Healing from chronic pain is a process involving the patience to learn and change. For many individuals, recovery isn’t about finding one perfect method or technique and adhering to it. Instead, it involves shifting from a feeling of danger, intensity, and preoccupation to a sense of safety and ease both mentally and physically. Often, when patients inquire about the time it will take to achieve recovery, we respond that it will take as long as necessary to alleviate fear.
Pain reprocessing therapy (PRT) is a powerful, evidence-based framework that can reduce and even eliminate chronic pain. However, relying on PRT tools with a rigid approach often fails to make a significant impact. Achieving overall health and mental well-being requires flexibility. Patients may naturally seek clear instructions on how to implement PRT perfectly. While we understand this desire and wish there were a quick fix, it’s essential to recognize that such rigidity, intensity, and constant problem-solving can contribute to the development of chronic pain in the first place.
The effectiveness of PRT and other techniques lies not just in the tools themselves, but also in the energy and attitude we bring to their practice. Sometimes, it involves learning how to combine different tools to help the brain and body feel safe again. Remember, the premise of PRT is to help clients achieve a sense of safety. In doing that, we, as therapists, also want to be flexible in our practice and draw on all the skills and techniques we have in our back pocket. And we want to encourage our patients and all of you to do the same.
PRT is often that bridge. It doesn’t replace other evidence-based approaches — it enhances them, deepening their impact by addressing the root of chronic pain: the brain’s misinterpretation of threat and moving toward safety.
According to Dr. Howard Schubiner, PRT helps patients understand why their symptoms occur and how to retrain the brain’s response to pain — offering both insight and practical tools that strengthen other therapeutic approaches. This week, our focus is on integrating other tools into your PRT practice, with the ultimate goal of reducing fear (and pain)!
You can combine PRT with methods such as cognitive-behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), eye movement desensitization and reprocessing (EMDR), internal family systems (IFS), or emotional awareness and expression therapy (EAET), to name a few. A combination of techniques and therapeutic modalities can help patients reduce fear, lower anxiety, alleviate trauma, enhance emotional awareness and expression, and achieve a sense of calm and safety. By integrating these different approaches, you can address the full spectrum of healing and achieve recovery.
Cognitive Behavioral Therapy and Pain Reprocessing Therapy
To provide some background on these modalities, cognitive-behavioral therapy (CBT) is used to challenge distorted thoughts and reframe maladaptive or faulty beliefs. To integrate CBT into your practice of PRT, you can:
- Challenge faulty beliefs about pain and the body.
- Modify behaviors that reinforce unhelpful thoughts and beliefs.
- Lower the stakes when catastrophizing about pain and other stressors, and reduce internal pressure.
CBT has long been considered a gold standard for pain management, with effective results. However, CBT has never achieved the kind of outcomes that PRT did in its first clinical trial published in JAMA Psychiatry. To be clear, we are in no way knocking CBT or saying its techniques are ineffective. In fact, at the PRT Center and our clinic, WellBody Psychotherapy, we often incorporate CBT into our work with patients. But for pain, it seems that CBT alone is not enough to reach recovery. Now, the question is, why might that be? We have a few theories:
- CBT does not aim to eliminate chronic pain — it helps patients manage and live with pain.
- CBT does not address that chronic pain may not be rooted in a physical problem, and therefore lacks the psychoeducation and belief-shifting PRT provides.
- CBT does not incorporate somatic work or retraining the primitive brain — the core mechanism of change in PRT.
We recently conducted a study comparing PRT and CBT for chronic back pain (led by Dr. Yoni Ashar, PhD). While results are not yet published, we are excited to share that PRT significantly outperformed CBT. Stay tuned — we will share updates as soon as the data is public!
Mindfulness-Based Stress Reduction and Pain Reprocessing Therapy
Mindfulness-Based Stress Reduction (MBSR) has been shown to enhance feelings of safety, which is foundational in PRT and pain recovery. We often incorporate MBSR techniques — particularly mindfulness — into PRT. In fact, mindfulness is one of the three components of somatic tracking (along with safety reappraisal and positive affect induction). Here, we focus on mindfulness.
Mindfulness means paying attention to the present moment without judgment. It increases safety, ease, and acceptance. When mindfulness is integrated into somatic tracking, individuals learn to pay attention to pain — the feared stimulus — with less fear. The more someone does this, the more fear decreases, and pain follows.
So why not use MBSR alone to eliminate pain? Research shows MBSR modestly reduces pain, but effects often fade. Why?
- MBSR doesn’t address faulty thoughts and beliefs about pain.
- MBSR does not include psychoeducation about neuroplastic pain.
- It’s difficult to look at pain with ease if you believe the body is damaged or unsafe.
PRT adds the missing link: helping patients understand why sensations are safe and how to approach them with curiosity instead of fear.
Pain Reprocessing Therapy and Other Honorable Mentions
For trauma-focused approaches like EMDR and IFS, PRT complements emotional healing by helping patients reinterpret the physical echoes that remain — the lingering alarm signals that can keep pain patterns active.
In approaches like EAET, where patients access and express long-avoided emotions, PRT reinforces the healing process by helping them stay with the sensations that accompany emotional release — teaching the brain that these feelings are safe, not dangerous.
Together, these approaches create a more complete path to healing. The more directions from which the brain receives safety, the more deeply it learns that the danger has passed. Use what you know — and remember the goal: reduce fear, quiet hypervigilance, and build safety.
Reading Corner
Emotional Agility by Susan David
Emotional Agility emphasizes flexibility with your emotions rather than suppressing or avoiding them. David argues that the key difference between those who thrive and those who struggle is emotional agility — the ability to recognize and accept feelings without letting them dictate behavior.
No matter someone’s intelligence, creativity, or personality, what determines success is how they manage their inner world — thoughts, feelings, and self-talk.
When dealing with chronic pain, emotions such as frustration, sadness, and anxiety are common. David’s work is especially helpful for those in recovery. By cultivating emotional agility, individuals can confront pain-related emotions without becoming overwhelmed. Emotional agility supports self-compassion, reduces rigidity and shame, and encourages adaptive coping — all of which enhance well-being and support recovery.