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CBT Techniques Can Change the Brain to Move Past Trauma and Chronic Pain

January 7, 2019
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CBT Techniques Can Change the Brain to Move Past Trauma and Chronic Pain


Whoever said ‘you can’t teach an old dog new tricks’ obviously knew nothing of neuroplasticity. Science has taught us that the brains of humans (and, yes, dogs) are constantly changing in response to an array of external and internal stimuli.

Neuroplasticity is the ability of the brain to change, allowing us to learn new skills and tasks. Medical imaging scans of the brain have given us physical proof.

But the brain can also change in response to negative forces, sometimes leaving the person feeling stuck in an emotional and physical nightmare. We see this with injured workers affected by trauma and/or chronic pain who have delayed recoveries long after their initial physical injury has healed. Fortunately, specialists with a deep understanding of neuroplasticity are able to help these injured workers return to function and work.

Trauma, Chronic Pain and The Brain

Trauma and chronic pain are often linked. A traumatic event, such as workplace violence, an auto accident or a horrific workplace accident may result in both chronic pain and posttraumatic stress disorder (PTSD).

Statistics show the prevalence of PTSD is substantially increased in people with chronic pain. One study showed the rate of PTSD in chronic pain patients was 35 percent, compared to just 3.5 percent of the general population. In another study, 50 percent of patients with chronic pain following a motor vehicle accident developed PTSD.

One of the symptoms of PTSD is the person’s reaction to triggers that remind him of the traumatic event; he may become emotionally or physically upset. For some people, the presence of chronic pain can serve as a trigger, which exacerbates the PTSD.

PTSD stems from the effects of trauma — psychological and physiological — rather than the type of trauma itself. Injured workers who understand this and what happens to the brain when they experience trauma and chronic pain can begin to accept the treatments that will help them recover.

A traumatic event has the same effect on the brain as an injury; survival instincts kick in and the fight/flight/freeze response is activated. What’s happening is the neurotransmitter signals from the affected area travel up the small peripheral nerves through the spinal cord to the emotional, thinking and finally, the action part of the brain, which sends the pain signal back down the spinal cord and tells our body to move out of harm’s way. This quick sequence of events keeps us safe.

With chronic pain, the brain turns on the pain receptors long after the injured tissues have healed. It is similar with trauma in that, some survivors keep experiencing the incident over and over due to certain triggers. The trauma is long over, but the brain won’t allow the injured worker to move beyond it. Injured workers with trauma and chronic pain need tools to develop new brain pathways that allow them to become unstuck.

There’s an expression we often use in our work with trauma/chronic pain patients: ‘neurons that fire together wire together.’ Understanding this is key to helping injured workers with trauma/chronic pain.

We literally grow new ‘maps’ in our brains, along with new brain cells and neural connections throughout our lives. With chronic pain and trauma, the negative thoughts and emotions essentially grow, taking up more space in the brain.

Experience can change neuronal structure. In the case of trauma, the experience of it changes the brain. Neurons that fire at the same time repeatedly wire together through chemical changes, creating a bond that connects them and makes them stronger.

What is needed is to get the brain focused on something different, something more positive, so different neurons can fire together, creating pathways for new skills that help the injured worker move away from the trauma/chronic pain.

One of the most effective treatments for this is cognitive behavioral therapy (CBT). CBT helps injured workers grow new neuro pathways, so they eventually replace those associated with the trauma and chronic pain.

Learning something new and different helps carve out a new pathway in the brain. Whatever the activity or task is, repetition eventually makes it become second nature. This is the rewiring of the brain that CBT teaches.

CBT involves a variety of techniques the injured worker uses to create new pathways in the brain. The techniques vary, depending on the individual.

Our COPE with Trauma program, for example, involves a 90-minute assessment with the patient during which the traumatic incident and symptoms are discussed. A plan of action with patient-specific treatment goals is then agreed upon by the psychologist and injured worker.

The plan typically takes between 4 and 12 weeks and is geared to solutions and problem solving. The injured worker is taught specific skills and assigned homework to continue reinforcing what he has learned in the sessions. Ultimately, the injured worker becomes responsible for his own care, rather than looking to the employer, medical provider or someone else for answers.


Recovering from trauma and chronic pain is not easy and can be frustrating. It takes the injured worker out of his comfort zone and requires him to take actions that are uncomfortable. But the lessons he learns are often life-changing. Those who engage in the process learn to accept and cope with their situations and lead functional lives.

Ascellus – Integrated Medical Case Solutions – is the premier behavioral medicine network for pain and trauma response with evidence-based outcomes and a proven track record for transforming workers’ compensation cases. Ascellus makes intervention efficient with a national network of 1,500+ psychologists and psychiatrists in all 50 states.


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Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.