Cognitive Functional Therapy

The aim of this section is to:

a) Provide a brief overview of cognitive functional therapy for low back pain

b) Provide links to multimedia resources and academic publications on cognitive functional therapy to further your understanding of cognitive functional therapy

What is Cognitive Functional Therapy?

Cognitive Functional Therapy (CFT) is an individualized behavioral approach for managing disabling low back pain. It was developed from a combination of behavioral psychology, neuroscience and physical therapy by  Professor Peter O’Sullivan and his research team.

Peter is a Specialist Musculoskeletal Physiotherapist within the Australian College of Physiotherapists and is a Professor of Musculoskeletal Physiotherapy at Curtin University. He has more than 100 published research papers and is an internationally recognized clinician, researcher and educator in Physiotherapy and specializes in the diagnosis and management of persistent pain disorders.

What conditions is Cognitive Functional Therapy useful for?

CFT can be used in the management of any chronic pain conditions and the principles can be applied to individuals with pain that has persisted beyond tissue healing times.


What does Cognitive Functional Therapy consist of?
The therapeutic process of CFT is condensed into 3 components:

1) Making sense of pain
2) Exposure with control
3) Lifestyle change

The resources below extrapolate on these 3 phases.

Hallmark CFT Publication
This article by O’sullivan et al 2018, illustrates how CFT can be utilized to provide individualized care for an individual with disabling LBP [1].

Clink on the image to gain full access to the PDF.


CFT and the myth of core stability

In this short (11 minute) video, Peter O’Sullivan discusses cognitive functional therapy and the myth of “core stability” in relation to chronic low back pain.


CFT Podcast

In this interview, a patient with low back pain shares their experience with being helped by CFT.


For further reading, a list of academic publications on CFT is provided in the section below.

Pain-Ed provides a comprehensive list of publications on CFT from 2005 to 2018 which can be found here.

O’Sullivan, 2015 published an article in the Aspetar Sports Medicine Journal presenting a targeted cognitive functional therapy approach towards managing low back pain in the athletic population [2].

The infographic below summarizes the key points and is a useful educational resource for both clinicians and athletes. Full credit to YLM Sports Science for creation of the graphic.

The use of CFT in managing LBP in sport is further explained in this Pain-Ed article by Physiotherapists JP Caneiro and Dr. Leo Ng.

Experiences of CFT from a recent physiotherapy graduate

Find the article here.

CFT success story

This article was written by a patient with chronic pain who was the patient demo at one of Peter O’Sullivan‘s Cognitive Functional Therapy workshops. It serves as an excellent example of how to conduct the process of CFT.

The article can be found here.



Using CFT in clinical practice

A short (10 minute) video where 2 clinicians discuss their experience using CFT in clinical practice with Peter O’Sullivan.


A physical therapist’s key takeaways on CFT

In this article, Diane Jacobs, an experienced physical therapist in Canada, presents her takeaways after attending a CFT workshop at a pain summit in 2017. The article is highly worthwhile reading to gain further insight into CFT. Access to the article can be found here.

1. O’Sullivan, P. B., Caneiro, J. P., O’Keeffe, M., Smith, A., Dankaerts, W., Fersum, K., & O’Sullivan, K. (2018). Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Physical therapy, 98(5), 408-423. doi:10.1093/ptj/pzy022

2. O’Sullivan, P. (2015). A targeted cognitive functional approach for the management of back pain. Aspetar Sports Medicine Journal.