Chronic Pain & Somatic Symptoms
Somatic Symptom and Related Disorders (DSM-5-TR)
Persistent pain or somatic symptoms with significant psychological components. Includes somatic symptom disorder, illness anxiety, and chronic pain conditions. CBT for chronic pain, clinical hypnotherapy, and acceptance-based approaches have evidence.
Prevalence: ~20% of adults have chronic pain; ~5-7% high-impact chronic pain
Clinical Picture
Chronic pain challenges the mind-body split that runs through Western medicine and much of psychotherapy. Pain is simultaneously a neurobiological event, a psychological experience, and a social phenomenon — and treatment that addresses only one dimension tends to fail. The biopsychosocial model is the accepted framework, but in practice, clients with chronic pain are often shuttled between medical providers ('there's nothing structurally wrong') and mental health providers ('it's all in your head'). Neither is adequate. Effective treatment validates the reality of pain while expanding the client's understanding of how psychological and social factors modulate the pain experience.
Treatment Considerations
CBT for chronic pain has the most robust evidence base and focuses on catastrophizing, fear-avoidance, and activity pacing. ACT-based approaches address the experiential avoidance that often amplifies suffering. Somatic approaches (Somatic Experiencing, Sensorimotor Psychotherapy) work directly with the body's pain responses and the nervous system dysregulation that often accompanies chronic pain. Mindfulness-based interventions (MBSR, MBCT) have good evidence for pain-related distress. For clients whose chronic pain intersects with trauma history, trauma-informed approaches that include body-based work tend to outperform purely cognitive interventions.
20 Therapeutic Approaches
Sorted by evidence tier: guideline-recommended first, then RCT-supported, then emerging/limited evidence.
Related Clinical Vignettes
Sources & References
Prevalence data from NIMH, WHO, and DSM-5-TR field trial publications. Evidence tiers reflect guideline status (APA, NICE, VA/DoD, WHO) and meta-analytic findings as of early 2025. Individual modality citations are listed on each modality page. Full bibliography available on the Sources page.