Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 98 (5), 408-423

Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain


Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain

Peter B O'Sullivan et al. Phys Ther.


Biomedical approaches for diagnosing and managing disabling low back pain (LBP) have failed to arrest the exponential increase in health care costs, with a concurrent increase in disability and chronicity. Health messages regarding the vulnerability of the spine and a failure to target the interplay among multiple factors that contribute to pain and disability may partly explain this situation. Although many approaches and subgrouping systems for disabling LBP have been proposed in an attempt to deal with this complexity, they have been criticized for being unidimensional and reductionist and for not improving outcomes. Cognitive functional therapy was developed as a flexible integrated behavioral approach for individualizing the management of disabling LBP. This approach has evolved from an integration of foundational behavioral psychology and neuroscience within physical therapist practice. It is underpinned by a multidimensional clinical reasoning framework in order to identify the modifiable and nonmodifiable factors associated with an individual's disabling LBP. This article illustrates the application of cognitive functional therapy to provide care that can be adapted to an individual with disabling LBP.


Figure 1.
Figure 1.
Multidimensional factors associated with resilience and vulnerability to disabling low back pain.
Figure 2.
Figure 2.
Triage of low back pain and the contribution of cognitive functional therapy. LBP = low back pain.
Figure 3.
Figure 3.
Radar graphs outlining the multidimensional profile of the 3 cases before and after the cognitive functional therapy (CFT) intervention.
Figure 4.
Figure 4.
Interplay of clinician- and patient-specific factors in the clinical journey with cognitive functional therapy.

Similar articles

See all similar articles

Cited by 11 PubMed Central articles

See all "Cited by" articles


    1. Vos T, Flaxman AD, Naghavi M et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012;380:2163–2196. - PMC - PubMed
    1. Coenen P, Smith A, Paananen M, O’Sullivan P, Beales D, Straker L. Trajectories of low back pain from adolescence to young adulthood. Arthritis Care Res (Hoboken). 2017;69:403–412. - PubMed
    1. Bunzli S, Watkins R, Smith A, Schütze R, O’Sullivan P. Lives on Hold. Clin J Pain. 2013;29:907–916. - PubMed
    1. Hodges PW, Tucker K. Moving differently in pain: a new theory to explain the adaptation to pain. Pain. 2011;152(Supplement):S90–S98. - PubMed
    1. Karayannis NV, Jull GA, Hodges PW. Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey. BMC Musculoskelet Disord. 2012;13:1–24. - PMC - PubMed

Publication types