Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain

Abstract

Biomedical approaches for diagnosing and managing disabling low back pain (LBP) have failed to arrest the exponential increase in health care costs, with a concurrent increase in disability and chronicity. Health messages regarding the vulnerability of the spine and a failure to target the interplay among multiple factors that contribute to pain and disability may partly explain this situation. Although many approaches and subgrouping systems for disabling LBP have been proposed in an attempt to deal with this complexity, they have been criticized for being unidimensional and reductionist and for not improving outcomes. Cognitive functional therapy was developed as a flexible integrated behavioral approach for individualizing the management of disabling LBP. This approach has evolved from an integration of foundational behavioral psychology and neuroscience within physical therapist practice. It is underpinned by a multidimensional clinical reasoning framework in order to identify the modifiable and nonmodifiable factors associated with an individual's disabling LBP. This article illustrates the application of cognitive functional therapy to provide care that can be adapted to an individual with disabling LBP.

Lumbar range of motion in chronic low back pain is predicted by task‐specific, but not by general measures of pain‐related fear

“…In this respect, a treatment called “cognitive functional therapy” (CFT) has been recently developed in the physical therapy field (O'Sullivan et al, ). Cognitive functional therapy is a multidimensional behavioural approach combining graded exposure therapy with physical treatments (e.g.…”

STarT Back Tool risk stratification is associated with changes in movement profile and sensory discrimination in low back pain: A study of 290 patients

“…Protective behaviours are considered maladaptive responses to feared, threatening and/or painful activities reflecting a person's attempt to enhance their perception of control and safety (O'Sullivan et al, ). Slower bending times and greater protective behaviours exhibited by the high‐risk subgroup may be influenced by greater pain summation (Hodges & Smeets, ) or altered muscle activity with repeated movement (Falla, Gizzi, Tschapek, Erlenwein, & Petzke, ).…”

Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations

“…It is increasingly advocated that training multidisciplinary team members in CB or motivational interviewing techniques would enhance communication, collaboration and thus patient adaptation, acceptance and behaviour change, all necessary for self-managing long-term conditions. 123,124 Research evidence on the DISCUSSION AND CONCLUSIONS NIHR Journals Library www.journalslibrary.nihr.ac.uk success of these techniques by non-psychologists as a way of supporting specific patient groups or specific health problems is now emerging. 30,125 All of these approaches reduce the reliance on traditional didactic information or instruction-giving and consider the 'whole person', including how their beliefs affect symptoms and behaviours.…”

“…A number of health professional undergraduate programmes and hospital trusts now include short training on these for students and staff, and detailed guidance on the use of some of these open and reflective skills in patient encounters can be found. 124 The RAFT programme was tested in seven different NHS hospital settings using existing clinicians, some of whom had a degree of prior relevant experiences, such as CB training or group work, whereas others had none at all (unlike other fatigue interventions in which clinical staff had to be experienced in group work in order to deliver the intervention). 99 The RAFT programme could be successfully delivered in terms of scheduling the programmes and managing tutor absence and sickness.…”