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Article Excerpt
Headaches are a complex medical problem that results in significant health expenditures, lost employee attendance and productivity, and relationship disturbance. Further, psychological counseling is one of the basic components of treatment of sufferers of chronic headaches. A study of 60 adults seeking medical care at a headache specialty clinic was conducted to provide preliminary information on levels of wellness and perceived stress in this population. Not surprisingly, overall levels of wellness were low and perceived stress was high compared to a norm group of adults. Specific components of wellness varied with spirituality being higher among the headache population and nutrition, exercise, and locus of control being lower A case study is presented from practice in a medical clinic, and implications for mental health counselors as providers in medical settings are discussed.
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Although headaches represent a significant health problem, producing an annual loss in employee productivity of $17 billion a year (Osterhaus, Gutterman, & Plachetka, 1992), they are often treated as less than legitimate illnesses by employers, family members, and friends as well as health care providers who often view headaches as having a psychosomatic etiology (Mueller, Gallahger, Steer, & Ciervo, 2000). Or, as Barolin (1997) noted, "there is no headache without a psychogenic component" (p. 71). Although many headache sufferers first seek treatment for their headaches from medical practitioners, for decades, traditional recommendations for headache management have specifically included a component of psychological counseling (Carney, Dietrich, Eliassen, Owen, & Badger, 1999; Kennedy & Barter, 1994; Ludin, Diener, & Mumenthaler, 1996). This information suggests that mental health counselors should have a basic understanding of the relationship between physical and emotional well being and be prepared to assist clients who are referred for treatment of chronic pain associated with headaches.
Headaches can be debilitating and negatively impact the individual, his or her family (Smith, 1998), and society. Compared to non-headache control groups, headache sufferers are more likely to be mildly anxious and depressed (Hatch et al., 1991; Deffenbacher et al., 1996) or to exhibit and experience simply more general, nonspecific distress (Venable, Carlson, & Wilson, 2001). It is well established that physical pain can create stress; recent studies have documented that pain may also be a result of stress (Gamsa & Vikis-Freibergs, 1991). Numerous studies report that both those who experience chronic headaches and their families suffer from compromised family functioning including less openness about feelings, greater instability, and diminished marital and sexual satisfaction (Basolo-Kunzer, Diamond, Maliszewski, Weyermann, & Reed, 1991; Terwindt et al., 2000).
Awareness of these issues from a holistic perspective led one of the authors, a neurologist heading a community-based headache specialty clinic, to request a mental health counselor on staff on a trial basis to address psychological issues in patients presenting with headaches. This clinic had adopted a holistic approach to medical care, consistent with a paradigm shift in medicine toward viewing wellness models as an alternative paradigm for practice (Armentrout, 1993; Randall, 1996). To our knowledge, this was the first time that holistic wellness models, depicting a philosophical approach integral to the practice of mental health counseling (Palmo, Shosh, & Weikel, 2001; Smith, 2001), have been applied to headache treatment. The negative and pervasive impact headaches have on daily life and relationships, and the connection between stressors and headache onset, have been well established. We hypothesized that assessment and treatment of headache patients from a mental health and wellness perspective, in combination with traditional medical interventions, could result in more effective outcomes than those resulting solely from use of the traditional medical model.
The present study was undertaken as an exploratory examination of the levels of wellness and perceived stress among a group of patients receiving care at the specialty headache clinic. Following a discussion of the nature of and treatment for headaches and an overview of the wellness model used, the research questions, methodology, and results are presented and discussed. A case study is described. The results and case example underscore the benefits described by Barker (2001) of incorporating mental health counseling in medical settings.
HEADACHES: NATURE AND IMPACT
Headaches represent a complex medical problem with causality attributed to a variety of factors (Silberstein, Lipton, & Goadsby, 1998). There are two distinct types of headache that are particularly common, migraine and tension. Migraine headaches usually begin when a person is between 10- and 40years-old, and are characterized by moderate to severe pain of a throbbing nature (Silberstein et al.). The headache may be triggered by environmental factors (e.g., certain foods, odors, bright sunlight, and irregular sleep patterns), psychological factors (e.g., ongoing stressful life situations), or physiological factors (e.g., hormonal changes). The Centers for Disease Control (1999) reported that the lifetime incidence of migraine headache has increased almost 70%, to a rate of 43.7 per 1,000 people. For women aged 45 to 64, this rate more than doubles. Over 85% of women and 82% of men who suffer migraine experience some headache-related disability, with roughly one-third reporting severe disability or requiring bed rest.
Tension-type headaches usually do not begin until a person is between 20-and 50-years-old, and are characterized by a dull ache similar to a vise-like, band-like pressure, and are often caused by psychological and physiological stress and tension (Silberstein et al., 1998). These headaches have been estimated at incidence levels of up to 86% of all women and 63% of all men (Rasmussen, Jensen, Schroll, & Olesen, 1991). The impact of tension-type headaches includes a limitation of functioning for 44% of individuals and discontinuation of normal activities for 18%.
The primary causes and consequences for both tension-type and migraine headaches include psychological and interpersonal factors, both of which affect the total well being of the client. Research into the psychological aspects of headache indicates that headache patients have poorly developed coping strategies for dealing with their condition (Wise, Mann, Jani, & Jani, 1994). Compared to a control group of patients hospitalized for other illnesses, head-pain patients show higher affective inhibition, indicating difficulty expressing negative feelings; an increased use of denial in that they minimize the stressors in their lives; and increased irritability which indicates elevated hostility and interpersonal difficulties. Rollnik, Karst, Fink, and Dengler (2001) reported that poor coping skills (specifically with pain) contribute to the transformation of occasional tension-type headache into a chronic condition.
Holm, Lokken, and Myers (1997) found a significant positive connection between life stress and incidence of headaches. Further, it has been shown that the frequency of serious illnesses, as well as both the frequency of serious and non-serious symptoms, is positively correlated with levels of perceived stress (Spacapan & Oskamp, 1987). Overall, numerous recent studies reveal a strong, positive relationship between health and individual lifestyle factors that can be modified (Shannon & Pyle, 1993). These lifestyle factors have been conceptualized in models of wellness, such as the Wheel of Wellness (Myers, Sweeney, & Witmer, 2000, 2001), and have been proposed as a basis for both assessment and intervention from a counseling perspective.
MODELS OF WELLNESS
Wellness was first conceptualized in ancient Greek society as a holistic concept incorporating aspects of body, mind, and spirit. More recently, Hettler (1984), a public health physician, developed a multidimensional wellness model to promote health in university and community settings. Hettler's model included six dimensions--social, occupational, physical, intellectual, spiritual, and emotional wellness--based in the belief that individuals make choices for successful existence as a process towards achieving wellness. Shortly after the publication of Hettler's model, Ardell (1986) developed a multidimensional model that incorporated stress management and individual meaning and purpose as important aspects of wellness This model was comprised of five broad dimensions: self-responsibility, nutritional awareness, stress awareness and management, physical fitness, and environmental sensitivity.
More recently, Ryff and Keyes (1995) noted that most...
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