Chronic Pain Worksheet (Printable) | DBT Pain Management & Symptom Tracking Tool
DBT Chronic Pain Tracking & Coping Worksheet
Pain Awareness • Distress Tolerance • Emotional Regulation • Self-Compassion
Mark Zauss, LMHC, LPC, CCMHC, NBCC, BC-TMC, ADHD-CCSP, C-DBT, CCTP, CCPT II
Double Board Certified Counseling Services, Inc.
Purpose of This Worksheet
Chronic pain affects the body, nervous system, mood, sleep, attention, and daily functioning. This worksheet uses DBT-based skills to help track pain patterns, reduce emotional suffering, improve coping, and support more effective communication with providers. The goal is not to “pretend pain is not real.” The goal is to reduce the secondary suffering that often comes from fear, frustration, avoidance, hopelessness, and emotional exhaustion.
Client Information
1. Pain Tracking
2. Body Awareness & Nervous System Response
3. DBT Mindfulness: Observe Without Judgment
Pain is real. Mindfulness does not deny pain. It helps separate the physical sensation from fear-based thoughts, judgment, and emotional escalation.
4. DBT Distress Tolerance Skills Used
Use these when pain is intense and you need to get through the moment without making things worse.
5. Emotion Regulation: Pain + Mood Connection
6. Pacing & Activity Balance
Chronic pain often worsens with the cycle of overdoing, crashing, resting too long, then overdoing again. Pacing helps reduce flare-ups.
7. Cognitive Reframe: Reducing Secondary Suffering
8. Interpersonal Effectiveness: Communicating About Pain
Use clear communication to ask for help without over-explaining, apologizing excessively, or shutting down.
9. End-of-Day Reflection
Self-Scoring
Complete the ratings, then click Calculate Score.
Clinical Summary
Clinical note: This worksheet is educational and therapeutic in nature. It does not replace medical evaluation or treatment. New, severe, worsening, or unexplained pain should be reviewed by an appropriate medical provider.
References (APA 7th Edition)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Hansen, K. E., & Turner, J. A. (2016). Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain. JAMA, 315(12), 1240–1249. https://doi.org/10.1001/jama.2016.2323
Eccleston, C., Morley, S., & Williams, A. (2013). Psychological approaches to chronic pain management: Evidence and challenges. British Journal of Anaesthesia, 111(1), 59–63. https://doi.org/10.1093/bja/aet207
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. American Psychologist, 69(2), 153–166. https://doi.org/10.1037/a0035747
Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness (Revised ed.). Bantam Books.
Keefe, F. J., Porter, L., Somers, T., Shelby, R., & Wren, A. V. (2013). Psychosocial interventions for managing pain in older adults: Outcomes and clinical implications. British Journal of Anaesthesia, 111(1), 89–94. https://doi.org/10.1093/bja/aet129
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Linton, S. J., & Shaw, W. S. (2011). Impact of psychological factors in the experience of pain. Physical Therapy, 91(5), 700–711. https://doi.org/10.2522/ptj.20100330
McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178–187. https://doi.org/10.1037/a0035623
Otis, J. D. (2007). Managing chronic pain: A cognitive-behavioral therapy approach. Oxford University Press.
Turk, D. C., & Okifuji, A. (2002). Psychological factors in chronic pain: Evolution and revolution. Journal of Consulting and Clinical Psychology, 70(3), 678–690. https://doi.org/10.1037/0022-006X.70.3.678
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
Cherkin, D. C., Sherman, K. J., Balderson, B. H., Cook, A. J., Anderson, M. L., Hawkes, R. J., Hansen, K. E., & Turner, J. A. (2016). Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain. JAMA, 315(12), 1240–1249. https://doi.org/10.1001/jama.2016.2323
Eccleston, C., Morley, S., & Williams, A. (2013). Psychological approaches to chronic pain management: Evidence and challenges. British Journal of Anaesthesia, 111(1), 59–63. https://doi.org/10.1093/bja/aet207
Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. American Psychologist, 69(2), 153–166. https://doi.org/10.1037/a0035747
Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness (Revised ed.). Bantam Books.
Keefe, F. J., Porter, L., Somers, T., Shelby, R., & Wren, A. V. (2013). Psychosocial interventions for managing pain in older adults: Outcomes and clinical implications. British Journal of Anaesthesia, 111(1), 89–94. https://doi.org/10.1093/bja/aet129
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Linton, S. J., & Shaw, W. S. (2011). Impact of psychological factors in the experience of pain. Physical Therapy, 91(5), 700–711. https://doi.org/10.2522/ptj.20100330
McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178–187. https://doi.org/10.1037/a0035623
Otis, J. D. (2007). Managing chronic pain: A cognitive-behavioral therapy approach. Oxford University Press.
Turk, D. C., & Okifuji, A. (2002). Psychological factors in chronic pain: Evolution and revolution. Journal of Consulting and Clinical Psychology, 70(3), 678–690. https://doi.org/10.1037/0022-006X.70.3.678