The Barbell Psychology approach combines barbell-based strength training with pain psychology to empower you to self-manage your pain, get strong, and live life to the fullest.
Understanding persistent pain
The peak body for the scientific study of pain worldwide, the IASP, officially defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”1.
Although pain is often associated with physical damage to parts of the body (like a bone fracture or muscle tear), this is not always the case, particularly with chronic pain. Often, pain can occur without tissue damage (and vice‐versa).
Your brain uses information from a variety of different sources to influence your experience of pain, based on its perception of potential threat to your body.
This is a highly complex process which is influenced by a wide range of biological, psychological and environmental factors4.
The greater the perceived need to take action to avoid a threat, the greater the pain you will tend to experience.
When it’s working the way it’s ‘supposed’ to, pain warns you of threats to your body, and keeps you safe. However, this system isn’t perfect – at times your pain system can be triggered even when your body isn’t in any danger.
Chronic or persistent pain is simply defined as pain lasting more than three months5. Once pain has continued for beyond this length of time, it often behaves quite differently to short‐term or acute pain, and can cause other problems like anxiety and depression.
Chronic pain is sometimes associated with a prior musculoskeletal injury or chronic health condition (e.g. multiple sclerosis, fibromyalgia), but often has no clear biological origin at all6.
When pain has persisted for a long time, your pain system can become over‐protective and no longer provide helpful information about potential threats to your body. In this case, it may be possible to ‘retrain’ your pain system to be less protective.
While medications, surgery, steroid injections, acupuncture and other so-called ‘passive’ treatments can often help to reduce pain in the short‐term, ‘active’ psychological and movement‐based therapies, which address the pain system as a whole, tend to be more helpful for persistent pain in the long‐term6.
How psychology can help
Sometimes people are surprised to learn that psychological therapy can be a highly effective tool for people with chronic pain. However, it makes perfect sense when you understand that pain is a highly-complex experience with multiple inputs – and that the psychological and environmental inputs are often especially important in chronic pain4.
Furthermore, because chronic pain can affect your overall mental health and many other aspects of your life, the most impactful interventions for chronic pain are those that focus on the whole person, not just the specific body parts that hurt6.
Does this mean that persistent pain is ‘all in your head’? No, absolutely not!
Although pain is something your brain helps to create (and yes, of course, your brain is in your head, literally speaking), it’s very real, and you certainly can’t get rid of it with so‐called ‘positive thinking’ or ‘mind‐over‐matter’.
Instead, psychological therapy works by addressing the psychological and contextual factors that influence (and are influenced by) pain and helps you, on the one hand, to be less negatively impacted by pain and, on the other, to retrain your over‐protective pain system gradually over time.
One particular psychological treatment approach, which has been shown to be effective for people with persistent pain, is acceptance and commitment therapy (ACT).
ACT is a mindfulness‐based behaviour therapy which focuses on helping individuals engage in life‐ enhancing (and pain‐retraining) behaviours by changing the way they experience their thoughts, feelings and sensations (including pain)7.
Numerous systematic reviews and meta‐analyses of clinical trials have demonstrated that ACT can be effective for managing chronic pain8; that ACT tends to significantly increase pain acceptance9, psychological flexibility9, physical wellbeing10, functioning9 and quality of life10,11; and significantly reduce pain intensity10,11, pain interference11, anxiety9,10,11, depression9,10,11 and disability11,12.
Strength training with chronic pain
Strength training (also referred-to as resistance training) simply refers to the process of using certain types of exercises to gradually increase your body’s ability to produce force.
This increase in strength occurs through a cycle of work and adaptation – a load is applied to the muscles and other tissues of the body when the exercises are performed, and a favourable adaptation occurs as a result.
As well as being vital for general physical health – World Health Organisation13 and Australian government14 guidelines recommend at least two days per week of muscle strengthening exercises – strength training is particularly beneficial for chronic pain patients.
Strength training has been shown to improve physical functioning and reduce pain in a wide variety of persistent pain conditions including fibromyalgia15,16,17, axial spondyloarthritis18, osteoarthritis19,17, rheumatoid arthritis17, low back pain17,20, spinal cord injury17, and patellofemoral pain17.
Strength training has also been demonstrated to significantly reduce symptoms of depression21 and anxiety22, both of which frequently occur alongside chronic pain.
There is a huge variety of exercise equipment that can be utilized in strength training, including resistance bands, weight machines, kettlebells, dumbbells and barbells – however, barbells are particularly useful for strength training and, in our opinion, a lot of fun!
Barbells usually enable you to lift heavier weights than other equipment allows; they can be incrementally loaded to allow you to systematically progress your training; they are ideal for whole‐body movements that engage lots of joints and muscles all at once; and they help to develop balance and coordination as well as strength.
For these reasons, barbells are the most widely used strength training equipment in strength sports such as powerlifting, weightlifting, strongman, bodybuilding and CrossFit.
Barbell training is also extremely safe. A review of 20 studies examining injury risk concluded that barbell sports have an injury rate of just two to four injuries per 1000 hours of participation, the majority of which are of minor severity. For comparison, sports like soccer, rugby and cricket, have injury rates of 15 to 81 injuries per 1000 hours.23
The Barbell Psychology difference
While it’s clear that both psychological therapy and strength training can each be extremely beneficial on their own, Barbell Psychology is a genuine whole‐person approach for individuals with persistent pain.
Because pain is not simply a biological phenomenon (nor a solely psychological one), but a complex ‘biopsychosocial’ experience, treatments that combine exercise with psychological therapy are recommended in clinical guidelines for the management of chronic pain2,24.
