Table 3 Theoretical underpinnings and behaviour change rational and techniques for CHESS intervention

Introduction to the course and each other

To make participants feel comfortable and relaxed and encouraging them to participate by introducing themselves to the group.

Biopsychosocial model, social cognitive theory

Breaking barriers and encouraging self and social awareness. Providing opportunity for change through social support, education and managing expectations

Understanding chronic headaches and acceptance

To increase understanding of chronic headaches and reasons for it and to introduce the concept of acceptance and need for self-management.

Principles of acceptance theory, biopsychosocial model

Information and education to increase capability, awareness and shape knowledge. Emotional regulation to enable acceptance

Mind, body and pain link

To start to introduce the concept that pain and mood are linked and that mood can have an influence on headaches. To explain the pain cycle individuals can get stuck in due to the unhelpful things we do, and explore the strategies that can be used to help break the cycle.

Cognitive behaviour theory, fear avoidance model, biopsychosocial model

Education to help shape knowledge and promote capability. Understanding emotional consequence

Dealing with unhelpful thought patterns

To introduce ideas about unhelpful thoughts, automatic thoughts and error in thinking. To understand the impact of unhelpful thinking and how such thought patterns can keep people in the pain cycle and explore ways to reframe these thoughts.

Cognitive behavioural theory, health beliefs model, Biopsychosocial model

Promotes capability in identification and reframing of thoughts

Summary

To clarify learning from day one and provide a reminder for things to do before day 2.

Provide the opportunity for embedding learning through summary and promotion of watching the DVD, promoting self-monitoring (headache diary), encourage behavioural practice (relaxation)

Reflections

To understand and empathise with the group and ascertain current thoughts.

Social cognitive theory, biopsychosocial model

Social support, feedback and monitoring of behaviour, social comparison through feedback, social reward and positive reinforcement

Back to basics

To get participants to think about future goals and explore these by identifying possible barriers, potential solutions and develop an associated action plan. To learn about the importance of lifestyle change by being aware of triggers.

Theory of planned behaviour and reasoned action, Cognitive behaviour theory, biopsychosocial model

Use of education and strategies to encourage enablement and knowledge acquisition. Use of problem solving, personalised goal setting, and action planning. Reflections on individuals capability, motivation and opportunity for change

Making headaches more manageable

To understand the link between stress, anxiety and headaches, and look for strategies that may help manage this better. To understand the link between sleep, anxiety and headaches to help identify strategies that may help improve sleep quality. To help practice the art of being in the present.

Cognitive behaviour theory, Theory of planned behaviour and reasoned action, biopsychosocial model

Regulation and reducing negative emotions. Education and shaping knowledge through instruction on how to perform relaxation and mindfulness with an embedded in session practice. Incentivisation to engage through provision of material to enable behavioural practice and habit formation

Treatment options

To increase knowledge about medication and use of medication for chronic headaches.

Social cognitive model, biopsychosocial model

Information about health consequence, pharmacological support (regulation), self-monitoring (use of headache diaries)

Communication – explaining your headaches to others

To improve listening and communication skills to aid better relationships. To reflect on consulting behaviour and promote effective communication and constructive consultations.

biopsychosocial model

To help with social integration. To promote effective healthcare utilisation.

Monitoring of outcomes from previous experiences, use of planning and problem solving, improving communication skills

Future management

To know what to do when experiencing a setback or a flare up.

Cognitive behaviour theory, Theory of planned behaviour and reasoned action, acceptance and commitment therapy. Biopsychosocial model

Preparation and embedded learning.

Summary

To clarify learning from the two days and introduce the structure of the one to one sessions

Embedding learning

One to one session with nurse

To make a classification of headache type and discuss medication management based on the classification. To also review lifestyle factors and goal setting to enable the participant to engage in behaviour change.

biopsychosocial model

Provision of pharmacological information and support as well as embedded learning. Review of goals including reflection on performance and consequence of change. Self-monitoring of headaches and subsequent health, social and environmental consequence. Social reward and positive reinforcement