A 30 year-old female post-concussion syndrome patient was struggling with post-traumatic headaches
She tried many treatments with her GP, neurologist, and with our clinic but had, for some reason or another, resisted psychological and dietary interventions.
is the most evidence-based psychological intervention for headaches, with an efficacy similar to medication in adults (CBT is superior to medication in the long-term) and superior to medication in those under 18-years-old.
CBT revolves around Socratic Dialogue.
This patient slipped and fell on December 31st while with her friends celebrating New Year’s Eve.
She told herself the following things:
- I should be better by now
- It was my fault I slipped & fell
- I deserve this
- I should be back at work
- They (her work) think I’m faking
- I’m going to have to climb the ladder all over again (and I won’t be able to cope)
Some Socratic Questions could look like this:
- Why do you say that?
- Did you intentionally walk on icy sidewalks?
- Did you know the city would have missed a patch when salting?
- How many times have you fallen walking?
- Do you usually look down at the ground when you walk?
- (her decision to wear stilettos that night was offered as evidence for fault) Were you the only one wearing stilettos ? Is that unusual for New Year’s Eve amongst your friends & family?
- How would you normally get around after having two drinks?
- What makes you think that you shouldn’t have suffered a concussion when you hit your head?
- From times before when you walked outdoors under similar conditions, did you have any reason to suspect that it was dangerous?
- What would you tell your younger sister if she said the same thing?
- What would she say to you if she knew you were saying this to yourself?
- Is there another way of looking at this situation?
- What could be the effect of changing your thoughts?
- What if and adversary were to say that to you?
- Interestingly, she said that she would just accept it and not defend herself.
- However, we then asked her what she would say if that adversary said the same thing to your mother?
- She said she would not be having that, and that she would stand up for her mom….
- Why would it be okay to defend your mom, but not you?
- This is an example of “Cognitive Dissonance” (see next section)
There are hundreds of questions you could ask, with curiosity, non-judgment and a not-knowing posture that would help identify the contextual factors that clarify the matter more accurately; and foster critical thinking…and hope…and self-agency to move ahead.