Cognitive Behavioral Techniques in the Management of Pain

  • Dennis C. Turk


The purpose of the present chapter is to examine the utility of a variety of cognitive behavioral treatments designed to enhance tolerance for painful stimuli. The chapter is organized into three main sections. First, before describing the specific coping strategies employed, a brief overview of the phenomenon of pain will be provided. Such an overview underscores the complexity and intractability of this universal experience, and reveals the bases for the traditional therapeutic modalities employed to ameliorate pain.


Coping Strategy Coping Skill Cognitive Behavioral Treatment Cognitive Coping Strategy Intense Stimulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Andrew, J.M. Recovery from surgery with and without preparatory instruction for three coping styles. Journal of Personality and Social Psychology, 1970, 15, 223–226.PubMedCrossRefGoogle Scholar
  2. Bandler, R., Jr., Madaras, G., and Bem, D. Self-observation as a source of pain perception. Journal of Personality and Social Psychology, 1968, 9, 205–209.PubMedCrossRefGoogle Scholar
  3. Barber, T.X., Spanos, N., and Chaves, J. Implications for human capabilities and potentialities. In T.X. Barber, N. Spanos, and J. Chaves (Eds.), Hypnosis, imagination and human potentialities. New York: Pergamon Press, 1974.Google Scholar
  4. Beecher, H. Measurement of subjective responses: Quantitative effects of drugs. New York: Oxford, 1959.Google Scholar
  5. Beecher, H. Pain: One mystery solved. Science, 1966, 151, 840–841.PubMedCrossRefGoogle Scholar
  6. Blitz, B., and Dinnerstein, A. Effects of different types of instructions on pain parameters. Journal of Abnormal Psychology, 1968, 73, 276–280.PubMedCrossRefGoogle Scholar
  7. Blitz, B., and Dinnerstein, A. Role of attentional focus in pain perception: Manipulation of responses to noxious stimulation by instructions. Journal of Abnormal Psychology, 1971, 77, 42–45.PubMedCrossRefGoogle Scholar
  8. Bobey, M., and Davidson, P. Psychological factors affecting pain tolerance. Journal of Psychosomatic Research, 1970, 14, 371–376.PubMedCrossRefGoogle Scholar
  9. Bond, M. Pain and personality in cancer patients. In J. J. Bonica and D. Albe-Fessard (Eds.), Advances in pain research and therapy (Vol. 1 ). New York: Raven Press, 1976.Google Scholar
  10. Bowers, K.S. The effects of USC temporal uncertainty on heart rate and pain. Psychophysiology, 1971, 8, 382–389.PubMedCrossRefGoogle Scholar
  11. Chappell, M.N., and Stevenson, T.I. Group psychological training in some organic conditions. Mental Hygiene, 1936, 20, 588–597.Google Scholar
  12. Chaves, J., and Barber, T.X. Cognitive strategies, experimenter modeling, and expectation in the attenuation of pain. Journal of Abnormal Psychology, 1974, 83, 356–363.PubMedCrossRefGoogle Scholar
  13. Clark, W.C., and Hunt, H.F. Pain. In J.A. Downey and R.C. Darling (Eds.), Physiological basis of rehabilitation medicine. Philadelphia: W.B. Saunders Company, 1971.Google Scholar
  14. Craig, K., Best, H., and Reith, G. Social determinants of reports of pain in the absence of painful stimulation. Canadian Journal of Behavioral Science, 1974, 6, 109–177.Google Scholar
  15. Davison, G.C., and Wilson, G. T. Processes of fear reduction in systematic desensitization: Cognitive and social reinforcement factors in humans. Behavior Therapy, 1973, 4, 1–21.CrossRefGoogle Scholar
  16. Dick-Read, G. Childbirth without fear. New York: Harper & Row, 1959.Google Scholar
  17. Draspa, L.J. Psychological factors in muscular pain. British Journal of Medical Psychology, 1959, 32, 106–116.PubMedCrossRefGoogle Scholar
