How does CBT work?

CBT works by helping you change how you think, feel, and act, to help prevent headaches or help you cope better with headaches you do have.  It helps you learn new coping strategies, such as managing headache triggers, deep breathing and relaxation, activity pacing, changing negative self-talk, and assertive communication.  It can improve your emotions and decrease your stress, which are common triggers for headaches. In CBT, you will learn ways to change how you think and behave, to help reduce the frequency of your headaches and cope better with the headaches you do have.   

What can I expect?  What will be asked of me?

Your therapist will help you to explore your thoughts, emotions, and behaviours, in the context of a trusting and collaborative relationship.  Your therapist will provide a safe atmosphere of trust where you can feel free to be yourself and participate in therapy. You will be asked to attend sessions on a weekly or biweekly basis, and you may be asked to do take home assignments to apply what you are learning in between sessions.  You will be asked to be an active participant in your therapy. Maybe you feel like you do not want to do therapy, even if it is recommended to you. Consider giving it a try. Engaging in CBT is not an easy decision, but it can lead to very positive changes in your life.

How long will I need to have CBT? Is it a lifelong commitment?

The number of sessions of CBT is different for everyone.   Some people attend CBT for only a short time until they start experiencing benefits (three to five sessions), and some people attend longer (15 – 20 sessions or more).  The number of sessions that are best for you can be discussed with your therapist. Usually, people start to experience benefit from CBT by the third session. If you are not feeling that therapy is helping you by the third session, it might be useful to consider CBT with a different therapist.  Like medication, sometimes it takes a trial of two or three therapists until you find the one who is the right fit for you.     

Where do I get CBT?  Where do I find a CBT therapist?

Many CBT therapists work in private practice, and your sessions may be covered by your insurance benefits.  CBT may also be offered by therapists working in public health care. You may need to be referred by your family doctor to a CBT therapist who is working in public health care. It is very important to feel safe and comfortable with the therapist. Everyone is different. 

Who is qualified to offer CBT?

CBT is a specialized form of psychological therapy that is usually performed by a therapist with special training.  Psychologists are familiar with CBT and are usually trained in offering it as a form of therapy. Other professionals such as counsellors, mental health therapists, psychiatrists, and nurses may also be able to provide CBT.  It is important to ask a potential therapist if they offer CBT, and if they are regulated by a College or similar regulatory body.  

When should I start seeing results?

It is important to set up goals and a reasonable timeline to achieve them. Decreasing the frequency of the attacks is one thing, but improving your quality of life, mood, self-esteem and interactions with others can also be very important. Therapy can take some time, as changing our thoughts and habits does not happen overnight. Patience is key! There may also be phases, it’s not a straight line. Once you build new toughts and habits, you will be challenged by different life events. Step by step, your new habits will sink in. Set up evaluation times with your therapist to summarize where you stand after a few weeks. 

What if it does not work?

If you feel like you’re not making progress, discuss with the therapist. What was the initial goal? Has there been any progress? If not, what could be the reasons? Is the relationship with the therapist good? Are there major things happening in your life that make change more difficult? If you decide to stop, make sure you make a good wrap up with the therapist. Remember that you can always give it another try in the future. 

If I feel better, should I stop sessions? 

This decision will really depend on so many different factors that it is better to discuss it with the therapist. Sometimes, it is better to keep going for a while to solidify your new habits. Sessions can also be spaced out, and you can reach to the therapist as needed. Life is a path, migraine fluctuates. Seeking support and guidance from a therapist is always an option.

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REFERENCES

1. Christiansen S, Jurgens TP, Klinger R. Outpatient Combined Group and Individual Cognitive-Behavioral Treatment for Patients With Migraine and Tension-Type Headache in a Routine Clinical Setting. Headache. 2015;55(8):1072-91.

2. Cousins S, Ridsdale L, Goldstein LH, Noble AJ, Moorey S, Seed P. A pilot study of cognitive behavioural therapy and relaxation for migraine headache: a randomised controlled trial. J Neurol. 2015;262(12):2764-72.

3. Martin PR, Mackenzie S, Bandarian-Balooch S, Brunelli A, Broadley S, Reece J, et al. Enhancing cognitive-behavioural therapy for recurrent headache: design of a randomised controlled trial. BMC neurology. 2014;14:233.

4. Ng QX, Venkatanarayanan N, Kumar L. A Systematic Review and Meta-Analysis of the Efficacy of Cognitive Behavioral Therapy for the Management of Pediatric Migraine. Headache. 2017;57(3):349-62.

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