Self-directed cognitive behavioral therapy may help alleviate chronic pain
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- Reviewed by Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Many people live with chronic musculoskeletal pain (such as back, neck, hip, knee, or other joint pain), which can be more challenging to treat than short-term pain. Yet there are effective treatment approaches, including cognitive behavioral therapy (CBT), a type of therapy that helps you reframe the way you think about pain and develop coping strategies. However, CBT is underused, possibly due to such barriers as time constraints or difficulty in finding a provider.
A study published in the August 4, 2026, issue of JAMA found that a largely self-directed version of CBT might offer a solution. In the study, self-managed CBT was even more effective than the standard CBT with a therapist.
Researchers enrolled 764 veterans from nine Veterans Administration health systems who had longstanding musculoskeletal pain of at least moderate severity. They were randomly assigned to two groups. One group received the usual CBT for chronic pain delivered by a clinician, which included four to 11 weekly in-person, video, or telephone sessions. The second group had a self-directed CBT program for 11 weeks. Participants learned pain management skills that they practiced on their own and received weekly personalized feedback from a coach.
After four months, the researchers measured how much pain affected the participants’ daily activities, mood, and enjoyment of life. Those using the self-directed approach had slightly more improvement in how much pain interfered with their daily lives, which was sustained for up to one year. They also completed more intended treatment sessions than those receiving usual clinician-delivered CBT.
Books and online programs can teach you CBT techniques to identify and change negative thoughts and behaviors with the goal of relieving chronic pain. You can also learn these techniques from a trained professional and then practice CBT on your own.
Image: © grinvalds/Getty Images
About the Author
Lynne Christensen, Staff Writer
About the Reviewer
Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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