  18. Egbert, L., Batit, G., Welch, C., and Bartlett, M. Reduction of post-operative pain by encouragement and instruction. New England Journal of Medicine, 1964, 270, 825–827.PubMedCrossRefGoogle Scholar
  19. Ellis, A. Reason and emotion in psychotherapy. New York: Lyle Stuart Press, 1962.Google Scholar
  20. Ellis, A. The essence of rational psychotherapy: A Comprehensive approach to treatment. New York: Institute for Rational Living, 1970.Google Scholar
  21. Evans, M., and Paul, G. Effects of hypnotically suggested analgesia on physiological and subjective response to cold stress. Journal of Consulting and Clinical Psychology, 1970, 35, 362–371.PubMedCrossRefGoogle Scholar
  22. Fagerhaugh, S. Pain expression and control on a burn care unit. Nursing Outlook, 1974, 22, 645–650.PubMedGoogle Scholar
  23. Fulop-Miller, R. Triumph over pain. New York: The Literary Guild of America, 1938.Google Scholar
  24. Glass, C.R., Gottman, J.M., and Shmurak, S.H. Response acquisition and cognitive self-statement modification approaches to dating skills. Journal of Counseling Psychology, 1976, 23, 520–526.CrossRefGoogle Scholar
  25. Goldfried, M. Systematic desensitization as training in self-control. Journal of Consulting and Clinical Psychology, 1971, 37, 228–234.PubMedCrossRefGoogle Scholar
  26. Goldfried, M. Reduction of generalized anxiety through a variant of systematic desensitization. In M. Goldfried and M. Merbaum (Eds.), Behavior change through self-control. New York: Holt, Rinehart and Winston, 1973.Google Scholar
  27. Goldfried, M., Decenteceo, E., and Weinberg, L. Systematic rational restructuring as a self-control technique. Behavior Therapy, 1974, 5, 247–254.CrossRefGoogle Scholar
  28. Goldfried, M., and Trier, C. Effectiveness of relaxation as an active coping skill. Journal of Abnormal Psychology, 1974, 83, 348–355.PubMedCrossRefGoogle Scholar
  29. Gottlieb, H., Hockersmith, V., Koller, R., and Strite, L. A successful treatment program for chronic back pain patients. Symposium presented at the annual meeting of the American Psychological Association, Chicago, Ill., 1975.Google Scholar
  30. Hill, H., Kornetsky, Ç., Flanary, H., and Wikler, A. Effects of anxiety and morphine on discrimination of painful stimuli. Journal of Clinical Investigation, 1952a, 31, 473.PubMedCrossRefGoogle Scholar
  31. Hill, H., Kornetsky, C., Flanary, H., and Wikler, A. Studies on anxiety associated with anticipation of pain, I. Effects of morphine. Archives of Neurology and Psychiatry, 1952b, 67, 612–619.PubMedGoogle Scholar
  32. Horan, J.J., and Dellinger, J.K. “In vivo” emotive imagery: A preliminary test. Perceptual and Motor Skills, 1974, 39, 359–362.PubMedCrossRefGoogle Scholar
  33. Horan, J.J., Hackett, G., Buchanan, J.D., Stone, C.I., and Demchik-Stone, D. Coping with pain: A component analysis of stress-inoculation. Cognitive Therapy and Research, 1977, 1, 211–221.CrossRefGoogle Scholar
  34. Hovland, C., Janis, I., and Kelley, H. Communication and persuasion: Psychological studies of opinion change. New Haven: Yale University Press, 1953.Google Scholar
  35. Janis, I. Psychological stress. New York: John Wiley and Sons, 1958.Google Scholar
  36. Johnson, J. Effects of accurate expectation about sensations on the sensory and distress components of pain. Journal of Personality and Social Psychology, 1973, 27, 261–275.PubMedCrossRefGoogle Scholar
  37. Johnson, J., and Leventhal, H. The effects of accurate expectations and behavioral instructions on reactions during a noxious medical examination. Journal of Personality and Social Psychology, 1974, 29, 710–718.PubMedCrossRefGoogle Scholar
