Headache therapy session 5: meaning and purpose Useful material
Balancing headache thoughts worksheet Dealing with worrying thoughts worksheets 1 & 2 Headache coping strategies worksheet Headache diary
My well-being actions worksheets 1 & 2 Possibility dimensions worksheet Possibility goal hotspot worksheet Real life and ideal life worksheet Steps to my possibility goal worksheet Thinking about headaches worksheet Quality of life worksheet
Objectives
- • ABC of headache management: C = cognitive patterns and cognitive strategies
- • Reflection on the meaning of headache
- • Exploration of quality of life aims
- • Coping strategies for acute headache episodes
Welcome
“One of the things you are really going to love about today’s session is that some elements might be quite unusual. As you have been actively participating in therapy, you may have become used to creative methods of dealing with your headache. As you know, it is important to strengthen your Action Systems, to develop robust coping styles and to look into the things you really want to do in life.”
Main therapy section
ABC of headache management: C = Cognitive pattern and cognitive strategies
Thinking about headaches & cognitive habits
Use the worksheets thinking about headaches (completed as per homework), balancing headache thoughts, and/or dealing with worrying thoughts 1 & 2.
“Let’s have a look at your worksheet thinking about headaches. It is useful to investigate episodes when your headaches or headache-related worries have challenged your efforts to deal with them since our last session.
“The worksheets balancing headache thoughts and dealing with worrying thoughts give examples of how to reframe negative thoughts. Let’s explore some of them.”
Meaning of headaches
“In preparation for the next exercise using imagery, think about an example of a recent intense headache episode.
“Take a few relaxed breaths and allow your mind to settle.
“Now we have investigated and talked a great deal about your recent headache experiences and thinking patterns. It doesn’t sound as if the headaches are useful for you at all. They hinder you from getting on with things you really want and need to do. They burden your relationships. They drain your energy and they worry you a great deal. All in all, they seem to be really powerful things, those headaches, as they can do all that, even though they are no use for you at all. If all that power and energy generated by the headaches has no use or purpose for you, could they be useful or purposeful for something else, for someone completely different? Think of the recent headache episode, the pressure it created, the force it had. If someone needed a force like that, one that can influence so much, what could it be used for?
“You may notice how your mind aims to free this energy. You have probably begun to wonder what will happen when the painful force is released. As you are now allowing yourself to let go of it, of this powerful force, you need to find a way to get it out of your head.
“Using your imagination, you can pretend to release the headache from your body and find a useful purpose for it somewhere else. Some people have imagined that their terrible headache could be useful for frightening unwanted intruders away and have placed it inside their home’s alarm system. Other people have extracted the pain out of their ears and placed the headache mass on their front lawn as fuel for friendly aliens. What could your headache be used for?”
Headache message
“Let’s continue with another imagery exercise. Take a few relaxed breaths and get settled. Allow your mind to wander. You have time and space right now. This means you can invite some pleasant memories into your mind. Memories about a beautiful place where you know you can be at peace. You can feel safe and relaxed. Notice the sensations in your body. If you sense any pain, just allow yourself to observe it, passively.
“Now, imagine that this pain has left your body and you can look at it, its shape, its colours, its texture - all its features. If they are particularly unpleasant, move away from them a little bit. Keep a comfortable distance and continue to observe this distant pain, because it seems that it wants to tell you something. It seems that it has a message for you. Notice how it conveys its message. It may change its features or release some sounds. It may simply show you where it wants to be in order to fulfil its purpose. Now, let yourself decide what you want to do with the pain. Just accept the message. Let it fulfil its purpose and let it go.”
Purpose and life aims
“We’ll now continue with another imagery exercise. It’s called the “miracle question.” Take a few relaxed breaths and allow your mind to settle.
Now, just imagine a fairy that could make a miracle come true for you. One day, without your knowledge, this fairy intends to release all the necessary resources and opportunities for you to achieve the dream of your life. How would you know that your dream had come true?
What would you have? What would you no longer have?
How would the miracle affect others around you?
What can you do now that you couldn’t do before?
With another spell, the fairy can swish your headaches away completely. Just like the first time, you won’t know when she casts the spell, but one day, sooner rather than later, you will realise that you no longer suffer headaches. What will this enable you to do?
How do others react?
What will no longer happen?
What will you gain?”
(See case examples: Terry, Connor, Henrietta, Tracey and Katie.)
Real life versus ideal life
Use the real life and ideal life and quality of life worksheets “Now, have a think about the amount of time you spend on activities that offer you a better quality of life. What fraction of time during a day or week do you have for quality experiences? On the worksheet real life and ideal life, indicate on the top pie chart how much of your time you allocate at present to activities that are meaningful and give you pleasure. The pie chart at the bottom represents your ideal share of time and resources between quality of life and headache activities. How do the proportions work out in your case? What is the difference between reality and your ideal distribution of your time and resources?” Depending on the patient’s response, e.g.:
“It looks as if only a little time is allocated, realistically, to the activities that you value the most. On the other hand, ideally, you would like to have much more time for them. What is it you must do, to make the most of those times that fill you with purpose and give you a sense of accomplishment?”
