Refractory Headache or Refractory Patient? Issues of Locus of Control in Chronic Daily Headache (CDH)
Both patient and provider should not underestimate the important role of the patient to exert agency or control over his or her own health. This chapter reviews the psychological construct of locus of control (LOC) as it applies to the treatment and management of CDH. Beginning with an overview of LOC and the related concept of self-efficacy, the chapter explores how these constructs have been measured and applied to understand the CDH population. In particular, research suggests that internal LOC and high self-efficacy are associated with favorable treatment outcomes for modifiable health behaviors of benefit to CDH patients. Two psychological treatments to enhance patient internal LOC and self-efficacy – cognitive-behavioral therapy (including biofeedback and use of relevant assessment tools) and motivational interviewing – are addressed. The chapter concludes with a discussion of suggestions for providers to increase their own LOC and self-efficacy in treating the CDH population, and concepts are illustrated with a case study.
KeywordsChronic daily headache (CDH) Refractory headache Refractory patient Locus of control (LOC) Health locus of control (HLOC) Headache-specific locus of control (HSLC) Self-efficacy Cognitive-behavioral therapy (CBT) Biofeedback Motivational interviewing Patient-provider collaboration Patient-provider frustration
The authors wish to thank Annette Wilson, Ph.D., for her contributions to the chapter, in particular the results of her biofeedback study.
Correspondence regarding this chapter should be addressed to Sarah E. Trost, Pain Management Center, Department of Anesthesiology, Medical College of Wisconsin, 959 N. Mayfair Rd., Wauwatosa, WI 53226.
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