By Ambre Emory-Maier, Guest Contributor
Introduction-understanding chronic illness
Chronic illness of any kind is a challenging human experience that no one wants. As human beings this diagnosis may be part of our lived experience. Chronic, defined as lasting for a long-time, with repeated occurrences and ongoing need for treatment, can be a defeating, scary word. There are various levels of chronic illness. You will find as you read this article how I have grown to view chronic migraine. Before we discuss ACT Therapy for migraine, let’s understand more about frequent and chronic migraine.
What is chronic migraine?
Migraine is a disorder that has several contributing causes. People can be diagnosed with episodic or chronic migraine disease. Episodic means migraine attacks occur on an occasional basis with less than 15 migraine days per month. A chronic migraine diagnosis means more than 15 migraine days per month, often with some symptoms present without an attack. There is baggage around the word, “chronic”, in addition to other bias that surrounds this disease. Migraineurs often encounter a lack of understanding of migraine itself, limited comprehension of hidden illness (“You do not look sick.”), judgement and insensitive behavior and language. As someone with migraine, it is often difficult to deal with emotions and thoughts that arise around the disease and treatment by others.
** While Migraine Strong writes about the latest in migraine treatments, this is not medical advice. We are patient educators and all information you read should be discussed with your doctor.
Psychotherapy- another tool to manage migraine disease
As we go through life, all of us need support and options to help us with live well whether we have a chronic illness or not. Migraine Strong has a great graphic about the “Treatment Pie” that offers tools for managing migraine. One of those tools is psychotherapy. Many people have an inherent fear of working with a therapist because of the stigma around mental health concerns. Psychotherapy is not something that doctors recommend initially when one is diagnosed with chronic migraine unless the patient discusses its impact on mood, or reports struggles with anxiety and depression.
It is my belief that psychotherapy should be part of one’s health maintenance especially when dealing with a chronic, neurological illness. Headache specialists or neurologists should make this recommendation as part of the treatment plan, careful to indicate the person’s symptoms are not due to a mental illness.
ACT-Acceptance and Commitment Psychotherapy
There are many different types of psychotherapy. One therapy that I find helpful is ACT, also known as Acceptance and Commitment Therapy. ACT is a form of Cognitive Behavior Therapy (CBT) that was developed in the 1980s. It is based from Relational Frame Theory (RFT) which describes how human beings link concepts together to form language. ACT encourages people to live in accordance to their personal values. One of things that make this practice different from some forms of CBT is its flexible, creative process. It is not “manualized” or a step-by step format. In my opinion the therapy mirrors life which never follows a manual!
ACT might seem radical as the therapy does not try to remove symptoms of depression, anxiety or body sensation. The work teaches the person to view the symptoms in a non-judgmental way and most importantly, as a normal part of human life. One of my therapist friends says, “it is only a problem if you choose for it to be a problem.” Rather than making a goal of eliminating symptoms, ACT’s goal is to improve valued living (quality of life).
Options and choices
ACT uses six areas of practice which invites one to choose what would be most effective at the current moment. They are:
- Acceptance- Embracing your history. It is also about developing compassion for the self.
- Cognitive Defusion- Letting thoughts come and go.
- Present Moment- Noticing thoughts, feelings & events.
- The Observing Self as Context- Being aware of one’s own flow of experiences without attachment to them.
- Values- Choosing life direction without bias of inner dialog.
- Committed action- Behavior change efforts.
At any point in time the individual can CHOOSE how to meet difficult thoughts, emotions and beliefs, not remove them. Then they can make change in behaviors (yes- thinking is an internal behavior). Taking useful action towards the things that one values and perceives as important like kindness, spirituality, family, work, community, health, and so on, is the Commitment part of the practice. This article is not saying you can overcome or stop nasty migraine attack symptoms though ACT. However, I have found ACT useful in dealing with anxiety, depression, anger, helplessness, fatigue, auras, vestibular disturbances and pain symptoms. It helps me decide what I need to do; take an abortive, rest, go for a walk, drink some water, cry, talk to my spouse, curse, journal, call a friend, go to work or offer myself compassion.
How ACT resonated for me
What resonated with me about ACT for migraine is that it aligns with Eastern philosophy around yoga and meditation that I continue to study, especially a form of meditation called iRest® developed by Dr. Richard Miller, Ph.D. This meditation practice and ACT approach teach us that unpleasant, uncomfortable experiences are part of the living on this earth, a spectrum of being human. We are not broken because we have migraine. We are whole and have migraine. So, the statement that everyone has some brokenness is actually a fallacy. Everyone is human with difficult experiences and consequences. For someone with a chronic migraine this concept can be uplifting and freeing.
