Cognitive-behavioral therapy in the treatment of chronic headaches and migraines - Causes, symptoms and treatment. MF.
Modern psychotherapy includes many different techniques and techniques that, individually or in combination, can be used to treat not only psychological, but also psychosomatic diseases, such as chronic headaches, in particular.
Headaches are a group of neurological diseases, but even in the case of their somatic nature, cognitive psychotherapy is successfully used to treat headaches, which in many cases has a much greater effect than drug treatment( although it does not completely abolish it).
In the treatment of chronic headaches, in particular migraines, only with the help of medication there is always the likelihood that the pain either does not disappear at all, or only temporarily decreases its intensity, or returns again after the drug has finished its effect on the body. To date, there is no universal cure for chronic headaches. The reason for this is that besides the organic factors of headache, there are a number of so-called risk factors that cause its chronic course. Among them, mental fatigue, emotional overstrain, water imbalance( lack of water) in the body, prolonged exposure to the sun, irregular eating. .. The individual physiological constitution can be arranged in such a way that a person must observe a strictly defined diet, and, for example, according to ignoranceignores it, to which the body reacts in such an unpredictable manner as a headache.
In each case, the combination of these factors is individual, and any of them can serve as a trigger for a headache. Relying on the fact that the headache is not only a spasm of the blood vessels of the brain that is removed with the help of certain medications, cognitive-behavioral therapy is that the therapist identifies and corrects the impact of these individual risk factors. For example, a journal of headaches is conducted in conjunction with the patient, through which hypotheses regarding the true causes of the headache are checked, and individual recommendations are formulated.
In the treatment of chronic headaches, cognitive-behavioral psychotherapy, among other things, is aimed at teaching special relaxation techniques: within a month, one can train a patient not only to remove a headache with non-medicament means, but also to prevent her repeated seizures. Actually, in terms of prevention of headaches, the effectiveness of cognitive-behavioral therapy is much higher than in the removal of momentary seizures. This is due to the fact that the patient comes to the therapist with a certain set of habits that have formed in his life for some time, and in them, potentially, the causes of his chronic disorder can be hidden. The therapist's job is to change these habits, to develop new patterns of thinking and brain work.
How cognitive-behavioral therapy is carried out by
Obviously, the less time a patient needs between knowing the illness and visiting a therapist, the shorter the expected duration of treatment. On average, the course of cognitive-behavioral therapy lasts one to two months, the number of sessions, as a rule, is not strictly regulated, but can range from 12 to 25 meetings. These meetings are distributed in such a way that in between them the patient could practice changing his lifestyle, psychological attitudes and habits of life. However, even the therapist can not know how long the treatment will last in each particular case.
The effectiveness of treatment often depends on the patient's personal relationship to his illness. This is a subtle psychological moment, which is also the subject of cognitive-behavioral therapy of headaches. If a person comes to treatment with an unconscious attitude to complain about life, but does not want to part with his illness, because it guarantees him this pity, the effect of therapy is significantly reduced.
Such a patient comes to therapy with a request for a "magic pill", which overnight will get rid of the problem that has haunted him for months, and even years. He can ignore the opinion of a specialist that the key factor in the treatment of a chronic headache may not be the tablet you are looking for, but his own attitudes and habits. Thus, it is possible to teach a person to remove and prevent the recurrence of headaches for a month, and the rest of the therapy will go to change his cognitive settings in order to avoid relapse.
Thus, the complex of cognitive therapy for chronic headaches includes:
1. Observation of the schedule( food, sleep, body water balance, etc.), general physical activity of the person during the day of the day and their correction.
During the first few meetings, the therapist will ask the patient in detail about his daily life, activities and circumstances, specifying this information as necessary and at subsequent sessions;
2. Teaching relaxation techniques and preventing the recurrence of headaches.
There are many types of relaxation. But in order to achieve the maximum effect in getting rid of the headache from the first meeting, it is preferable to start with simple physiological methods - without excesses like visualization, NLP, etc. This slow deep breathing, the so-called hyperventilation and muscle relaxation. Physiological relaxation lasts no more than 15 minutes, and as a rule, 95% of the participants in the session feel a decrease in pain. And most importantly, this is a fairly simple technique to the next time to hold it yourself.
3. Work with the psychological component of the occurrence of headaches and the patient's attitude towards his illness. As practice shows, the psychological component of chronic pain, which does not have a unique physiological origin, is about 40%.If the patient is haunted by fear of the return of a headache, he emotionally enhances its effect. Cognitive therapy teaches us to get rid of such "thought-weeds" in a timely manner.
Recovery prognosis
The International Association for the Treatment of Headaches asserts that, according to studies, cognitive-behavioral therapy in the treatment of headaches gives a more effective result than medication. Therefore, today it is recommended by doctors as a primary technique - and only then drug support should be used, which is mainly used for symptomatic relief.
However, cognitive-behavioral therapy for headaches and migraine does not always go hand in hand with medication. Many patients for one reason or another do not want to take medicine. In addition, in Russia, in the use of medicines( for the treatment of headaches and migraines, as a rule, triptans and biologically active additives are prescribed), it is often practiced when the patient is prescribed medication for a short period of time and then abruptly discontinues the drug course. This approach is difficult to call correct: in some cases, the course of treatment with medicines should last at least six months, depending on the nature of the disease. As research shows, the most effective method of treating chronic headaches is the combined use of cognitive and medicament instruments.
Vitaliy Tevelev, psychotherapist at the Center for Psychiatry and Neurology Matzpen
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