Alexandra Martin

Efficacy of biofeedback for migraine: A meta-analysis

Abstract In this article, we meta‐analytically examined the efficacy of biofeedback (BFB) in treating migraine. A computerized literature search of the databases Medline, PsycInfo, Psyndex and the Cochrane library, enhanced by a hand search, identified 86 outcome studies. A total of 55 studies, including randomized controlled trials as well as pre–post trials, met our inclusion criteria and were integrated. A medium effect size (Symbol, 95% CI = 0.52, 0.64) resulted for all BFB interventions and proved stable over an average follow‐up phase of 17 months. Also, BFB was more effective than control conditions. Frequency of migraine attacks and perceived self‐efficacy demonstrated the strongest improvements. Blood‐volume‐pulse feedback yielded higher effect sizes than peripheral skin temperature feedback and electromyography feedback. Moderator analyses revealed BFB in combination with home training to be more effective than therapies without home training. The influence of the meta‐analytical methods on the effect sizes was systematically explored and the results proved to be robust across different methods of effect size calculation. Furthermore, there was no substantial relation between the validity of the integrated studies and the direct treatment effects. Finally, an intention‐to‐treat analysis showed that the treatment effects remained stable, even when drop‐outs were considered as nonresponders. Symbol. No caption available.

Meta-analysis of biofeedback for tension-type headache: efficacy, specificity, and treatment moderators.

The aims of the present meta-analysis were to investigate the short- and long-term efficacy, multidimensional outcome, and treatment moderators of biofeedback as a behavioral treatment option for tension-type headache. A literature search identified 74 outcome studies, of which 53 were selected according to predefined inclusion criteria. Meta-analytic integration resulted in a significant medium-to-large effect size (d = 0.73; 95% confidence interval = 0.61, 0.84) that proved stable over an average follow-up phase of 15 months. Biofeedback was more effective than headache monitoring, placebo, and relaxation therapies. The strongest improvements resulted for frequency of headache episodes. Further significant effects were observed for muscle tension, self-efficacy, symptoms of anxiety, depression, and analgesic medication. Moderator analyses revealed biofeedback in combination with relaxation to be the most effective treatment modality; effects were particularly large in children and adolescents. In intention-to-treat and publication-bias analyses, the consistency of these findings was demonstrated. It is concluded that biofeedback constitutes an evidence-based treatment option for tension-type headache.

Psychometric properties and population-based norms of the Life Orientation Test Revised (LOT-R).

OBJECTIVES The relevance of the construct optimism in health psychology has been convincingly demonstrated in numerous studies. Population-based studies about dispositional optimism and the psychometric properties of the Life Orientation Test LOT-R as well as population-based norms are lacking. DESIGN A representative population survey in Germany was conducted to investigate psychometric properties of the LOT-R and to deliver population-based norms. METHODS A representative sample of 2,372 adults aged 18-93 years were screened using self-rating instruments. Results. The confirmatory factor analysis (CFA) confirmed two factors. Optimism and pessimism are negatively correlated (r=-.20). Indications for convergent validity were demonstrated with depression, satisfaction with life, subjective state of health and health care utilization. Optimism is more strongly related to all indicators than pessimism. Since there are only marginal age and gender differences, norm data are given for the entire population. CONCLUSIONS Our study confirms the bi-dimensionality of the LOT-R and thus underpins that optimism and pessimism are two independent constructs rather than a single bipolar trait. Psychometric properties were found to be satisfactory. Together with the norm values reported in the paper, this instrument can, thus, be employed to measure dispositional optimism or pessimism in individual diagnostics as well as in epidemiological research.

Lifetime traumatic experiences and posttraumatic stress disorder in the German population: results of a representative population survey.

Abstract Only a few European population-based studies on the epidemiology of posttraumatic stress disorder (PTSD) are available to date. This study aims to broaden the epidemiological knowledge of traumatic experiences (TEs), PTSD, and comorbid mental conditions in a representative German sample (N = 2510). The Composite International Diagnostic Interview list of traumatic events, the Posttraumatic Diagnostic Scale, and Patient Health Questionnaire (PHQ)-9 as well as PHQ-15 were used in this survey. Main results were low frequencies of TEs (24%) and PTSD (2.9%). Older participants (>60 years) reported significantly more TEs and more posttraumatic symptoms, whereas there was no significant difference in PTSD prevalence. A third of the subjects diagnosed with PTSD were found positive for depressive syndromes, and 27% were found positive for somatization syndrome. The results show that TEs and posttraumatic symptoms are frequent in senior citizens and thus have to be considered when treating older patients with mental health conditions.

