Hide video

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

  1. Thoughts, feelings, behaviors = interconnected
  2. Brief and time-limited (in this setting)
  3. Emphasis on current behavior
  4. Collaboration between therapist and family
    • Family role - define goals, express concerns, learn & implement learning
    • Therapist role - help family define goals, listen, teach, encourage
  5. Based on "rational thought"
    • Facts, not assumptions
  6. Structured and directive
  7. 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
  8. Homework is core feature

Cognitive Techniques

Psychoeducation about automatic/ maladaptive thoughts, cognitive distortions

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

Useful Websites

Understanding Pain – And What’s to be Done About It in 10 Minutes

The Center for Pediatric Pain Research (IWK Health Centre and Dalhousie University)

German Paediatric Pain Centre

Pain Management Network

Pain Toolkit

Headache Relief Guide (Children’s Mercy Hospital)

MollyPoint Help