Behavioral and Cognitive Behavioral Therapy for Chronic Low Back Pain

Status: Strong Research Support


Behavioral Therapy (BT) and Cognitive Behavioral Therapy (CBT) for CLBP are terms for psychological interventions that often get applied inter-changeably in the CLBP literature. Therapies based upon these principles seek to help the patient with pain reduce symptom intensity, regain functioning, and reduce suffering. Many techniques get incorporated into this form of therapy and rarely are single components applied in actual practice. Techniques can include time-contingent pacing, spouse involvement and reinforcement of adaptive responding, use of quotas and goals for gradual return of functioning, reframing of affective and cognitive responses, learning of coping skills, and learning of the relaxation response (e.g. progressive muscle relaxation, biofeedback). In order to better learn and integrate skills into one’s life style, CBT relies upon self-monitoring, skill rehearsal, and social reinforcement. CBT for CLBP is most often administered either individually or in small groups over 8-12 sessions and is often incorporated into a broader medical and/or physical therapeutic program.

Key References (in reverse chronological order)

  • Morley, S., Eccleston, C., Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80 (1-2), 1-13.
  • Turner JA, Jensen MP. (1993). Efficacy of Cognitive therapy for Chronic Low Back Pain. Pain, 169-177.
  • Basler, HD, Jakle, C., Kroner-Herwig, B. (1997). Incorporation of Cognitive-Behavioral Treatment into the Medical Care of Chronic Low Back Pain Patients: A Controlled Randomized Study in German Pain Treatment Centers. Patient Education and Counseling, 31, 113-124.
  • Turner, JA, Clancy S. (1988). Comparison of Operant Behavioral and Cognitive-Behavioral Group Treatment for Chronic Low Back Pain. Journal of Consulting and Clinical Psychology, 56 (2), 261-266.

Clinical Resources

  • Chou, R., Huffman, LH. (2007). Nonpharmacological Therapies for Acute and Chronic Low Back Pain: A Review of the Evidence for an American Pain Society/American college of Physicians Clinical Practice Guideline. Annals of Internal Medicine, 147, 492-504.
  • Chou, R. et al (2007). Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147 (7), 478-491.
  • Hoffman, BM, Papas, RK, Chatkoff, DK, Kerns, RD. (2007). Meta-Analysis of Psychological Interventions for Chronic Low Back Pain. Health Psychology, 26(1), 1-9.
  • Van Tulder, MW, Ostelo, R, Vlaeyen, JWS, Linton, SJ, Morley, SJ, Assendelft, WJJ. (2000). Behavioral Treatment for Chronic Low Back Pain. Spine, 26(3), 270-281.

Training Opportunities

Formal training in CBT and BT for pain management is often available through workshops held at the American Pain Society, International Association for the Study of Pain, and the Association for the Advancement of Behavioral Therapy. Several centers conducting trials of CBT also provide informal training, predoctoral training, psychological internship rotations, or postdoctoral fellowships in CBT for pain management. For information about training opportunities at these centers contact the following centers:

Laurance A. Bradely, Ph.D.
Division of Rheumatology
178A Shelby Research Building
University of Alabama – Birmingham
Birmingham, AL 35294
Francis J. Keefe, Ph.D.
Director, Pain Management Program
Box 3159
Duke University Medical Center
Durham, NC 27710
Dennis C. Turk, Ph.D.
Dept. Anesthesiology
University of Washington
Box 356540
Seattle, WA 98195
David A. Williams, Ph.D.
Chronic Pain and Fatigue Research Center
Dept. of Internal Medicine/Rheumatology
University of Michigan
24 Frank Lloyd Wright Drive, Lobby M
Ann Arbor, MI 48105