Dialectical Behavioral Therapy for Chronic Pain Mgmt

Dialectical Behavioral Therapy for Chronic Pain Management Florence Chaverneff, Ph.D. – September 24, 2016

Still a recent form of cognitive behavioral therapy, dialectical behavioral therapy (DBT) combines dialectics and mindfulness meditation for therapeutic purposes.

The goal with this method is to help patients “gain insight and skills to manage their thoughts, emotions, and behaviors.”

A study presented at the American Academy of Pain Management’s Annual Meeting in San Antonio, Texas, proposed the use of this technique in pain management.

DBT was initially developed in the United States as a treatment complement for patients with the most severe cases of borderline personality disorder (ie, cases of suicidal attempts and ideation).  

The treatment has proven successful in this patient population, and provided a way to help them practice “radical acceptance … and be more motivated to change.” Researchers hypothesized that, since the treatment had been effective for this “difficult population,” it might also be applicable to other areas.

They started a program in Corpus Christi, Texas, for school-aged children with behavioral issues, in which some of the DBT strategies were applied.

The authors explained that DBT is achieved through 4 “skills training modules:

  1. mindfulness,
  2. interpersonal effectiveness,
  3. emotion regulation, and
  4. distress tolerance.

In an interview with Clinical Pain Advisor, Adriana Dyurich, MS, one of the study authors, elaborated on the concept of radical acceptance:

“in order to be able to generate change, one has to be aware and very clear about what is happening right now, accept the moment completely as it is … and accept that these are the cards that one was dealt, and figure out what to do with these.”

With a 12 week-long program of skill development based on the 4 main modules of DBT, some of the symptoms of chronic pain (eg, hopelessness, difficulty in getting social support, stress tolerance) may be addressed.

DBT is not currently used in the United States as a mechanism to manage chronic pain.

References

Linehan, M. DBT Skills Training Manual. 2nd edition. New York, NY: Guilford Press; 2015.

Dyurich A, Prasad V, Prasad AR. Dialectical Behavioral Therapy (DBT) as a tool to help manage psychological and emotional aspects of chronic pain. Presented at: AAPM 2016. San Antonio, TX; September 21-25, 2016.  

Advertisements

11 thoughts on “Dialectical Behavioral Therapy for Chronic Pain Mgmt

  1. Angela M. Oddone LCSW, Resiliency Strategies LLC

    Mindfulness, guided imagery meditation combined with slow, deep breathing and distraction can also be helpful. They should not be used solely to substitute for pain management when pain levels are high enough to interfere with the ability to function and significantly decrease quality of life; but, can, indeed, make a significant contribution in addition to nutrition, safe and gentle exercise and medical management of pain. A good therapist also advocates for their patients.

    Liked by 1 person

    Reply
    1. Zyp Czyk Post author

      I was exceptionally lucky that my neurologist referred me to a therapist without telling me she was an addiction therapist (I may not have spent the money if I’d known).

      This true addiction specialist figured out in 2 sessions that I wasn’t addicted and wrote a letter certifying this to my new doctor. I wonder if this kind of “certification” could be used by more pain patients.

      Do you think there are other addiction therapists who are brave enough to do this?

      Liked by 1 person

      Reply
      1. Angela M. Oddone LCSW, Resiliency Strategies LLC

        You were lucky! Most therapists, like most doctors & PTs don’t have the time or capacity to learn enough about EDS to understand what we experience. Most doctors who practice insurance-driven care still won’t prescribe opioids for chronic pain. I always recommend asking the PCP to do pharmacogenetic testing. That + an evaluation by a licensed mental health professional + maybe also ongoing monitoring by a qualified therapist re: misuse or abuse of controlled substances & alcohol & over the counter drugs are most likely the most successful combination of documentation that would provide for a prescibing physician, PA or nurse practitioner to support them to make a patient-centered decision re: pain management medications, including opioids if needed.

        Liked by 1 person

        Reply
        1. Zyp Czyk Post author

          I have been keeping a detailed pain/activity/mood/medication diary for over a decade, so I gave my therapist a couple of weeks of it.