The idea points to the wholeness of the individual and normalizes suffering. In other words, one is not defined by their illness, emotions and thoughts that may accompany daily experiences. ACT and iRest® teach instead of avoidance of these experiences, embrace them just as they are and nothing more.
No judgement. Resistance to the current reality creates a push-back. As I tell my students, when you fight with reality, it fights back.
The biggest benefit of ACT therapy for migraine
One benefit that I like yet find challenging about ACT therapy and iRest® is that it develops self-compassion and compassion for others. Compassionate living is being aware of what one needs and moving towards meeting that need in a healthy, beneficial manner. We sit with the experience of holding caring space with all that is present.
On a migraine attack day, one of my migraine “foxhole friends” sometimes talks about wishing for peace around the psychological and neurological symptoms. They want release from the negative emotions and thoughts arising out of the uncontrollable reality. Sometimes they blame themselves for the suffering. It is a difficult time. My response is acceptance is a practice and peace is a state of being. Acceptance is the act that can bring one to peace. Both come and go like the tide, rising and dissipating like everything else. Admittedly, some days this practice does not work at all.
I would like to strongly emphasize that ACT is a practice mainly for psychological symptoms, not the debilitating physical migraine attack symptoms themselves. However, ACT for migraine might help during an attack. Pain and other symptoms come from the physical distress of a migraine attack. Suffering is an overall state of being that often involves a story or narrative such as, “I am broken because of how I am feeling and it is my fault.” This is called “the second arrow” in Buddhism. The “second arrow” creates additional suffering, placing the fault of the experience on the person. Remember having migraine disease is NOT your fault. ACT may create an ability to not “get hooked” by or fused with the physical symptoms, negative thoughts and emotions.
A bit about mindfulness
Currently, mindfulness is popularized by the health and wellness industry as a balm for almost everything. Many people are proponents of this practice. I am a certified yoga and meditation instructor and many times when I meet people or work with new students, they mention the need for mindfulness training. When I inquire about the reason, I often hear that the reason is to stop their negative thoughts and uncomfortable emotions. I say I am sorry to disappoint you but that is not mindfulness.
Part of ACT is mindfulness which is acceptance of present just as it is without judgement on the experience as “negative” or “positive.” Mindfulness does not allow for processing of emotions and thoughts around living. It is useful to a certain degree but it is a specific tool for specific things.
How to learn more about ACT and ACT therapy for migraine?
One needs a skilled therapist trained in ACT as a guide and a co-creator for re-framing core beliefs, developing a practice and addressing avoidance behaviors. While you can find workbooks and books about ACT, it is always better to have a guide! I encourage you to learn more about Acceptance and Commitment Therapy through research and talking to a mental health professional. Look up the Association for Contextual Behavioral Science (ACBS) to find a therapist that practices ACT.
Migraine is a chronic disease that can be debilitating and impact daily living. This article’s purpose is to offer another healthy modality in managing this illness. Remember, we are all on the path to living well with migraine.
Miller, Richard C. The iRest® Program for Healing PTSD. A Proven-Effective Approach to Using Yoga Nidra Meditation & Deep Relaxation Techniques to Overcome Trauma. New Harbinger Publications, Inc. California: 2015
https://contextualscience.org/ Accessed 1.3.2022
*This article has been medically reviewed by Beth McCreary, Ph.D. Dr. McCreary received her doctorate in Clinical Psychology from The Ohio State University in 1999. She attained board certification in Behavioral and Cognitive Psychology from the American Board of Professional Psychology (ABPP) in 2015. Dr. McCreary conducts cognitive-behavioral psychotherapy for anxiety conditions including generalized anxiety, panic, agoraphobia, social anxiety, phobias, traumatic stress, and obsessive-compulsive conditions. Dr. McCreary incorporates mindfulness practices and Acceptance and Commitment therapy (ACT) methods into her work. She supports Ms. Emory-Maier in living with migraine.
About the Author: Ambre Emory-Maier has been a migraine sufferer since childhood. She developed vestibular migraine with aura and Alice in Wonderland Syndrome around menopause. Professionally, Ambre has worked for over thirty-five years in the dance field as an administrator, teacher, stager, rehearsal director, choreographer, researcher, dancer and writer. She also teaches yoga and well-being practices and partners with a medical doctor on how these practices can help restore those who have experienced trauma. When not immersed in her work, Ambre loves to spend time reading, travelling, gardening, being with family and many pets in a busy household and learning new things. Because of migraine and its impact on her life, Ambre is dedicated to help others navigate and integrate this illness into their lives.