Specific effects of depression, panic, and somatic symptoms on illness behavior

Objective: In terms of restricted financial resources, the contribution of mental disorders to health care use and illness behavior is highly relevant. However, the specific contributions of panic disorder, depression, and somatic complaints to illness behavior in unselected samples is unclear. Methods: A representative sample of 2507 inhabitants of Germany was selected and grouped into people with panic disorder (30), somatic syndrome (102), major depression (24), depressive syndrome (77), and controls (2269). Assessment instruments were the complete version of the Patient Health Questionnaire (PHQ), the Scale for the Assessment of Illness Behavior (SAIB) as well as measures of health care use. Results: Although all clinical groups showed increased illness behavior, their impact was independent and specific. Subjects fulfilling the criteria of panic disorder showed the highest scores for illness behavior and health care use. People with mental disorders showed a greater increase in visits to general practitioners and medical specialists than to psychiatrists or psychologists. Regression analysis revealed that somatic complaints and depression have independent associations with illness behavior and health care use. Conclusions: Different mental and psychosomatic disorders contribute independently to health care use and other aspects of illness behavior. PHQ = Patient Health Questionnaire; SAIB = scale for the assessment of illness behavior; GP = general practitioner.

Features of hypochondriasis and illness worry in the general population in Germany.

Objective: Although hypochondriasis is considered to be of high relevance in the healthcare sector, its prevalence in the general population has been investigated in few studies. The aims of this study were to estimate prevalence rates of hypochondriasis and of subthreshold conditions and to describe their associated features such as quality of life and healthcare utilization in a representative community sample. Methods: Analyses of the present study are based on the German Health Interview and Examination Survey–Mental Health Supplement (N = 4181, representative for the German population from 18–65 years). The assessment included interviews for somatic conditions and mental disorders and self-report ratings on health-related quality of life, healthcare utilization, disability days, and physical activity. Results: Only three cases (0.05%) were identified as meeting full criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) hypochondriasis. The prevalence rate of the less restrictively defined form of hypochondriasis, (“subthreshold hypochondriasis”) was 0.58% and an additional 2.12% reported having had illness worries for at least 6 months but did not meet further hypochondriasis criteria. The two subthreshold diagnostic groups provided strong evidence of difference from the nonhypochondriac controls: comorbidity with psychiatric and medical disorders and healthcare utilization were higher, and quality of life was markedly reduced. Conclusions: The results provide additional support to not only consider “full” DSM-IV hypochondriasis, which is a very rare disorder in the general population, but also to include less restrictive hypochondriac conditions—associated with a clinically relevant degree of psychological and physical impairment—into clinical and scientific considerations. DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; GHS = The German National Health Interview and Examination Survey; GHS-CS = core survey; GHS-MHS = mental health supplement; H0 = no illness worry group; H1 = unrealistic illness worry group; H2 = subthreshold hypochondriasis; M-CIDI = Munich Composite International Diagnostic Interview.

Association between Obesity and Adult Attention-Deficit/Hyperactivity Disorder in a German Community-Based Sample

Objective: The goal of the present study was to examine the association between attention-deficit/hyperactivity disorder (ADHD) and obesity in a representative community based sample of the German population. Method: Participants were 1,633 German residents (53.6% female) aged 18–64 years. A retrospective assessment of childhood ADHD and a self-report assessment of adult ADHD were administered for diagnosis of adult ADHD. In addition, binge eating and purging behaviors as well as depression and anxiety were assessed using selfrating instruments. Results: The estimated prevalence of ADHD in obese participants was 9.7% compared to 3.8% in overweight and 4.3% in under-/normal-weight participants. The prevalence of obesity was 22.1% among adults with ADHD and 10.2% among persons without ADHD. Adult ADHD was significantly associated with a greater likelihood of being obese but not overweight even after adjusting for sociodemographic characteristics. Results were similar when adjusting for depression and anxiety symptoms and for purging behaviors. Odds ratios decreased after adjusting for binge eating; however, the results were still significant which shows that the relationship between obesity and ADHD in adulthood is not fully explained by binge eating. Conclusion: Overall, the results indicate that adult ADHD is associated with obesity in a community-based sample of the adult German population.

