lifestyle.
Behavioral Changes Stemming from Beliefs
Maladaptive Beliefs to Behaviors: Beliefs such as pain-related hopelessness and avoidance lead to behaviors like neglecting physical therapy, avoiding social interactions, and increased sedentary lifestyle. These behaviors can further reinforce the chronic pain cycle by worsening physical condition and isolating individuals from potential support systems.
Adaptive Beliefs to Behaviors: On the flip side, adaptive beliefs encourage positive behaviors. For instance, holding onto hope and accepting uncertainty can lead to more consistent engagement in rehabilitation exercises, exploration of different pain management techniques (e.g., mindfulness, cognitive-behavioral therapy), and a willingness to participate in social activities despite pain. These behaviors can improve physical strength, reduce the impact of pain on daily life, and enhance overall well-being.
Conclusion
In summary, chronic pain is a multifaceted issue that extends beyond physical sensations to include psychological and emotional dimensions. By adopting a cognitive perspective, individuals can identify and modify maladaptive beliefs and meta-cognitive beliefs, paving the way for more adaptive thinking and behaviors. This shift not only helps manage pain more effectively but also improves quality of life, demonstrating the profound impact of our thoughts on our physical experiences.
Understanding Chronic Pain: A Cognitive Perspective Quiz
Understanding Chronic Pain: A Cognitive Perspective: Test Your Knowledge
What is a common consequence of chronic pain?
Which of the following is an example of a maladaptive belief about pain?
What is an example of an adaptive meta-cognitive belief?
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