My viewpoint of Cognitive Functional Therapy.

Cognitive Functional Therapy (CFT) is the combination of bio-pyschosocial care (not bio-medical), cognitive behavioural therapy, motivational interviewing and exercise. It is a comprehensive and sound therapy model:) The model has been proposed and developed by Peter O’Sullivan. He created the model primarily for chronic low back pain but I see commonalities in the CFT approach with those of Jeremy Lewis, Adam Meakins, Greg Lehman, Bahram Jam, Sandy Hilton, and Lorimer Moseley.  The recognize the unique needs and varying levels of complexity of each patient. CFT attempts to identify the most pressing needs of each individual and confront fears and beliefs through education, exercise, and behaviour change.

What is bio-psychosocial care? “The biopsychosocial model is a broad view that attributes disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical, etc), psychological factors (mood, personality, behavior, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.)” Link. A physiotherapist considers how each of these areas may influence an outcome.

What is cognitive behavioural therapy? “During CBT, patients have the opportunity to work with a therapist to find the source of negative thinking and transform those thoughts into a positive, growth mindset. The ultimate goal of CBT is to replace negative thoughts and actions with productive behaviors that make the individual feel equipped to overcome any difficult moment.” Link. A physiotherapist will use techniques to confront negative associations with movement, try to reframe the relationship.

What is motivation interviewing? “Motivational interviewing is a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. It is a practical, empathetic, and short-term process that takes into consideration how difficult it is to make life changes.” Link. A physiotherapist must listen well, pay close attention to individual drives and attempt to increase motivation from within.

What is exercise therapy? Exercise therapy uses principles of graded exposure, pain edge principles, exposure therapy, and meaningful activities to elicit positive change through exercise. A combination of targeted exercise and global exercise are used to build capacity, confront fears,  and offer a myriad of health benefits. Careful attention is paid to meet clients at their level, to chose meaningful activities, and to explain ways to regress and progress exercise.

What is patient education? It is the process of offering relevant, well planned information to help foster a greater understanding of the pain process. As often as possible it should be tailored to a patients style – video, infographics, written – and should allow for reflection and questions. Lorimer Moseley just wrote a nice piece in the British Journal of Sports Medicine on this topic.

What are shared action plans? I prefer to use “if then” statements of action. This provides patients with a clear trigger and resulting action. The action plan is guided by the physiotherapist and lead by the patient. The physiotherapist must ask “what did you take away from this session, what do you see as important next steps?”

By using the above approaches the physiotherapists end goal is to have patients back moving following a musculoskeletal injury or pain episode. It is not meant to be quick fix (although sometimes it is) but a process of learning and facilitating. The better equipped we are to coach and facilitate healing the better off our patients will be.

As stated above CFT was developed for disabling low back pain but I believe this holistic approach can be used for a host of Msk conditions in both short and long term cases. In my view the use of such an approach for episodic injuries would improve outcomes and lessen likelihood for persistent pain to occur. It would be interesting to see the approach used in clinical trials for other injuries and pain episodes.

Follow the links in this blog and see how CFT might fit into your practice. Thanks for reading,
Dave Carter