When neuroscientist Irene Tracey – now Vice-Chancellor of the University of Oxford – demonstrated through imaging techniques how expectations can amplify or dampen pain, a quiet revolution became evident: Pain is not just a signal from the tissue, but also a construct of the brain. For high performers, this means that those who train their minds can curb the pain spiral – often faster than one might think.

Pain arises from an interplay of nerve stimuli and assessment in the brain. This assessment influences how intensely and how unpleasantly we experience pain. Cognitive techniques target exactly this: they alter the interpretation and thus the response. Important terms: cognitive restructuringthe conscious recognition and replacement of distorted thoughts with more helpful evaluations, interoceptionperception of internal bodily states such as breathing, heartbeat, tension, pain catastrophizingthe tendency to exaggerate pains and expect the worst consequences, parasympathetic activationcalming mode of the nervous system, reduces stress and dampens pain signals. Crucially: We do not have to "think away" what is happening in the body. We learn how the brain categorizes the signal – and thus adjusts the controls for intensity, unpleasantness, and function.

Those who train their pain assessment not only experience less suffering but also gain more performance capacity. A systematic review of cognitive behavioral therapy (CBT) found significant improvements in pain-related disability in 84% of the interventions studied – particularly in cases of chronic back pain, generalized pain, migraines with depression, and chronic pain under long-term opioid use ^[1]. Even brief breathing interventions can have an acute effect: In a clinical waiting room, a four-minute "cyclic sighing" session immediately reduced pain intensity and unpleasantness without changing anxiety or depression scores ^[2]. Even internal dialogue counts: A study involving cold water immersion showed that targeted positive self-talk measurably increased pain tolerance – the more helpful thoughts, the longer the endurance ^[3]. Additionally, body-based relaxation practices such as yoga and Tai Chi can strengthen interoception and improve pain and function; for knee complaints, Tai Chi showed benefits over health education in several RCTs, partly comparable to more active controls, although more robust studies are needed ^{[4] [5]}.

The evidence reveals three robust levers. First: Structured CBT. A PRISMA-guided review of randomized studies reports that CBT – whether in-person, digital, or combined – reduces pain-related disability in the majority of cases. Components such as psychoeducation, cognitive restructuring, graded activity, and emotion regulation seem particularly effective; patients with back pain and those with comorbid mental health burdens particularly benefit ^[1]. Relevance in daily life: Those who systematically adjust their thinking patterns and gradually increase movement regain functionality. Second: Micro-intervention breathing. In a randomized pilot study in a waiting room, a four-minute, asynchronously guided "cyclic sighing" sequence acutely reduced pain intensity and unpleasantness compared to an attention-synchronized control condition ^[2]. Mechanistically plausible: prolonged exhalation promotes parasympathetic activation and diminishes the affective component of pain – an immediately accessible “emergency button.” Third: Self-talk as a tolerance booster. In an experimental setting, positive, client-generated self-speak significantly increased ice tolerance; changes in the thought profile correlated with better pain self-control ^[3]. This suggests that targeted instructions ("I can manage this") are not only motivating but also neuropsychologically effective. Additionally, the mind-body literature indicates that interoceptive abilities – the fine sensing and accepting of internal signals – are a key mechanism of yoga and related practices ^[4]; in knee complaints, Tai Chi showed improvements in pain and function in RCTs compared to health education, although similar effects were observed in active comparison therapies, supporting its meaningful addition to the repertoire ^[5].

- Integrate CBT into daily life: Choose a recurring pain scenario (e.g., afternoon back pain). Write down typical thoughts ("This will only get worse"). Replace them with realistic, helpful statements ("Pain does not mean harm; movement in moderation helps – I will start with 5 minutes"). Pair this with graded activity: short, scheduled movement blocks that increase minimally each week. Evidence: CBT reduces pain-related disability, particularly with cognitive restructuring and graded activity ^[1].
- Train positive self-talk: Define three sentences for acute peaks: "Breathe, relieve, I remain capable of action." "The wave will pass." "I am safe and can move within limits." Repeat them for 60–90 seconds during moments of stress. Studies show that such self-assertions measurably increase pain tolerance ^[3].
- Four minutes of "Cyclic Sighing" at pain peaks: Two short nasal inhalations in succession (the second smaller), followed by a long, complete exhalation through the mouth. 1 cycle every 10–15 seconds, totaling 4 minutes. Ideal before meetings, after long sitting, or in the waiting room. RCT data: immediately reduces pain intensity and unpleasantness ^[2].
- Firmly anchor interoceptive relaxation: Choose 2–3 sessions of yoga per week (calm flows, longer exhalations) or Tai Chi (gentle weight transfers, upright posture). Focus: feeling instead of performing, acceptance instead of struggle. Research: Interoceptive strategies are likely a pathway of mind-body practice for chronic pain ^[4]. For knee complaints, Tai Chi can improve pain and function – start with guided sessions, pay attention to posture corrections, and increase moderately ^[5].

Pain is not just a signal – it is negotiable. With clever cognition, targeted breathing, and interoceptive practice, you shift the dial towards function and freedom. Train your brain like a muscle: short, frequent, consciously – and make mental artistry a firm part of your performance routine.