Empowering chronic headache sufferers

Chronic headache pain affects sufferers and their families. Many headache sufferers lack self-discipline in controlling their headache pains. Although preventive medication is a must, medical treatment which excludes psychotherapeutic intervention reduces its effectiveness. Sufferers report increased tensions and stress with members of their families. This article reports on a program which includes headache sufferers' involvement in both family and individual therapy activities in a clinical setting. The role of the family therapist is primarily to encourage and empower sufferers to become involved in activities which can promote and increase communication, trust and self-confidence, leading toward a development of skills which can enable sufferers to utilize positive coping strategies in their effort to control headaches.     

Brief consultation with headache sufferers

Abstract

This paper describes the author's efforts at involving chronic headache sufferers in brief consultations with individual, family, and group therapy programs in an inpatient medical treatment facility. A variety of difficult issues facing chronic headache sufferers are presented, including the rationale for utilizing each therapeutic modality and the role and strategies that the therapist undertakes in each program. The author provides some case vignettes and discusses the importance of communication between the therapist, the primary physician, and the medical staff members.     

Social Validation of Relaxation Training in Pediatric Headache Control

This paper defines social validation, discusses its importance and illustrates procedures which have been used to measure the social validity of relaxation procedures in the treatment of chronic non-malignant pediatric headache disorders. Both participants and their parents reported positive benefits of the intervention and recommended it to other headache sufferers.     

Toward the re‐enchantment of psychotherapy: Stories as container

Abstract

Storytelling by a therapist to clients may serve to increase clients’ ability to bear pain, to increase self‐complexity, and expand clients’ senses of the allowable. A model delineating the therapeutic impact of therapist storytelling in psychotherapy is proposed. Stories may change clients’ selves so that they may accommodate traumatic experiences and internal complexity. Stories increase clients’ capacity to tolerate painful experience and therefore serve as a container of tragic life experiences. The artistry of therapeutic story selection is defined as choosing stories consonant with clients’ strengths, rather than with the nature of the trauma. The power of story‐listening to alter consciousness in pleasant ways (storystoned) increases its usefulness as an intervention that is neither anxiety provoking nor re‐traumatizing.     

Functional headaches in patients of a pediatric and adolescent neuropsychiatric counseling facility

After the evaluation of the anamnestic, clinical, and paraclinical data of 100 children and young persons with functional headache, the conclusion is reached: It is not considered cogently necessary; on clinical, paraclinical, therapeutic, and prognostic grounds, to differentiate between tense headache and migraine (complicated migraine forms excepted) in functional headache in children. A prevalence of girls below the age of 12, as described in literature, was not confirmed. Only from the age of 12 is there an increase in proportion of girls as first sufferers of functional headache. Short-term prognosis suggests effective non-medicamentive treatment.     

The use of family myths as an aid to strategic therapy

The concept of family myth can be used by the therapist to help organize the wealth of information provided by a family in therapy. Rituals, symbols and metaphors can be viewed as structurally related components within the family myth system which enable the therapist to interpret non-literal, analogic communications as a coherent yet primarily symbolic, narrative about the family's shared perceptions of its functioning. The concept of myth is explored in relation to mythology, the family therapy literature, and a case study. Several strategic intervention strategies are proposed which utilize the family's own metaphors, symbols and rituals to re-edit the family myth. Re-editing the myth on a symbolic level should be associated with improved system functioning, including more concrete areas of the family's life.     

Parent–Teen Interactions as Predictors of Depressive Symptoms in Adolescents with Headache

This study investigated parent–adolescent conflict, family functioning, and adolescent autonomy as predictors of depressive symptoms in adolescents with primary headache. Frequent headaches during adolescence can have a negative impact on activity levels and psychological functioning. Depression is particularly prevalent in adolescents with headache but little research has examined the role of parent–teen interactions in predicting depressive symptoms. Thirty adolescents diagnosed with migraine or chronic daily headache completed self-report measures of pain intensity, parent–adolescent conflict, family functioning, and depression. Adolescents and their parents also participated in three videotaped interaction tasks, scored by independent raters to assess adolescent autonomy. Regression models revealed that pain intensity, parent–adolescent conflict, and autonomy predicted depressive symptoms. Higher levels of conflict, poorer family functioning and lower levels of autonomy were associated with more depressive symptoms. This study highlights the association between parent–teen interactions and psychological functioning in adolescents with primary headache. Implications for intervention are discussed.     

Headache and sensation seeking

According to the cognitive theory of sensation seeking, headache sufferers were predicted to score lower than controls on Zuckerman's Sensation Seeking Scale. 26 subjects who experienced chronic headaches scored significantly lower than a group of 26 controls. The relationships between the Sensation Seeking Scale and a number of personality tests are described. Replication of the findings on this scale with headache patients is encouraged as well as exploration of other personality dimensions which show significant relations with sensation seeking.     