Possibility goals
Use the possibility goat hotspot and possibility dimensions worksheets
“We want to look at a different chart now. Let’s call the aim you really would like to work towards in life your ‘possibility goal.’ We call it that because life is full of possibilities.
What exactly is your possibility goal? How can you describe or name it?
Sometimes we get closer to our life aim or possibility goal and sometimes we move further away. On your goal dimension from 0% to 100%, how close have you come towards your possibility goal already?
How much of your possibility goal would you like to achieve in... days or weeks?
How much would you like to achieve in...months or years?”
Depending on the patient’s response, e.g.:
“You seem to have made some progress already; what resources do you have available to achieve more of your goal?
What else do you need to move towards your goal in... years... months... weeks?
How can you make the best use of your current resources in future?
What other resources, skills or support can you use to gradually accomplish your goal?”
Additional explorations:
“Let’s think about possibility goals other people might have.
Let’s imagine your... spouse, parent, teacher, neighbour... has a possibility goal just like you.
How close are they to their aim? Take a guess.
How much do you imagine they would like to accomplish in... years... months... weeks?
In comparing your possibility goal with that of others, what insights and ideas can you gain?”
Feedback and normalisation:
“Even though others might not have headaches, it is unlikely that they are perfect and have fully achieved all their aims.”
Reflecting on a possibility goal
Use the possibility goal hotspot worksheet “Now, having discussed your life aims and the possibilities for moving towards them, it seems a good idea to allow you more time to reflect on those things. I am going to ask you a few questions about your possibility goal. This time you don’t have to answer them aloud. Just listen and observe the answers your mind comes up with.
Take a few relaxed breaths and sit back.”
Note for therapist: Therapist reads the questions on the possibility goal hotspot worksheet, slowly, one by one. Patients are simply encouraged to consider and contemplate their personal answers.
Some patients may insist that they have no ideas about developing life goals, no resources or may report a low achievement level. Whilst it may be true that some are more fortunate than others and some may have a more complex trauma or headache conditions than others, most people have the opportunity to make a few positive changes at least. Reluctance and presentation of obstacles can be an indication of a mismatch in expectations or of poor engagement. Such issues require different therapeutic skills, for instance a motivational interviewing style or a deeper exploration of the meaning of the obstacles.
Possibility goal hierarchies
Use the steps to my possibility goal worksheet “You are exploring the steps towards your possibility goals and life aims. List activities you possibly want to accomplish in your life. What is it you really value?
“Alternatively, you could imagine yourself at an age of about 75 or older, reflecting on your life and your achievements. What would you say was really valuable to you in your past life?
“What strategies and resources do you have now in order to get there? “What are the things that need to happen next?”
Purpose and accomplishment during headache-free periods
Use the worksheets headache coping strategies and my well-being actions 1 & 2 “Now let’s review the activities you have accomplished during headache- free periods.
Physical exercise
Coping strategies and mind-absorbing activities Positive emotional and thoughtful attitudes.
What has worked best?
What was the best time for your activities?
What have you changed in order to improve your well-being?”
Coping during headache episodes
Use the mind-absorbing activities worksheet “You have gained practice and skill in the application of different coping strategies. You can now have them ready and apply them when you have headache episodes. You can still revert to taking medication or using your usual pain relief if necessary.
“At the onset of a headache episode, immediately use the pattern interrupt method ‘STOP!’ followed by your most effective coping strategy. Your aim at this point is to divert your attention from thinking about and monitoring the pain, not directly to stop the pain. In order to carry on with your routines, you have to adjust your pace in combination with brief and effective relaxation. You can combine your task or job with abdominal breathing and your positive self-statement (e.g., ‘I can cope. I am all right’). Think ahead about switching your strategies. If you have used relaxation for a few minutes, then go for a walk next or aim for a change of environment.
Later on, when you notice that you are coping better or your headache is easing off, practise deep relaxation once more and combine it with pain relief imagery to consolidate the experience that you can influence your Action Systems.” Notes for therapist-. The therapist has, by now, a good understanding of the task management needs, and the memory and cognitive support that is required to set up a coping strategy plan for use during headache episodes. The patient might benefit from guidance regarding the selection and timing of the coping strategies for application during and after headache periods. Relaxation should still be part of the daily schedule.
Ending
Use the headache diary, mind-absorbing activities and possibility dimensions worksheets
“Use the headache diary and record your coping strategies as you apply them during headache episodes. Continue to keep track of your purposeful activities and possibility goals.”
