Chronic Pain Formulation

When to use the Chronic Pain Formulation

The Chronic Pain Formulation is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for chronic pain.

It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device — or download it as a print-ready PDF.

How it works

The Chronic Pain Formulation is a guided formulation canvas: you take a single recent situation and map it across the five connected areas of the cognitive model — the trigger, the thoughts that arise, the emotions felt, the physical sensations, and the behaviours that follow — to reveal the cycle that keeps a difficulty going.

Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.

The CBT approach behind it

In common with other CBT methods, the Chronic Pain Formulation works by mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going — and practical, testable ways to change it.

Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.

Evidence & sources

This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:

• Vlaeyen, J.W.S. & Linton, S.J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain. Pain, 85(3), 317-332. doi:10.1016/S0304-3959(99)00242-0
• Turk, D.C. & Winter, F. (2006). The Pain Survival Guide. Washington, DC: APA.