The refractory headache patient--II. High medication consumption (analgesic rebound) headache

'Analgesic rebound headache' is identified by habituation of an individual to pain reducing medication, the exacerbation of headache pain a few hours after medication consumption and a marked increase in headache frequency and intensity for several weeks after medication is discontinued. We describe three studies undertaken to clarify the existence and characteristics of this proposed headache syndrome. In Study 1 we compared a group of headache sufferers who consume large amounts of analgesic medications to headache sufferers who did not consume excessive analgesics. It was found that the two groups did not differ on age, duration of headache problem or gender. However, the groups did differ on subjective headache pain (with the high medicators experiencing more headache pain than low medicators) and diagnosis (with high medicators being more likely to have a muscle contraction component to their headaches). In an analysis of drug use within the high medication group, it was found that 91% were taking some kind of analgesic and that a majority (84%) were taking more than one type of medication. In Study 2 we found that the group of high medicators were not as successful in reducing headache activity as a result of a self-regulatory behavioral treatment as the matched controls. Furthermore, there was a direct relationship between reduction and treatment success in the high medication consuming population. Lastly, in Study 3 we examined the current psychological functioning of the two groups; no differences were found between the two groups indicating the lack of 'addictive' personality characteristics as an explanation for the high medicating population. These findings all support the existence of a sub-population of headache sufferers who consume excessive amounts of analgesic medication and who are relatively refractory to behavioral treatment.     

Four process studies in the behavioral treatment of chronic headache

Four studies of ‘process’ variables in the behavioral treatment of chronic headache are examined. No relation between headache activity-level reduction and therapist variables such as level of experience (study 1) or warmth, competence or helpfulness as perceived by the patient (Study 2) was found from treatments using relaxation training and/or biofeedback. A significant relation was found, however, between regularity of relaxation practice at home (Study 4) and headache-activity reduction and between regularity of showing some degree of hand warming in thermal biofeedback treatment for vascular headache and headache activity-level reduction (Study 3). Finally, no relation was found between changes in EMG and headache activity-level for tension-headache sufferers treated with frontal EMG biofeedback.     

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or,the machines may be necessary some time of the time

Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.     

心理治疗中隐喻的使用、疗效检验及作用机制

隐喻是用一种具体、熟悉的概念去表达和理解一种抽象、不熟悉的概念的语言形式和认知方式,因其在心理治疗中可以有效传递治疗信息而被治疗师们广泛使用。早期的隐喻理论阐述了隐喻具有高创造性和增强长时记忆的认知加工优势,虽然不同心理治疗流派在治疗过程中对使用来访者还是治疗师产生的隐喻各有侧重,但它们都认为隐喻可以通过高创造性的内容、形成更优的长时记忆以及带来高度的认知卷入来帮助咨访双方有效加工、传递和保存治疗信息。精神分析流派强调治疗性隐喻在无意识水平上的意义交换产生的顿悟过程,认知行为疗法既强调隐喻可以促进认知图式的重构,也强调其组块性和形象性产生的记忆功能,接纳与承诺疗法认为隐喻传递信息时具有非评判、非分析、直觉经验的方式有利于促进个体发生改变,后现代疗法中强调让来访者重新叙述自己的人生故事或者发展出一种形象性或象征性表达,让来访者产生更具有功能的观点和看法。因此治疗性隐喻具备了跨越不同心理治疗理论取向的广泛认同基础。在实证研究上,大多数研究聚焦于探索在某种治疗方法中加入隐喻是否会有更佳的治疗效果,其中使用CBT作为框架的研究最为集中,有些研究发现隐喻干预在缓解心理症状方面优于常规干预,也有研究发现隐喻干预和非隐喻干预都可以有效缓解被试的心理痛苦,因此虽然没有获得十分一致的结论,但这些研究总体上证明了在心理治疗中使用隐喻是有效的。随着研究的深入,对治疗性隐喻起效的心理神经机制进行探索的实证研究也有效观测到了隐喻理论中提出的认知加工优势,包括隐喻的高创造性可以诱发顿悟（并伴随杏仁核、海马、梭状回等特异性神经网络的显著激活）、带来更佳的治疗效果,隐喻内容更容易被记住、有助于治疗持续发挥作用,以及隐喻可以增加来访者的认知卷入程度进而带来更大程度的认知改变。综上,无论从理论构建还是实证证据上,治疗性隐喻都是一种具有独特认知加工优势的认知工具和治疗信息传递途径。未来研究可以从更加科学的设置对照组、增加隐喻特异性的效果衡量指标以及探索其他可能的心理机制三个方面来进一步观察在治疗性隐喻的独特优势。最后,对在心理治疗实践中更好的使用隐喻以及研发嵌入隐喻的低成本高效益的社会心理健康服务方案提供了建议。     

Evaluation of a Peer-Led Mutual Support Group for Chinese Families of People with Schizophrenia