Are psychological features useful in classifying patients with somatic symptoms

Objective: To evaluate psychological characteristics that could be used for the classification of somatic syndromes requesting medical care. Positive psychological classification criteria are needed to justify the classification of somatic syndromes as Diagnostic and Statistical Manual of Mental Disorders- or International Classification of Diseases-10 section F/mental disorders diagnosis. Methods: From a population-based sample of 2510 people, subsamples reporting high scores for somatic symptoms (SOM+; n = 154) versus average scores for somatic symptoms (SOM−; n = 167) were defined. Telephone interviews (e.g., structured interviews for diagnoses, healthcare use, symptom history, possible psychological characteristics), self-rating scales (e.g., Pain Disability Index, depression scale Patient Health Questionnaire-9), and general practitioners reports were collected for these subsamples. In addition to somatic symptoms, we used healthcare use and disability as major external validation criteria. Results: There was strong evidence for ten of the 28 binary coded psychological variables to identify those people with somatic symptoms who needed medical help and/or were seriously disabled. These variables included “avoidance of physical activities,” “bias for somatic illness attributions,” “self-concept of being physically weak,” and “desperation because of somatic symptoms.” The relevance of these psychological characteristics was partially further confirmed by stepwise regression analyses, which showed incremental validity compared with variables like somatic symptoms and depression. Conclusions: This study identified several psychological characteristics of people with somatic complaints who need medical care. These features can be assessed, using binary variables that are more feasible for classification processes. These psychological criteria should be included in classification rules for people with somatic syndromes (e.g., somatoform disorders). PHQ = Patient Health Questionnaire; PDI = Pain Disability Index.

Psychophysiologic treatment of chronic tinnitus : A randomized clinical trial

Background: Tinnitus seems to be associated with psychophysiological over-activation (e.g., of head and shoulder muscles). Therefore we aimed to develop and evaluate a new intervention program including a psychophysiological approach. Methods: Forty-three tinnitus sufferers were randomized to 2 groups, one receiving a psychophysiologically oriented intervention lasting 7 intervention sessions (plus 2 assessment sessions), whereas the other group waited for a comparable time period. Afterward, patients on the waiting list also received the intervention. Physiological variables were muscle activity of head and shoulders and electrodermal activity. Psychological assessments took place at pretreatment, post-treatment, and 6 months later. Follow-up data were available from 95% of participants. Major outcome variables were self-rating scales (e.g., tinnitus annoyance assessed by the Tinnitus Questionnaire), and diary data (self-control, daily time of perceiving the tinnitus). Results: On most tinnitus specific variables, patients in the treatment group improved significantly more than patients on the waiting list. Main effect sizes for tinnitus-specific variables were up to 0.89. Muscle reactivity of head muscles at the beginning predicted significant treatment effects. Conclusion: Compared with meta-analytical reviews of psychological interventions for tinnitus sufferers, the presented treatment is brief and in the upper range of effectiveness. ES = effect size; GSI = General Symptomatic Index (mean score of Brief Symptom Inventory); IG = intervention group; MG = merged group; SCL-90R = symptom check list; TQ = Tinnitus Questionnaire; WLG = waiting list group.

What is “normal” disability? An investigation of disability in the general population

ABSTRACT Many studies have investigated the highly relevant association between pain and disability in clinical groups using the Pain Disability Index (PDI). To interpret these results, knowledge of disability in the general population is crucial. Moreover, to investigate criterion validity of the PDI, the influence on health care utilisation (HCU) is of special interest. In the present study, a broadened version of the PDI was psychometrically evaluated with a large representative sample of the general population. The independent impact of disability on HCU was also investigated. A representative sample of the German general population (N = 2510) was screened for disability, somatic complaints, mental health (PHQ) and HCU. Following a psychometric evaluation of the PDI, data are provided about the distribution of disability in the general population. For the prediction of HCU, stepwise linear regression analysis was calculated. The psychometric evaluation of the PDI revealed a one‐factor solution, high reliability, and satisfactory construct validity. Percentage scores for the distribution of disability are provided for those people reporting at least one pain/somatic symptom. These data allow a better description of disability in clinical samples. Somatic complaints, disability, unemployment or retirement, depression and anxiety explained 26% of the variance for HCU. The PDI is an economical, reliable and valid self‐rating instrument for assessing disability caused by physical symptoms. HCU in the general population is determined by the number and severity of somatic complaints and also by disability. Symptoms and disability play a crucial but somewhat independent role.