  38. Johnson, R.F.Q. Suggestions for pain reduction and response to cold-induced pain. The Psychological Record, 1974, 24, 161–169.Google Scholar
  39. Kanfer, F.H., and Goldfoot, D. Self-control and tolerance of noxious stimulation Psychological Reports, 1966, 18, 79–85.PubMedCrossRefGoogle Scholar
  40. Kanfer, F.H., and Seidner, M. Self-control factors enhancing tolerance of noxious stimulation. Journal of Personality and Social Psychology, 1973, 25, 381–389.PubMedCrossRefGoogle Scholar
  41. azdin, A.E. Covert modeling and the reduction of avoidance behavior. Journal of Abnormal Psychology, 1973, 81, 87–95.CrossRefGoogle Scholar
  42. Kazdin, A.E. Covert modeling, model similarity, and reduction of avoidance behavior. Behavior Therapy, 1974, 5, 325–340.CrossRefGoogle Scholar
  43. Knox, V.J. Cognitive strategies for coping with pain: Ignoring vs. acknowledging. Unpublished doctoral dissertation, University of Waterloo, 1972.Google Scholar
  44. Langer, E., Janis, I., and Wolfer, J. Reduction of psychological stress in surgical patients. Journal of Experimental Social Psychology, 1975, 1, 155–166.CrossRefGoogle Scholar
  45. Lazarus, R.S. Psychological stress and the coping process. New York: McGraw-Hill, 1966.Google Scholar
  46. Lazarus, R.S., Averill, J.N., and Opton, E.M., Jr. The psychology of coping: Issues of research and assessment. In G. Coelho, D. Hamburg, and J. Adams (Eds.), Coping and adaptation. New York: Basic Books, Inc., Publishers, 1974.Google Scholar
  47. Levendusky, P., and Pankratz, L. Self-control techniques as an alternative to pain medication. Journal of Abnormal Psychology, 1975, 84, 165–168.PubMedCrossRefGoogle Scholar
  48. Lewinsohn, P. Depression: A clinical-research approach. Paper presented at the Washington-Oregon Psychological Association joint meeting. Crystal Mountain, Washington, 1968.Google Scholar
  49. Liebeskind, J.C., and Paul, L.A. Psychological and physiological mechanisms of pain. Annual Review of Psychology, 1977, 28, 41–60.PubMedCrossRefGoogle Scholar
  50. Mahoney, M.J. Cognition and behavior modification. Cambridge, Mass.: Ballinger Publishing Company, 1974.Google Scholar
  51. McGlashan, R., Evans, F., and Orne, M. The nature of hypnotic analgesia and placebo response to experimental pain. Psychosomatic Medicine, 1969, 31, 227–246.PubMedGoogle Scholar
  52. Meichenbaum, D. Examination of model characteristics in reducing avoidance behavior. Journal of Personality and Social Psychology, 1971, 17, 298–307.CrossRefGoogle Scholar
  53. Meichenbaum, D. Cognitive modification of test anxious college students. Journal of Consulting and Clinical Psychology, 1972, 39, 370–380.PubMedCrossRefGoogle Scholar
  54. Meichenbaum, D. Cognitive factors in behavior modification: Modifying what clients say to themselves. In C. Franks and T. Wilson (Eds.), Annual review of behavior therapy: Theory and practice. New York: Brunner/Mazel, 1973.Google Scholar
  55. Meichenbaum, D. Self-instruction and the therapeutic modification of self-statements or cognitive-behavior therapy. Paper presented at the eighth annual convention of the Association for the Advancement of Behavior Therapy, Chicago, Ill., 1974.Google Scholar
  56. Meichenbaum, D. A self-instructional approach to stress management: A proposal for stress inoculation. In C. D. Spielberger and I.G. Sarason (Eds.), Stress and Anxiety (Vol. 1 ). Washington, D.C.: Hemisphere Publishing Corporation, 1975.Google Scholar
  57. Meichenbaum, D. Cognitive-behavior modification: An integrative approach. New York: Plenum Publishing Company, 1977.Google Scholar
  58. Meichenbaum, D., and Cameron, R. Stress inoculation: A skills training approach to anxiety management. Unpublished manuscript, University of Waterloo, 1973.Google Scholar
