Multi-Component Cognitive Behavioral Therapy for Rheumatologic Pain

Status: Strong Research Support


Cognitive Behavioral Therapy (CBT) for Rheumatologic pain conditions is based upon the idea that adaptation to persistent pain involves personal control over nociceptive, affective, cognitive, and behavioral aspects of the pain experience. Typically CBT for Rheumatologic pain involves three components. The first is education about chronic pain. Through education, the patient and clinician share a common knowledge base upon which to discuss the nature of pain, options for treatment, and the importance of patients playing an active role in pain management. The second component is symptom self-management skills targeting pain, affect, cognition, and functional status (e.g. relaxation techniques, graded activation, and pleasant activity scheduling. The third component involves the promotion of life style change, maintenance of benefit, and relapse prevention. Such skills involve stress management, goal setting, structured problem solving, reframing, and communication skills. 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 Rheumatologic conditions can be administered either individually or in small groups over 8-12 sessions.

Key References (in reverse chronological order)

  • Leibing, E., Pfingsten, M., Bartmann, U., Rueger, U., Schuessler, G. (1999). Cognitive-behavioral treatment in unselected rheumatoid arthritis outpatients. Clinical Journal of Pain, 15(1):58-66.
  • Keefe, FJ, Caldwell, DS, Williams, DA, Gil KM, Mitchell, D., Robertson, C., Martinez, S., Nunley, J., Beckham, JC, Helms, M. (1990a). Pain coping skills training in the management of osteoarthritic knee pain: A comparative study. Behavior Therapy, 21, 49-62.
  • Keefe, FJ, Caldwell, DS, Williams, DA, Gil KM, Mitchell, D., Robertson, C., Martinez, S., Nunley, J., Beckham, JC, Helms, M. (1990b). Pain coping skills training in the management of osteoarthritic knee pain -II: Follow-up results. Behavior Therapy, 21, 435-447.
  • Parker, J.C., Frank, R.G., Beck, NC, Smarr, KL, Buescher, KL, Phillips, LR, Smith, EI, Anderson, SK, Walker, SE. (1988). Pain management in rheumatoid arthritis patients: A cognitive-behavioral approach. Arthritis and Rheumatism, 31, 593-601.

Clinical Resources

  • L. Simon, A. Lipman, A. Jacox, M. Caudill-Slosberg, L. Gill, F. Keefe, et al. (2002). Guideline for the Management of Pain in Osteoarthritis, Rheumatoid Arthritis, and Juvenile Chronic Arthritis. Glenview, IL: American Pain Society.American Pain Society.
  • Cognitive Behavioral Therapy for Arthritis Pain (Cost=$35.00). (A treatment Manual). Contact: Francis J. Keefe, Ph.D., Box 3159, Duke University Medical Center, Durham, NC 27710
  • Keefe, F. J. Beaupre, P.M., & Gil, KM (1997). Group therapy for patients with chronic pain. In R. J. Gatchel & D.C. Turk (Eds.). Psychological treatments for pain: a practitioner’s handbook. New York: Guildford Press.

Training Opportunities

Formal training in CBT for Rheumatologic conditions is often available through workshops held at the American Pain Society, the International Association for the Study of Pain, and through the American College of Rheumatology. Several centers conducting trials of CBT for Rheumatologic conditions 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