Psychological Assessment and Therapy

Psychologist Jeffrey Pingel, Ph.D. explains the role of psychological assessment and psychological therapy at MHNI.

What is the difference between psychological assessment and psychological therapy?

Psychological assessment may occur early in a person’s treatment at MHNI. A person's living circumstance, mood, ways of coping with pain, stresses that may relate to the head pain, health habits, and patterns of substance use (e.g., cigarette smoking, alcohol consumption, overuse of analgesic medication) may be relevant to their headache condition. Psychological assessment is for fact gathering only and may include objective testing of a person's coping ability, mood, interpersonal problems, and cognitive difficulties.

Our team wants to be informed of any circumstance and/or factor which can influence an individual's headache condition or recovery. One of our physicians or nurses may suggest a referral to a MHNI psychologist for an initial evaluation if an assessment seems appropriate.

Psychological therapy, on the other hand, involves ongoing contact and sessions and thus involves more than one or two sessions with an MHNI psychologist.

What is psychological therapy and how might it help the headache sufferer?

Psychological therapy involves discussion with a trained mental health professional (e.g., psychologist, psychiatrist, social worker, etc.) about problems in living - unhappy relationships, uncomfortable emotions, disturbing thoughts and experiences. People who seek psychological therapy are distressed about a matter in their life. The purpose of the discussion is to get perspective on the problem, solve it (if possible), and feel less distressed. Certain circumstances won’t easily change so psychological therapy helps the person adapt and make the best of the situation.

Some patients at MHNI believe that certain family or work circumstances aggravate their headache. For example, I see several individuals each year who describe this pattern: the headache worsens Sunday night into Monday morning and is most severe on Monday and Tuesday; later in the week toward the weekend the pain improves, and Saturday is the best day. Almost always an interpersonal problem exists related to work or school. The goal of psychological therapy is to identify the problem and discuss better ways to cope.

One problem the psychologists at MHNI and St. Joseph Mercy Chelsea increasingly observe is an intense fear of head pain, a type of anxiety reaction to escalating pain. This can result in overuse of pain pills because the person feels panicky. Behavior therapies such as biofeedback and relaxation are very helpful in lessening this reaction.

Do all headache sufferers need psychological therapy?

The short and easy answer is: no. MHNI’s staff understands that people with chronic headaches often doubt themselves, or are questioned by family members, friends, and co-workers about their emotional well-being. Headache sufferers (and their loved ones) want to make sense of their pain. There is a traditional assumption that their pain is related to something they are doing to themselves (e.g., not handling stress, feeling unmotivated and hopeless, losing their temper).

We often observe that emotional upset and aberrant behavior is a result of intense and daily pain. The patient’s personality returns to a steady state once the headaches are more controlled.

On the other hand, some individuals have a history of severe depression or anxiety reactions, independent of the headache condition. Such mood disturbance may affect the headache and interfere with the person’s response to medical treatment. A person who is overly anxious or impatient about their headache condition may prematurely give up on the proper use of daily medication.