  59. Meichenbaum, D., and Turk, D. The cognitive-behavioral management of anxiety, anger, and pain. In P. Davidson (Ed.), The behavioral management of anxiety, depression, and pain. New York: Brunner/Mazel, 1976.Google Scholar
  60. Meichenbaum, D., Turk, D., and Burstein, S. The nature of coping with stress. In I. G. Sarason and C.D. Spielberg (Eds.), Stress and anxiety (Vol. 2 ). New York: Hemisphere Publishing Corporation, 1975.Google Scholar
  61. Melzack, R. The puzzle of pain. Harmondsworth, England: Penguin, 1973.Google Scholar
  62. Melzack, R., and Casey, K. Sensory, motivational and central control determinants of pain: A new conceptual model. In D. Kenshalo (Ed.), The skin senses. Springfield, Illinois: Charles C Thomas, 1968.Google Scholar
  63. Melzack, R., and Casey, K. The affective dimension of pain. In M. Arnold (Ed.), Feelings and emotions. New York: Academic Press, 1970.Google Scholar
  64. Melzack, R., and Scott, T. The effects of early experience on the response to pain. Journal of Comparative and Physiological Psychology, 1957, 50, 155.PubMedCrossRefGoogle Scholar
  65. Melzack, R., and Wall, P. Pain mechanisms: A new theory. Science, 1965, 150, 971.PubMedCrossRefGoogle Scholar
  66. Mulcahy, R., and Janz, N. Effectiveness of raising pain perception threshold in males and females using a psychoprophylactic childbirth technique during induced pain. Nursing Research, 1973, 22, 423–427.PubMedCrossRefGoogle Scholar
  67. Nathan, P.W. The gate-control theory of pain: A critical review. Brain, 1976, 99, 123–158.PubMedCrossRefGoogle Scholar
  68. Neufeld, R., and Davison, P. The effects of vicarious and cognitive rehearsal in pain tolerance. Journal of Psychosomatic Research, 1971, 15, 329–335.PubMedCrossRefGoogle Scholar
  69. Novaco, R.W. The treatment of chronic anger through cognitive and relaxation controls. Journal of Consulting and Clinical Psychology, 1976, 44, 681.PubMedCrossRefGoogle Scholar
  70. Novaco, R.W. A stress inoculation approach to anger management in the training of law enforcement officers. American Journal of Community Psychology, 1977, 5, 327–346.PubMedCrossRefGoogle Scholar
  71. Orne, M.T. Psychological factors maximizing resistance to stress with special reference to hypnosis. In S. Klausner (Ed.), The quest for self-control. New York: Free Press, 1965.Google Scholar
  72. Paul, G.L. Insight vs. desensitization in psychotherapy: An experiment in anxiety reduction. Stanford: Stanford University Press, 1966.Google Scholar
  73. Pavlov, I.P. Conditioned reflexes. Milford, 1927.Google Scholar
  74. Pavlov, I.P. Lectures on conditioned reflexes. International Publishers, 1928.Google Scholar
  75. Petrie, A. Individuality in pain and suffering. Chicago: University of Chicago Press, 1967.Google Scholar
  76. Pilowsky, I. Dimensions of abnormal illness behavior. Australian and New Zealand Journal of Psychiatry, 1975, 9, 141–147.PubMedCrossRefGoogle Scholar
  77. Reeves, J.L. EMG-biofeedback reduction of tension headaches: A cognitive skills-training approach. Biofeedback and self-regulation, 1976, 1, 217–227.CrossRefGoogle Scholar
  78. Richardson, F.C., and Suinn, R.M. A comparison of traditional systematic desensitization, accelerated massed desensitization, and anxiety management training in the treatment of mathematics anxiety. Behavior Therapy, 1973, 4, 212–218.CrossRefGoogle Scholar
  79. Sachs, L.B., Feuerstein, M., and Vitale, J.H. Hypnotic self-regulation of chronic pain. Paper presented at American Psychological Association annual convention, Washington, D.C., 1976.Google Scholar