          First, she clarified that when I noted taking “10v” (v for Vicodin), I meant milligrams, not tablets. :-)

          But after reading about each daily and hourly location and amount of pain (like right SI joint pain7 @10:30, headache pain8 @2, or left wrist pain5 @7), she decided I was just “a person with pain taking medication for it”, not an addict.

          She told me she’d asked many clients to keep a medication diary and I’m the only one that had. Apparently, addicts don’t, can’t, or won’t keep a written record of their drug consumption.

          This seems to be such a simple way to determine addiction, I’m surprised it’s not used regularly.

          Liked by 1 person

          Reply
          1. Angela M. Oddone LCSW, Resiliency Strategies LLC

            An addict wouldn’t report accurately or honestly. Another issue is we’re discriminated against for a) having a rare, complex, chronic illness &/or b) for taking narcotic pain meds by doctors who decline to treat us. I’m still trying to get my med list at a large health care group accurately updated so I won’t be turned away based on a chart review of my medical record there. One of the main reason I choose to not use oxycodone or other opioid meds is to avoid that discrimination & to lower my doctors’ anxiety so they can focus on what I need rather than be so fear-based they’re like deer in headlights. It shouldn’t be that way. But, sadly, it is.

            Liked by 1 person

            Reply
  2. Karthy C

    Actually DBT has been used for 20 years or more for dealing with Chronic Pain and an assortment of other issues. It has morphed into Cognitive Therapy and Mindfulness. This Article is presenting this as something ‘New.” The grey area between Mental Disorders, and Physical Conditions is getting greyer. This “Mindfulness” is being used in Psychological Clinics and has been for years. This has become on of those one size fits all “treatments” for everything from “Borderline Personality Disorder” a particularly grey “Condition” that varies from some really pathological behavior, to distressed teenage girls who cut themselves.
    This “Disorder” is another catch all. They do not make much of a distinction between the two Extremes. In fact, most Mental health Professionals are unable to diagnose the Pathological version, there is a lot of variability.
    Many people with Chronic Pain, especially the females will be Diagnosed as having Borderline Personality Disorder, it meshes nicely with the Symptoms of Chronic Pain. The more recent DSMV has made these descriptions even vaguer, and instead of defining the disorder, opened it up to more interpretation. This was to aid in billing, not to define a Psychological Condition, or make it easier to diagnose these Conditions. Instead of clarifying and defining these Disorders, the DSMV made it even more open to interpretation.
    There is nothing new here, they have been using DBT or some version of it for everything, Situational Depression, Chronic Pain, and everyday distress. The only thing “New” would be research on the effectiveness. The more glaring issue that should be obvious is where is the Real Scientific Research? Where is the follow up. Many of these Studies are able to manipulate for a desired outcome by using short term Self Assessment Surveys. This is another area they should be demanding more “Science” instead we are moving away from Science to more Pseudo Science. Surveys can be misleading dependent on the methods used.

    Liked by 2 people

    Reply
    1. Zyp Czyk Post author

      The DSM-5 is an unmitigated disaster for chronic pain patients – any undiagnosed health condition can be labeled “Somatic Symptom Disorder”. This is a catch-all bucket for any “difficult” pain patient not responding to non-opioid therapy.

      Like “opioid use disorder”, it turns a normal response to constant pain into a mental disorder and neatly sidesteps the need to relieve the pain at all.

      On the other hand, I see great value in therapy of any kind that’s focused on adapting to painful realities and finding some purpose in a life circumscribed by pain. I could sure use some help in this area, but I simply cannot afford it.

      Liked by 1 person

      Reply
      1. Angela M. Oddone LCSW, Resiliency Strategies LLC

        I do everything I can to make therapy affordable & accessible as well as patient-centered. That’s why I’m only in network with 2 insurance companies & all local EAPs + I’ll see people who don’t have insurance or have other insurance policies I’m not in for just the co-pay. My home-based office makes that possible. I also do coaching via phone, FaceTime & Skype with my fee on a sliding scale based on need and ability to pay. The EDS community has so much financial & medical PTSD and need for knowledgeable case management help & advocacy. Your work has been a huge & essential contribution!

        Liked by 1 person

        Reply

Other thoughts?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s