Family interventions in schizophrenia have shown positive effects on patients but little attention has been paid to their effects on family members, particularly those in non-Western countries. This randomized controlled trial evaluated the effectiveness of a bi-weekly, 12-session, family-led mutual support group for Chinese caregivers of schizophrenia sufferers over 6 months compared with standard psychiatric care. It was conducted with 76 families of outpatients with schizophrenia in Hong Kong of whom 38 were assigned randomly to either a mutual support group or standard care. Families' psychosocial health status and patients' symptom severity and length of re-hospitalizations at recruitment, one-week and 12-month post-intervention were compared between groups. Results of repeated-measures mixed model indicated that the mutual support group experienced significantly greater improvements in families' burden, functioning and number of support persons and length of patients' re-hospitalizations at two post-tests. The findings provide evidence that mutual support groups can be an effective family-initiated, community-based intervention for Chinese schizophrenia sufferers.     

Framing public policy and prevention of chronic violence in American youths

Metaphors can both inspire and mislead the public. Current metaphors for youth violence are inconsistent with scientific evidence about how chronic violence develops and evoke inaccurate or harmful reactions. Popular, problematic metaphors include superpredator, quarantining the contagious, corrective surgery, man as computer, vaccine, and chronic disease. Four new metaphors that more accurately reflect the science of child development are proposed to shape the field. Preventive dentistry offers a lifelong system of universal, selected, and indicated intervention policies. Cardiovascular disease offers concepts of distal risk factors, proximal processes, equifinality and multifinality, and long-term prevention. The Centers for Disease Control and Prevention's public health model focuses on injury and the victim to elicit popular support. Public education for illiteracy offers concepts of long-term universal education coupled with specialized help for high-risk youths and goes beyond metaphor to represent a truly applicable framework. Research is proposed to test the scientific merit for and public receptivity to these metaphors.     

Autogenic Feedback in the Treatment of Two Children with Migraine Headache

Autogenic feedback was used to treat two subjects, ages 12 to 14, suffering form migraine headache. A multiple baseline across subjects design was used to evaluate treatment outcome. Marked improvement was displayed on all three measures of headache activity for both subjects by the end of treatment and was maintained throughout the follow-up period. These results are comparable to those obtained when similar procedures are applied to chronic adult headache sufferers and suggest that continued investigation is warranted.     

Physiologic and self-report comparisons between tension headache sufferers and nonheadache controls

Tension headache sufferers and nonheadache controls were compared with respect to (1) frontal EMG during both baseline and presentation of an imagined stressor, (2) trait anxiety, (3) locus of control expectancies for health related behaviors, and (4) exposure to stressful life events. Tension headache sufferers displayed higher resting muscle tension levels than did nonheadache controls. However, both groups responded similarly to the imagined stress stimulus and displayed significant muscle tension elevations of similar magnitude. While tension headache sufferers reported higher levels of trait anxiety, no differences were found between the two groups for locus of control expectancies and exposure to stressful life events. The diagnostic and treatment implications of these findings are discussed.     

Headache triggers: To avoid or not to avoid,that is the question

Abstract

Traditional clinical advice in the management of headaches is to avoid trigger factors. There is a danger, however, that avoidance of triggers results in a sensitisation process whereby tolerance for the triggers decreases, in a manner analogous to increments in anxiety arising from avoidance of anxiety-eliciting stimuli. Reported here are six single-case experiments in which the aim was to desensitise headache sufferers to an experimentally validated trigger, namely “visual disturbance”. The results demonstrated that repeated, prolonged exposure to a headache trigger led to desensitisation with participants experiencing less visual disturbance, less negative affect and less head pain in response to the trigger. These findings have theoretical significance as they speak to the issue of the aetiology of chronic headache, and practical significance as they suggest that a key aspect of current management may contribute to the disorder becoming worse rather than better.     

A Cognitive-Behavioral Approach to Chronic Pain Management

More than one third of Americans suffer from recurring or persistent pain. Because this condition can result in depression, social isolation, disruption of intimate relationships, and prolonged disability, chronic pain sufferers may seek counseling. This article provides counselors with an introduction to the role of psychosocial processes in the experience of pain and offers assessment and intervention recommendations based on a cognitive-behavioral therapy approach to pain management.     

The hidden meanings of metaphors in family therapy

This study investigates how two therapists' beliefs and practices influence the therapeutic process when they organize social interaction according to a metaphor of a royal family. The therapeutic process is described through the case of a boy called Pelle. He comes to therapy together with his family. It is shown how the therapists collaborate in the process of implementing the worldview of the predefined normative standard for family life. In the short term the therapists' use of the metaphor can be seen as an intervention to accomplish immediate change in a non-threatening way. In the long term the cost of using the metaphor was that the mother got a confirmation about herself as a less powerful parent and the child got an image of being a failure. This study points out that metaphors as therapeutic tools have to be analyzed critically before they are used or more specifically the therapists have to examine what kind of values and meanings are hidden in the metaphor and who will gain and loose if it is used as an intervention.