Cognitive-behavioral therapy (CBT) has been convincingly proven to help pain and headache sufferers. Many people are very skeptical about the value of psychological treatments and tell me, just get rid of my migraines and I will be fine. Unfortunately, sometimes it takes time to relieve chronic headaches and pain. So, while we are trying to find relief, it helps to learn how to function better despite pain, how not to panic and become completely paralyzed by headaches, how to inform and interact better with family, friends, and employers. Research indicates, that people who take charge of their care, get involved in working with the doctor to find relief, learn relaxation techniques, rather than just sit back and wait for doctors to “fix” the problem, do much better. CBT, which usually involves relaxation training, is one way to improve your care and it usually involves 8 to 12 structured sessions. Here is an example of what might take place during these sessions:
1. Three-component CBT model (thoughts, feelings, behaviors), pain monitoring
2. Relaxation training (diaphragmatic breathing, progressive muscle relaxation, guided imagery)
3. Migraine trigger avoidance
4. Pain-fatigue cycle, activity pacing, and pleasant event scheduling
5. Identifying and challenging negative thoughts (Activity, Belief, Consequences, Dispute model)
6. Problem-solving skills training and assertive communication
7. Review and practice
8. Review and practice
9. Relapse prevention
Another form of CBT is Acceptance Commitment Therapy (ACT) and this is what a typical schedule of sessions of ACT looks like:
1. The limits of control (short and long-term costs and benefits; fingertraps), focus on experience (body scan)
2. Values (what you care about, how you want to live yourlife)
3. Cognitive defusion (observing thoughts without trying to evaluate orchange them)
4. Mindfulness (being in the moment, raisin exercise)
5. Committed action (“road map” connecting values, goals, actions,obstacles, and strategies)
6. Review and continued action in support of values
7. Review and continued action in support of values
8. Moving forward
CBT usually is conducted by a a social worker or a psychologist and sometimes this treatment is covered by insurance. Group sessions have also been shown to be effective. However, sometimes insurance does nor cover this service or a therapist is not available. Online, web-based CBT seems to work too. Two Australian web sites offer free CBT for anxiety, depression and other problems, although they are not specifically tailored for people with headaches or pain. ThisWayUp.org.au and moodGYM.anu.edu.au are both excellent free resources for people who are looking for help, but cannot find or afford a therapist. The psychologists who developed and run these sites published results of their treatments in scientific journals, showing that self-taught CBT can be very effective. Here is a schedule of lessons for anxiety and depression on ThisWayUp website:
Lesson 1
About anxiety and depression
Learn about your own symptoms of anxiety and/or depression, and learn to tackle the physical symptoms of anxiety/depression.
Lesson 2
Identifying thoughts and tackling low activity
Learn to identify the thought symptoms of anxiety/depression, and learn to tackle the behaviours associated with anxiety/depression.
Lesson 3
Tackling thoughts
Learn to tackle the thought symptoms of anxiety/depression.
Lesson 4
Tackling avoidanceLearn to tackle avoidance behaviours associated with anxiety/depression by facing your fears.
Lesson 5
Mastering your skillsLearn to master your ability to face your fears using graded exposure, and learn to cope with the distressing emotions associated with anxiety/depression.
Lesson 6
Staying well
Learn how to avoid relapses and how to keep getting better!
