Develop your skills in CBT for chronic pain

I’ve never found one single book that covers all the areas I think are important for chronic pain management, but today I want to review one that I have found helpful – and I’ll review another tomorrow! I got this one about two years ago, and I’ve referred to it quite often, especially for worksheets.

The book is Cognitive behavioural therapy for chronic illness and disability by Renee Taylor (2006), published by Springer, New York. I got mine from University Bookshop (another wicked place…) for NZ$125 , but as you can see it’s available from Amazon as well.

Renee Taylor is a clinical psychologist, but one with a unique twist – she’s based in the Department of Occupational Therapy, University of Illinois, Chicago, and her book reflects the orientation of this department in that she incorporates the Model of Human Occupation developed by Dr Gary Kielhofner.

She uses four case examples of chronic illness throughout the book to illustrate various aspects of CBT for disability – fatigue, chronic pain from rheumatoid arthritis; sleep disturbance in a man with advanced prostate cancer, and gastrointestinal difficulties in a young man. Alongside the physical illness, each case study has varying degrees of Axis I and Axis II dysfunction to demonstrate the complexity of the biopsychosocial model as it plays out in people’s lives. While I’d probably prefer less of the ‘psychiatric’ labelling that DSM IV provides, it’s nice to see some examples that represent the type of people who do attend pain management centres.

The book is divided into three sections – Theoretical foundations and practice guidelines; Related knowledge; and Specific applications of CBT to the four different physical disorders.
Section one provides an overview of CBT as a therapeutic approach, particularly noting the relevance of CBT to disability, discussing the psychological (note that this is NOT psychosocial?!) issues often found in chronic illness, and then details assessment and sessions as well as CBT techniques used in health.
Section two introduces several concepts that I have to admit I haven’t seen discussed in most CBT texts – empathy, hope and motivation. It’s the motivation chapter that includes the Model of Human Occupation construct of volition – personal causation, values and interests – that help to shape occupational choice.
Section three provides a brief review of some of the literature on the various clinical conditions (fatigue etc), and discusses assessment and treatment options for each.

Things I like about this book – great to see MOHO used to frame motivation, and the inclusion of hope and empathy is also quite novel and positive. I like the clinical examples used throughout to illustrate how the techniques can be applied along with the clinical reasoning for their inclusion. Finally, I really do like the figures used throughout – while the graphics themselves are quite simple, the design of several forms and figures make them really usable. I have to admit I’ve copied and used the ‘Thought Reversal Record’ and the ‘Problem solving worksheet’ with patients!

Things I liked less about this book – I found the writing style to be a bit dry, and the general layout or typesetting of the book makes it more of a textbook than a ready-reference book. I’m also bothered by the lack of attention to social factors and that the approach does not directly discuss working within a team (either interdisciplinary or multidisciplinary).

If you haven’t read a book that clearly discusses how to use CBT where people have beliefs that are true – but not helpful – this is an excellent book.  It’s really good for the worksheets and figures, and it’s great for including some positive psychology concepts along with MOHO.  A good one for your shelf – or if you’re recommending a book to a library, this one would be an excellent choice.