Stress is a reliable trigger for headache and migraine. So for people who live with migraine, learning healthy ways to cope with stress, trauma and powerful emotions is a must. Gaining psychological skills from talk therapy can really help. Studies show that talk therapy can reduce headaches up to 67 percent.
Many different types of psychotherapy exist, with some approaches especially effective for treating migraine:
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Acceptance and Commitment Therapy (ACT)
Which talk therapy approach is best for your life with migraine? Here’s an overview.
Cognitive Behavioral Therapy (CBT)
What is it? The crux of Cognitive Behavioral Therapy (CBT) is that thoughts, emotions and behaviors are all influenced by each other. When your thinking skews toward the negative, it tends to lead you into strong emotions and unhelpful behaviors, sparking further negative thinking and fueling a vicious cycle. CBT tends to be short-term. It involves a structured, problem-solving approach to identifying, altering, and coping with unhelpful thinking and behavior patterns.
How does it work? CBT tends to focus on the present and on making positive future changes, rather than on problems of the past, in order to build flexibility and coping skills. The therapist will often assign you “homework exercises” like relaxation strategies (such as meditation, mindfulness, and breath training), building healthy habits (such as diet, exercises, hobbies, and sleep), and activity pacing to help you develop coping skills outside of sessions.
Why does it help with migraine? Life with migraine brings discomfort, physical pain, and distressing thoughts and feelings. In CBT, you learn to adapt your thinking to be less influenced by strong negative emotions or thinking patterns and more grounded in objectivity. In doing so, you can learn how to challenge your own difficult thoughts related to, for example, anxiety about migraine attacks; hopelessness over engaging in daily or enjoyable activities; or any rigid beliefs about your ability to deal with migraine.
The bottom line: CBT is widely used for anxiety, depression, relationship and life stress, chronic pain, and more. Research supports CBT as an effective intervention for migraine and chronic headache. Many people experience reductions in headache frequency and pain intensity.
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Dialectical Behavior Therapy (DBT)
What is it? Dialectical Behavior Therapy (DBT) is a form of CBT that focuses on learning emotion regulation, mindfulness, interpersonal skill building, and distress tolerance. “Dialectical” refers to the opposing forces in life. In this type of therapy, you learn to acknowledge and accept difficult circumstances while at the same time, be open to — and work toward — positive change.
How does it work? DBT often involves a mix of individual and group therapy, with in-session role playing, self-soothing skill building, and coaching over the phone to manage in-the-moment distress. The collaborative nature of DBT also helps people improve their relationships.
Why does it help with migraine? The emotion regulation, distress tolerance, and mindfulness aspects of DBT can be helpful in working toward acceptance: developing a flexible, non-judgmental mindset that allows you to move forward in your life with migraine. DBT also gives you in-the-moment coping skills for when you come across a migraine trigger or when pain intensifies your stress and emotions.
The bottom line: DBT helps improve romantic, familial, and social relationships by improving your communication and self-advocacy skills. DBT is also an excellent treatment option if you have a history of trauma, self-injury, or suicidal thoughts.
Acceptance & Commitment Therapy (ACT)
What is it? Acceptance & Commitment Therapy (ACT) helps you achieve psychological flexibility through acceptance of difficulties and pain, and a commitment to values-based actions. It is an empowering form of therapy in which you commit to actions to build a fulfilling, meaningful life.
How does it work? Instead of trying to avoid or control uncomfortable feelings and thoughts, ACT helps you approach and accept them as appropriate responses to your struggles. ACT encourages you to be mindful of any negative, pain-related thoughts you may have. That way, you can then make the conscious choice to let them pass through the mind without believing or immediately acting on them.
Why does it help with migraine? You learn to be aware of and accept your emotional and physical experiences with migraine in order to build flexibility, tolerance and understanding of these experiences. In addition, the all-encompassing migraine experience can make some people lose sight of their true identity. ACT guides you to identify the things important to you, then strengthen your commitment to taking action toward living a life consistent with these values.
The bottom line: Research supports ACT as an effective treatment for a variety of psychological and health issues, including migraine and chronic headache, depression, and anxiety.
Getting talk therapy can be an important step toward managing your migraine. Wondering how to find the right therapist for you? Read our expert Q&A “How To Find a Therapist to Reduce Migraine.”