Blanchard and Andrasik’s treatment begins with a
psychoeducational component, in which the follow-
ing points are emphasized to the headache sufferer:
(a) tension, anxiety, and worry can cause headache;
(b) headache is a signal from the body that the person
is not effectively coping with stress; (c) any situation
can lead to stress—our interpretations and beliefs
about a situation determine whether or not it pro-
duces stress; and (d) there are some common beliefs
or expectations that may lead to stress and headache.
In the treatment, patients are taught to monitor their
thinking processes via aself-monitoring recordwhen-
ever tension, worry, or anxiousness occurs. A sample
self-monitoring record for events associated with
headaches is shown in Figure 17-3. For each situa-
tion, patients list the cues that trigger tension and
anxiety, the physical sensations, their thoughts right
before the onset of the tension, a rating of their emo-
tions, and their behavioral responses to the episode
(e.g., withdrawal or attack).
The therapist uses these data to tailor specific
interventions. First, attempts are made to connect
situations, the patient’s thoughts, and the emotional
and behavioral responses. The therapist emphasizes
that the patient’s thoughts are a crucial link in the
process that produces headaches and that these
thought patterns can be modified. The patient’s
“maladaptive”thoughts, expectancies, and beliefs
(those associated with stress and headache) are
examined closely and their validity challenged.
For example, a professor may report that thoughts
regarding inadequacy (“I’m never going to get this
chapter written”) typically precede the experience
of tension and anxiety that leads to headache. The
therapist might challenge these thoughts (“Is it
really true that you have never finished any articles
or chapters?”) and train the professor to disrupt the
situation thought tension headache chain by
using alternative thinking and coping strategies
(repeating, internally, more adaptive thoughts such
as“This task is difficult but I will get it done, just as
I have been able to do in the past”). Finally, as the
patient is able to implement these alternative ways
of thinking and coping in real-life situations and
achieves some success, the therapist reinforces prog-
ress through praise.
Biofeedback
Biofeedbackis popular and, for some, has become
almost synonymous with behavioral medicine itself.
Under certain conditions, patients can learn to
modify or control physiological processes, such as
heart rate, blood pressure, and brain waves.
Biofeedback encompasses a wide array of proce-
dures. Basically, however, some aspect of the patient’s
physiological functioning (e.g., heart rate, blood pres-
sure, skin temperature) is monitored by an apparatus
that feeds the information back to the patient in the
form of an auditory, tactile, or visual signal. The idea is
for the patient to then modify that signal by changing
the physiological function. Thus, a patient experienc-
ing severe headaches might have electrodes placed on
the forehead. The electrodes pick up tiny muscle con-
tractions in that region of the head, which are ampli-
fied and transformed into tones. The tones vary as the
muscular activity changes. The patient’staskistovol-
untarily reduce or eliminate the tone, thus signifying a
reduction of muscular tension and a corresponding
reduction in the headache.
Biofeedback has been shown to be efficacious
(better than placebo treatment) for a number of dif-
ferent problems (Brannon & Feist, 2010). For exam-
ple, biofeedback has been used successfully in clinical
studies to reduce migraine and tension headache
pain, hypertension, and low back pain. However,
several caveats must be acknowledged. First, in
some cases, the effects of biofeedback are not super-
ior to the effects obtained from relaxation. This is
important because biofeedback requires expensive
equipment and trained personnel. Thus, the cost of
this treatment is much higher than some alternatives,
like relaxation. Second, because biofeedback and
relaxation are often included in the same treatment
package, it is sometimes hard to separate the effects
of one from the other. However, some studies have
done so and reported that biofeedback may provide
unique positive effects, especially for those who do
not respond to relaxation techniques (Lehrer, Carr,
Sargunaraj, & Woolfolk, 1994).
Still, many critics remain uncomfortable about
the scientific status of biofeedback. Some are suspi-
cious because of the cultish, faddish, or evangelisticHEALTH PSYCHOLOGY ANDBEHAVIORAL MEDICINE 497