Headache therapy session 8: using what I have learnt in the future

Useful material

Possibility goal hotspot worksheet Quality of life worksheet Real life and ideal life worksheet Steps to my possibility goal worksheet

Therapy outcome measures I

Headache disability inventory Headache needs assessment Hospital anxiety and depression scale SF-36 or Nottingham health profile Headache intensity scale Headache frequency scale Headache diary

Objectives

• • Revision of possibility goals, life aims and values
• • Administration of therapy outcome measures

Welcome

“Today is your last therapy session. I am curious to hear how communicating more directly or how phrasing your needs using Т-messages’ has been received within your social relationships.

As you know, the ultimate way of overcoming adversities and headache problems is to focus on the things you really value in your life. Processes like pain monitoring and scanning for possible danger can move backstage again, where they can do their work without interfering with your main intentions.

“Today, we’ll revisit your life goals and values. The exercises are meant to motivate you to proactively use the self-management approach beyond this programme.”

Main therapy section

Quality of life

Use selected possibility goal and quality of life worksheets “You identified your possibility goals in previous sessions. Let’s have another look at them. Should new ones be added or some dropped? What values do they represent? How do they fit with quality-of-life activities, i.e., are your possibility goals important for you and not urgent?

With these values and possibility goals in mind, what now gives you a feeling of a better quality of life:

• - Each day?
• - Each week or in the medium term?
• - Each month or in the longer term?”

Use the possibility goat hotspot worksheet:

“Now, it seems a good idea to allow you once again to mindfully reflect on your possibility goals. I am going to read the questions about your possibility goal hotspot. You just listen and observe which answers come to mind.”

Read the questions from the possibility goat hotspot worksheet.

Following that, discuss:

“How are your values demonstrated in your daily activities and routines towards your possibility goals?

How can you increase activities that can move you towards your goals?

What resources are you using now in order to gradually achieve your goals or outcomes?

You have explored, practised and applied headache management strategies. You have noticed the benefits of your efforts.

What headache coping strategies and coping resources have you preferred? How useful can they be in the near future?

How can you now use your new insights and learning to progress with your goals and optimise your health management?”

Therapeutic Reinforcement Techniques

Circle of accomplishment

“You have thought about your top life goal many times. I want you now to pretend in your imagination that you have already accomplished this top goal.

We have a large circle here on the floor in the office. Let’s imagine that as you enter the circle, you enter the scene when you have fully accomplished your life goal. In a moment, you are going to step into this circle and vividly imagine what it is like to have achieved your goal.

Now, take a few breaths, let the air out slowly and allow your mind to settle into the exercise. Do this a couple of times and then step into the circle.

Now allow your mind to get used to the new situation you find yourself in.

You are experiencing the mastery of your life goal. You have done it!

Without talking about it out loud, just reflecting on it in your mind, notice how you know that you have achieved your goal.

What in your body tells you that you have it?

What is the sensation like?

Notice whether the sensation in your body remains stable or whether it changes.

Watch the scenario around you, seeing it through your own eyes.

What is it that you see, hear, feel that resembles the accomplishment of your goal?

Notice the characteristics of the scene in which you have achieved your goal. Notice every detail.

Move around in the scene and take everything in.

Are you alone or with others?

How do others respond to your achievement? How does their response to your top achievement affect you?

Absorbing all these experiences into your mind, build a good memory of everything and of what it is like to have accomplished your goal. Do this right now. Anchor your achievement.

Build a good memory of all the sensations and images so that you can retrieve this experience whenever and wherever you like. Make it as strong as you can.

Step out of the circle now. Well done.”

This exercise should be repeated in the session.

Imagery: movie about your success story

“Now I want you to focus on your achievement and success again. I want you to pay attention to my instructions and just notice your thoughts and images.

Take a deep breath and relax. Do this a few times. Allow your mind to settle into the exercise.

1 want you to imagine that you have created a movie about your journey, beginning at the moment when you set your aim until the actual moment of achieving it.

You are the main character acting out your story.

Let’s get the movie going. Become aware of the scene, the other characters and the time frame.

Maybe, the movie starts with a distant memory, long before you had much awareness about the direction of your life. In a moment, right now, you find the beginning of your chosen episode - the point when you began to consciously reflect on your life and decided to make gradual changes. Step inside the movie now.

You are the main character enacting your vision towards your goal. Immerse yourself in the feeling of moving towards your goal and coming closer and closer to the points when you can accomplish it.

Take all the time it needs. Revisit the stages on your journey.

Notice what happens and how you feel.

You have now reached your goal. What is that like, exactly?

Now replay the movie again. Take in every detail of the experience, your gradual progress, your step-by-step success. Relax.

Now replay the movie again. Notice what you didn’t notice before. Use all your senses. Take your time. This is important. Relax.

Now replay the movie once more. Totally experience yourself working towards your goal and achieving it. Relax.

Anchor the experience so that you remember it today or tomorrow or anytime you need it.”

As the therapist has detailed knowledge about the patient’s goals and values, these can be mentioned specifically instead of the generic words “goals” or “values.”

Real life and ideal life

Use the real life and idea! life worksheet

“You are coming to the end of your therapy. You have made great progress in applying proactive headache management strategies. You eventually focused on improving the quality of your life, rather than just focusing on overcoming the headaches. You have formulated your values and the purposeful activities that can move you towards them.

How have you managed to accomplish this?

How have your diaries, scores and charts reflected any changes over time? What needs to happen next?

What was hindering your activities and what is helpful?”

Ending

Therapy outcome measures I

“Today you have focused on your ways of achieving your possibility goals. You have made very good progress in optimising your activities and coping with residual headaches. Be mindful every day of your resources and your steps towards them.

Before you go, it seems a good idea to record the changes in your headache experience using the questionnaires.”

Therapist administers therapy outcome measures I, as listed above.