Indeed, a recent study of an eight‐week treatment program for people with persistent pain combining ACT with exercise, just like the Barbell Psychology ReTrain program, found significant decreases in pain intensity, pain interference, anxiety and depression, and improved overall psychological wellbeing25.
In short, Barbell Psychology is a whole-person approach that puts you – the person with pain – at the centre of treatment and gives you the tools to take back control, effectively and confidently manage your pain, get strong, and live life to the fullest.
- Raja, S. N., Carr, D.B., Cohen, M., Finnerup, N.B., Flor, H., Gibson, S., Keefe, F.J., Mogil, J.S., Ringkamp, M., Sluka, K.A., Song, X.J., Stevens, B., Sullivan, M.D., Tutelman, P.R., Ushida, T., Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. PAIN, 161(9), 1976-1982.
- Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., O’Sullivan, P. P. B. (2019). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British Journal of Sports Medicine, 54(2), 79–86.
- Hoy, D., March, L., Brooks, P., Blyth, F., Woolf, A., Bain, C., Buchbinder, R. (2014). The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73(6), 968–974.
- Main, C. J. (2013). The importance of psychosocial influences on chronic pain. Pain Management, 3(6), 455–466.
- Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Kosek, E., Lavandʼhomme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., Smith, B. H., Svensson, P., Wang, S. J. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003–1007.
- Mardian, A. S., Hanson, E. R., Villarroel, L., Karnik, A. D., Sollenberger, J. G., Okvat, H. A., Rehman, S. (2020). Flipping the Pain Care Model: A Sociopsychobiological Approach to High-Value Chronic Pain Care. Pain Medicine.
- Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2016). Acceptance and commitment therapy: the process and practice of mindful change. New York: Guilford Press.
- Simpson, P. A., Mars, T., & Esteves, J. E. (2017). A systematic review of randomised controlled trials using Acceptance and commitment therapy as an intervention in the management of non- malignant, chronic pain in adults. International Journal of Osteopathic Medicine, 24, 18–31.
- Hughes, L. S., Clark, J., Colclough, J. A., Dale, E., & Mcmillan, D. (2017). Acceptance and Commitment Therapy (ACT) for Chronic Pain. The Clinical Journal of Pain, 33(6), 552–568.
- Veehof, M. M., Oskam, M.-J., Schreurs, K. M., & Bohlmeijer, E. T. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152(3), 533–542.
- Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. (2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive Behaviour Therapy, 45(1), 5–31.
- Vowles, K., Fink, B., & Cohen, L. (2014). (543) Acceptance and Commitment Therapy for chronic pain: a diary study of treatment process in relation to reliable change in disability. The Journal of Pain, 15(4).
- World Health Organization. Global Recommendations on Physical Activity for Health (2010).
- Australia’s Physical Activity and Sedentary Behaviour Guidelines and the Australian 24-Hour Movement Guidelines. (n.d.). Retrieved from https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys- act-guidelines#npa1864.
- Busch, A. J., Webber, S.C., Richards, R.S., Bidonde, J., Schachter, C.L., Schafer, L.A., Danyliw, A., Sawant, A., Dal Bello-Haas, V., Rader, T., & Overend, T.J. (2013). Resistance exercise training for fibromyalgia. Cochrane Database of Systematic Reviews, 12. Art. No.: CD010884.
- Hooten, M. W., Qu, W., Townsend, C. O., & Judd, J. W. (2012). Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia: A randomized equivalence trial. Pain, 153(4), 915–923.
- Geneen, L., Smith, B., Clarke, C., Martin, D., Colvin, L. A., & Moore, R. A. (2014). Physical activity and exercise for chronic pain in adults: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews.
- Sveaas, S. H., Bilberg, A., Berg, I. J., Provan, S. A., Rollefstad, S., Semb, A. G., Dagfinrud, H. (2019). High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients. British Journal of Sports Medicine.
- Oral, A., & Ilieva, E. (2011). Physiatric approaches to pain management in osteoarthritis: a review of the evidence of effectiveness. Pain Management, 1(5), 451–471.
- Owen, P. J., Miller, C. T., Mundell, N. L., Verswijveren, S. J., Tagliaferri, S. D., Brisby, H., Belavy, D. L. (2019). Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. British Journal of Sports Medicine.
- Chekroud, S. R., & Chekroud, A. M. (2018). Efficacy of Resistance Exercise Training With Depressive Symptoms. JAMA Psychiatry, 75(10), 1091.
- Gordon, B. R., Mcdowell, C. P., Lyons, M., & Herring, M. P. (2017). The Effects of Resistance Exercise Training on Anxiety: A Meta-Analysis and Meta-Regression Analysis of Randomized Controlled Trials. Sports Medicine, 47(12), 2521–2532.
- Keogh, J. W. L., & Winwood, P. W. (2016). The Epidemiology of Injuries Across the Weight- Training Sports. Sports Medicine, 47(3), 479–501.
- SIGN (2013). Management of chronic pain. Scottish Intercollegiate Guidelines Network Publication No., 136. Retrieved from https://www.sign.mac.uk/sign-136-management-of-chronic- pain.html.
- Casey, M. B., Cotter, N., Kelly, C., Elchar, L. M., Dunne, C., Neary, R., Doody, C. (2020). Exercise and Acceptance and Commitment Therapy for Chronic Pain: A Case Series with One-Year Follow-Up. Musculoskeletal Care.