  80. Sanchez-Craig, B.M. A self-control strategy for drinking tendencies. Ontario Psychologist, 1975, 7, 25–29.Google Scholar
  81. Sarason, I.G. Test anxiety and cognitive modeling. Journal of Personality and Social Psychology, 1973, 28, 58–61.PubMedCrossRefGoogle Scholar
  82. Sarbin, T. Imagining as muted role-taking: A historical-linguistic analysis. In P. Sheehan (Ed.), The function and nature of imagery. New York: Academic Press, 1972.Google Scholar
  83. Schachter, S. The interaction of cognitive and physiological determinants of emotional state. In C.D. Spielberger (Ed.), Anxiety and behavior. New York: Academic Press, 1966.Google Scholar
  84. Shor, R. Physiological effects of painful stimulation during hypnotic analgesia under conditions designed to minimize anxiety. International Journal of Clinical and Experimental Hypnosis, 1962, 10, 183–202.PubMedCrossRefGoogle Scholar
  85. Smith, G., Chiang, H., and Regina, E. Acupuncture and experimental psychology. Paper presented at symposium, Pain and Acupuncture, Philadelphia, 1974.Google Scholar
  86. Smith, G., Egbert, L., Markowitz, R., Mosteller, F., and Beecher, H. An experimental pain method sensitive to morphine in man: The submaximum effort tourniquet technique. Journal of Pharmacology and Experimental Therapeutics, 1966, 154, 324–332.PubMedGoogle Scholar
  87. Staub, E., Tursky, B., and Schwartz, G. Self-control and predictability: Their effects on reactions of aversive stimulation. Journal of Personality and Social Psychology, 1971, 18, 157–162.PubMedCrossRefGoogle Scholar
  88. Sternbach, R. Pain patients: Traits and treatments. New York: Academic Press, 1974. Suinn, R.M. Removing emotional obstacles to learning and performance by visuomotor rehearsal. Behavior Therapy, 1972, 3, 308–310.CrossRefGoogle Scholar
  89. Suinn, R.M., and Richardson, F. Anxiety management training: A nonspecific behavior therapy program for anxiety control. Behavior Therapy, 1971, 2, 498–510.CrossRefGoogle Scholar
  90. Turk, D.C. Cognitive control of pain: A skills-training approach. Unpublished master’s thesis, University of Waterloo, 1975.Google Scholar
  91. Turk, D.C. A coping skills-training approach for the control of experimentally-produced pain. Unpublished doctoral dissertation, University of Waterloo, 1977a.Google Scholar
  92. Turk, D.C. A coping skills-training approach for control of experimentally-produced pain—training manual. Unpublished manuscript. Yale University, 1977b.Google Scholar
  93. Turk, D.C. Application of coping-skills training to the treatment of pain. In C.D. Spielberger and I.G. Sarason (Eds.), Stress and anxiety (Vol. 5 ). New York: Brunner/Mazel, 1978.Google Scholar
  94. Turk, D.C., and Meichenbaum, D. Cognitive behavior modification of pain. Paper presented at tenth annual convention of the Association for the Advancement of Behavior Therapy, New York, 1976.Google Scholar
  95. Tursky, B. Laboratory approaches to the study of pain. In D.I. Mostofsky (Ed.), Behavioral control and modification of physiological activity. Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1976.Google Scholar
  96. Wolff, B., and Langley, S. Cultural factors and the response to pain: A review. American Anthropologist. 1968, 70, 494–501.CrossRefGoogle Scholar
  97. Wolpe, J. Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press, 1958.Google Scholar
  98. Zimbardo, P. The cognitive control of motivation: The consequences of choice and dissonance. Glenview, Illinois: Scott, Foresman, and Co., 1969.Google Scholar

Copyright information

© Plenum Press, New York 1978

Authors and Affiliations

  • Dennis C. Turk
    • 1
  1. 1.Department of PsychologyYale UniversityNew HavenUSA

Personalised recommendations