Dialectical Behavior Therapy for Migraine

Dialectical behavior therapy is a combination of Cognitive Behavioral Therapy and mindfulness developed by Marsha Linehan to treat clients diagnosed with borderline personality disorder (BPD). Over many years it has been perfected and subjected to studies proving that it is one of the very few effective treatments for BPD. It has also been studied as an effective treatment for a wide variety of mental health issues.

One of the unique aspects of dialectical behavior therapy is its incorporation of opposites. Clients are taught to embrace both acceptance of the current circumstances and readiness to change. While simple in concept, the process of embracing these opposites takes patience and practice.

Acceptance

In the case of migraine, acceptance is multi-faceted. Acceptance involves an acknowledgement of reality without placing any value judgement on that reality. Acceptance is not agreement. It doesn’t involve giving up or not continuing to work with our doctors. It’s completely separate from individual opinions about the circumstances. Whether you like your situation or not isn’t the point. Acceptance is a recognition of what is without wishing it were different.

We accept that…

• migraine is incurable.
• not everyone understands migraine.
• there are few effective treatments.
• there is a shortage of qualified doctors.
• attacks will happen regardless of how many triggers we avoid.
• medical treatment will be a long-term reality.

Change

At the same time, we embrace the need for personal change to improve our situation by:

• tracking migraine attack frequency and severity.
• diligently avoid known triggers.
• continue to search for the right doctor and treatments.
• educating others about our disease to fight stigma.
• donating our time and resources to help discover a cure.
• believing in the possibility of and hope for a cure.

Both acceptance and change are possible with time and practice. Acquiring and practicing dialectical behavior therapy skills will help us with this journey.

Dialectical behavior therapy includes:

1. Individual therapy
2. Group therapy
3. Phone coaching
4. Therapist consultation team

Dialectical behavior therapy for migraine

I was certified and began facilitating dialectical behavior groups from 2007-2009 at a community mental health center. I also taught these skills through individual therapy to children, adolescents and adults from 2010 to 2012. One of the things I discovered was that the skills of dialectical behavior therapy are effective tools for nearly anyone who struggles with overwhelming feelings, intolerable situations, or difficulty with interpersonal relationships. That’s just about anyone at one time or another.

Teaching is one of the best ways to learn. Consequently, the more I often I led groups, the more I learned about using these skills in everyday life. In an effort to practice what I preached, these skills became part of my migraine arsenal. They helped me to cope with impossible symptoms, respond to disappointing circumstances, and communicate more effectively with others.

I have wanted to share these discoveries with others for several years. It was just a matter of finding the right opportunity. This series is not designed to encompass an entire therapy program nor is it designed to address the needs of those diagnosed with borderline personality disorder or other mental health conditions. It will provide you with information on how to incorporate the skills of dialectical behavior therapy into your everyday life, especially as it relates to migraine and other headache disorders.

The format of this series is as follows:

1. Dialectical behavior therapy for migraine – This is where you are now.
2. Finding Our Wise Mind
   1. Core Emotions Primer
   2. Our Alarm System
      
   3. Using “What” Skills
      1. Observe
      2. Describe
      3. Participate
   4. Using “How” Skills
      1. Non-judgmental stance
      2. One mindfully in the moment
      3. Effectively
3. Distress Tolerance Skills
   1. Self-Soothing Strategies
   2. Distraction
   3. Improving the moment
   4. Acceptance
4. Emotion Regulation Skills
   1. PLEASE
   2. Building Mastery
   3. Opposite-to-Emotion Action
5. Interpersonal Effectiveness
   1. DEAR MAN
   2. GIVE
   3. FAST
6. Wrap-up

When each installment is published, I will update this page with links to each one. Feel free to comment at the end of any article or contact me privately and I’ll be happy to answer your questions.

Resources:

If, during the course of this series, you believe you would benefit from the full dialectical behavior therapy program, please go to BehavioralTech.org for a listing of qualified therapists near you.

For more ideas on how to incorporate dialectical behavior therapy into everyday life, please see:

• DBT Self Help
• Middle Path
• Dialectical behavior skills training (from BPD from the inside out)