Understanding and Promoting Resiliency in Patients with Chronic Headache

Stonnington, Cynthia M.; Kothari, Dhwani J.; Davis, Mary C.

doi:10.1007/s11910-015-0609-2

Cited by 15 publications

(18 citation statements)

References 50 publications

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“…31 Further, self-efficacy mediated the association between pain severity and disability 32,33 and may be an important mechanism in pain reduction. 34 For example, French et al 35 found that self-efficacy scores were positively associated with use of adaptive coping efforts to both prevent and manage headache episodes among 146 individuals with diagnoses of tension-type headache or comorbid tension and migraine diagnoses. In contrast, low self-efficacy has been linked with less effective coping strategies and outcomes.…”

Section: Resultsmentioning

confidence: 99%

Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors

et al. 2018

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Background/Objectives Nonpharmacological interventions such as biofeedback, cognitive behavioral therapy, and relaxation techniques are Level-A evidence-based treatments for headache. The impact of these interventions is often equivalent to or greater than pharmacological interventions, with fewer side effects. Despite such evidence, the rate of participation in nonpharmacological interventions for headache remains low. Once obstacles to optimizing use of behavioral interventions such as local access to nonpharmacological treatment and primary headache providers are traversed, identification of barriers contributing to low adherence is imperative given the high levels of disability and cost associated with treating headache disorders. In this review of factors in adults associated with underuse of nonpharmacological interventions, we discuss psychological factors relevant to participation in nonpharmacological treatment, including attitudes and beliefs, motivation for change, awareness of triggers, locus of control, self-efficacy, acceptance, coping styles, personality traits, and psychiatric comorbidities associated with treatment adherence. Finally, future prospects and approaches to optimizing treatment matching and minimizing adherence issues are addressed. Methods An interdisciplinary team conducted this narrative review. Neuropsychologists conducted a literature search during the month of July 2017 using a combination of the keywords (“headache” or “migraine”) and (“adherence” or “compliance”) or “barriers to treatment” or various “psychological factors” discussed in this narrative review. Content experts, a psychiatrist, and a complementary and integrative health specialist provided additional commentary and input to this narrative review resulting in integration of additional noteworthy studies, book chapters and books. Results Various psychological factors such as attitudes and beliefs, lack of motivation, poor awareness of triggers, external locus of control, poor self-efficacy, low levels of acceptance and engagement in maladaptive coping styles can contribute to non-adherence. Conclusions To maximize adherence, clinicians can assess and address an individual’s level of treatment acceptance, beliefs that may present as barriers, readiness for change, locus of control, self-efficacy and psychiatric comorbidities. Identification of barriers to adherence as well as the application of relevant assessment and intervention techniques have the potential to facilitate adherence and ultimately improve treatment success.

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Section: Resultsmentioning

confidence: 99%

Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors

et al. 2018

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Section: Mindfulness-based Stress Reduction (Mbsr) Developed By Jonmentioning

confidence: 99%

“…Participants are taught to stay present in the moment with whatever psychological experience is encountered, change their relationship with the psychological experience, and strengthen actions that are linked to chosen values . ACT has been implemented for a variety of medical conditions, although to our knowledge, has not yet been tested specifically in transplant populations. Stress Management and Resilience Training (SMART), developed by Amit Sood, was designed to expand awareness of neuroscience of stress and resilience, and learn skills to improve attention and enhance compassion, gratitude, acceptance, meaning and purpose, and forgiveness .…”

Section: Introductionmentioning

confidence: 99%

A resilience intervention involving mindfulness training for transplant patients and their caregivers

Stonnington

Darby

Santucci

et al. 2016

Clinical Transplantation

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Solid organ and stem cell transplant patients and their caregivers report a substantial level of distress. Mindfulness-based stress reduction has been shown to alleviate distress associated with transplant, but there is limited experience in this population with other mindfulness-based interventions, or with combined transplant patient and caregiver interventions. We evaluated a novel, 6-week mindfulness-based resilience training (MBRT) class for transplant patients and their caregivers that incorporates mindfulness practice, yoga, and neuroscience of stress and resilience. Thirty-one heart, liver, kidney/pancreas, and stem cell transplant patients and 18 caregivers at Mayo Clinic in Arizona participated. Measures of stress, resilience, depression, anxiety, health-related quality of life, positive and negative affect, and sleep were completed at baseline, 6 weeks, and 3 months postintervention. At 6 weeks and 3 months, patients demonstrated significant (P<.005) improvements from baseline in measures of perceived stress, depression, anxiety, and negative affect. Quality-of-life mental component (P=.006) and positive affect (P=.02) also improved at follow-up. Most participants adhered to the program, were satisfied with class length and frequency, and reported improved well-being as a result of the class. MBRT holds promise as an intervention to enhance resilience and manage stress for transplant patients and their caregivers.

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“…The treatment of pain often includes pharmacological approaches, but many patients still continue to experience substantial levels of pain (24) and often describe the treatment effects as unreliable and dissatisfactory (25). This leaves the patient with little or no control over their condition.…”

Section: Behavioral Findings For Active and Passive Pain Copingmentioning

confidence: 99%

“…In contrast to helplessness, pain acceptance is based on an accurate appraisal of costs and benefits, with the realistic conclusion that the costs to fight (unavoidable) pain are too high given the low probability of benefits. It describes a readiness to accept the presence of pain and its inescapability, while no energy is being wasted to persevere in the attempt to change what cannot be changed (6, 24). Pain acceptance increases cognitive capacities and allows attending to rewarding events and stimuli in the environment while pain is ongoing.…”

Section: Behavioral Findings For Active and Passive Pain Copingmentioning

confidence: 99%

How Accurate Appraisal of Behavioral Costs and Benefits Guides Adaptive Pain Coping

2017

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Coping with pain is a complex phenomenon encompassing a variety of behavioral responses and a large network of underlying neural circuits. Whether pain coping is adaptive or maladaptive depends on the type of pain (e.g., escapable or inescapable), personal factors (e.g., individual experiences with coping strategies in the past), and situational circumstances. Keeping these factors in mind, costs and benefits of different strategies have to be appraised and will guide behavioral decisions in the face of pain. In this review we present pain coping as an unconscious decision-making process during which accurately evaluated costs and benefits lead to adaptive pain coping behavior. We emphasize the importance of passive coping as an adaptive strategy when dealing with ongoing pain and thus go beyond the common view of passivity as a default state of helplessness. In combination with passive pain coping, we highlight the role of the reward system in reestablishing affective homeostasis and discuss existing evidence on a behavioral and neural level. We further present neural circuits involved in the decision-making process of pain coping when circumstances are ambiguous and, therefore, costs and benefits are difficult to anticipate. Finally, we address the wider implications of this topic by discussing its relevance for chronic pain patients.

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Understanding and Promoting Resiliency in Patients with Chronic Headache

Cited by 15 publications

References 50 publications

Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors

Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors

A resilience intervention involving mindfulness training for transplant patients and their caregivers

How Accurate Appraisal of Behavioral Costs and Benefits Guides Adaptive Pain Coping

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