The Effectiveness of a Group-Based Acceptance and Commitment Additive Therapy on Rehabilitation of Female Outpatients With Chronic Headache: Preliminary Findings Reducing 3 Dimensions of Headache Impact
ABSTRACT Examine whether acceptance and commitment additive therapy is effective in reducing the experience of sensory pain, disability, and affective distress because of chronic headache in a sample of outpatient Iranian females.
Chronic headaches have a striking impact on sufferers in terms of pain, disability, and affective distress. Although several Acceptance and Commitment Therapy outcome studies for chronic pain have been conducted, their findings cannot be completely generalized to chronic headaches because headache-related treatment outcome studies have a different emphasis in both provision and outcomes. Moreover, the possible role of Iranian social and cultural contexts and of gender-consistent issues involved in Acceptance and Commitment Therapy outcomes deserve consideration.
This study used a randomized pretest-post-test control group design. The sample was selected from consecutive female outpatients with chronic headache, attending and/or referred to a headache clinic in a governmental hospital from April 2011 to June 2011. In total, 80 female outpatients were interviewed, and after implementing inclusion/exclusion criteria, thirty females were considered eligible to participate in the study. Half (n = 15) were randomly selected to participate in the treatment group. Four participants of this group failed to complete the treatment sessions (n = 11). The Acceptance and Commitment Therapy group received the medical treatment as usual and 8 sessions of Acceptance and Commitment Therapy. The other half (n = 15) served as the control group that received only medical treatment as usual. The short form of McGill pain questionnaire, the migraine disability assessment scale, and the trait subscale of the state-trait anxiety inventory were administered, which operationalized 3 dimensions of impact of chronic headache, sensory pain, disability, and emotional distress, respectively, to explore the impact of recurrent headache episodes. Pretest and post-test measures on these 3 dimensions of impact were the primary outcome measures of this study. Analyses of covariance with the pretreatment score used as a covariate were conducted on pain intensity, degree of disability, and level of affective distress before and after therapy to assess therapeutic intervention effectiveness.
Chronic tension type of headache (63%) and chronic migraine without aura (37%) were the headache types reported by the participants. Data analyses indicated the significant reduction in disability (F[1,29] = 33.72, P < .0001) and affective distress (F[1,29] = 28.27, P < .0001), but not in reported sensory aspect of pain (F[1,29] = .81, P = .574), in the treatment group in comparison with the control group.
The effectiveness of a brief acceptance and commitment additive therapy in the treatment of Iranian outpatient females with chronic headache represents a significant scientific finding and clinical progress, as it implies that this kind of treatment can be effectively delivered in a hospital setting.
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ABSTRACT: To determine whether a 1-day behavioral intervention, aimed at enhancing psychological flexibility, improves headache outcomes of migraine patients with comorbid depression. Migraine is often comorbid with depression, with each disorder increasing the risk for onset and exacerbation of the other. Managing psychological triggers, such as stress and depression, may result in greater success of headache management. Sixty patients with comorbid migraine and depression were assigned to a 1-day Acceptance and Commitment Training plus Migraine Education workshop (ACT-ED; N = 38) or to treatment as usual (TAU; N = 22). Patients completed a daily headache diary prior to, and for 3 months following, the intervention. Clinical variables examined included headache frequency/severity, medication use, disability, and visit to a health care professional. Comparisons were made between baseline findings and findings at the 3-month follow up. Participants assigned to the ACT-ED condition exhibited significant improvements in headache frequency, headache severity, medication use, and headache-related disability. In contrast, the TAU group did not exhibit improvements. The difference in headache outcomes between ACT-ED and TAU was not statistically significant over time (ie, the treatment by time interaction was nonsignificant). These results complement those of a previous report showing effects of ACT-ED vs TAU on depression and disability. A 1-day ACT-ED workshop targeting psychological flexibility may convey benefit for patients with comorbid migraine and depression.These pilot study findings merit further investigation using a more rigorously designed large-scale trial.Headache The Journal of Head and Face Pain 03/2014; 54(3):528-38. DOI:10.1111/head.12258 · 3.19 Impact Factor
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ABSTRACT: Acceptance and commitment therapy (ACT) has attracted a lot of interest during the last 10-15 years with a strong increase of the number of randomized controlled trials (RCTs). The present review and meta-analysis includes 60 RCTs (4,234 participants) on psychiatric disorders, somatic disorders, and stress at work. The mean effect size across all comparisons was small (0.42). Compared to the Öst (2008) meta-analysis there was no significant improvement in methodological quality and deterioration in effect size (from 0.68). When ACT was compared to various forms of cognitive or behavioral treatments a small and non-significant effect size of 0.16 was obtained. An evidence-base evaluation showed that ACT is not yet well-established for any disorder. It is probably efficacious for chronic pain and tinnitus, possibly efficacious for depression, psychotic symptoms, OCD, mixed anxiety, drug abuse, and stress at work, and experimental for the remaining disorders.Behaviour Research and Therapy 10/2014; 61. DOI:10.1016/j.brat.2014.07.018 · 3.85 Impact Factor
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ABSTRACT: Posttraumatic stress disorder (PTSD) is often comorbid with chronic migraine (CM) and chronic tension-type headache (CTTH). Trauma-focused cognitive behavioral psychotherapies, selective serotonin reuptake inhibitors (SSRIs), and venlafaxine have demonstrated efficacy in the treatment of PTSD. Amitriptyline, topiramate, sodium valproate, and botulinum toxin A are efficacious for treatment of chronic daily headache (CDH). Treatment studies on individuals with CDH and comorbid PTSD, however, are limited. As such, multiple therapeutic agents or modes of interventions typically are necessary, such that comprehensive treatment simultaneously utilizes approaches with established efficacy for each individual condition.Current Treatment Options in Neurology 10/2014; 16(10):312. DOI:10.1007/s11940-014-0312-7 · 2.18 Impact Factor