When to refer for Cognitive Behavioral Therapy?
- Difficulty adjusting to new life change
- Lifestyle changes have not been effective or patient has had difficulty implementing changes
- Patient is averse to medication intervention
- School/Social/Family avoidance
- There are clear environmental stressors/triggers for headaches
- Parents are exhibiting enabling behaviors
- Tendency toward internalization, perfectionism
- Conflictual interactions among patient-parent/family/sibling
Characteristics of CBT
- Thoughts, feelings, behaviors = interconnected
- Brief and time-limited (in this setting)
- Emphasis on current behavior
- Collaboration between therapist and family
- Family role - define goals, express concerns, learn & implement learning
- Therapist role - help family define goals, listen, teach, encourage
- Based on "rational thought"
- Facts, not assumptions
- Structured and directive
- Assumption that most emotional and behavioral reactions are learned
- Therefore, goal of therapy is to help clients unlearn unwanted reactions and learn new ways of responding
- Homework is core feature
Cognitive Techniques
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Cognitive Techniques
- Help the patient challenge the cognitive distortions
- Anxious brain vs. rational brain
- What's the evidence for and against the thought?
- How would you think about this if it were your friend?
- Perspective taking (will it matter in a year)?
- Can use what category the cognitive distortion fits into to help with thought challenging
- If it's an all-or-nothing thought, introduce some doubt to make it a "maybe" thought
Conceptualization Rehabilitation Model
- Pain may or may not get better
- Focus on independent functioning
- Signs of progress
- Increased functioning
- Enhanced coping
- Improved self-efficacy
→ Limit pain, not eliminate pain
→ Enhance life engagement, despite pain
Role of Pediatric Psychology
Empathy
- "It's hard enough being X years old, let alone having chronic pain"
Normalization
- "I've worked with a lot of kids who have similar difficulties"
Validation
- "Your pain is real"
Psychoeducation
- "Pain is multifactorial" /Biopsychosocial Model/ Gate Theory of Pain
Non-Threatening Description of Role
- "I look for pain patterns / triggers, and ways to help you develop coping skills"
Positive and/or corrective emotional experience
- To promote engagement and adherence
Parenting Behaviors
Pain reducing behaviors:
- Distraction
- Humor
Pain promoting behaviors:
- Empathy
- Apologizing
Teach parents to:
- Minimize their reactions to child's pain
- Praise child for self-management of pain
- Praise child for engaging in normal activities despite pain
- Ignore when appropriate
- Eliminate status checks
