Bruce W. Carlson

Effect of preventive (β blocker) treatment, behavioural migraine management, or their combination on outcomes of optimised acute treatment in frequent migraine: randomised controlled trial

Objective To determine if the addition of preventive drug treatment (β blocker), brief behavioural migraine management, or their combination improves the outcome of optimised acute treatment in the management of frequent migraine. Design Randomised placebo controlled trial over 16 months from July 2001 to November 2005. Setting Two outpatient sites in Ohio, USA. Participants 232 adults (mean age 38 years; 79% female) with diagnosis of migraine with or without aura according to International Headache Society classification of headache disorders criteria, who recorded at least three migraines with disability per 30 days (mean 5.5 migraines/30 days), during an optimised run-in of acute treatment. Interventions Addition of one of four preventive treatments to optimised acute treatment: β blocker (n=53), matched placebo (n=55), behavioural migraine management plus placebo (n=55), or behavioural migraine management plus β blocker (n=69). Main outcome measure The primary outcome was change in migraines/30 days; secondary outcomes included change in migraine days/30 days and change in migraine specific quality of life scores. Results Mixed model analysis showed statistically significant (P≤0.05) differences in outcomes among the four added treatments for both the primary outcome (migraines/30 days) and the two secondary outcomes (change in migraine days/30 days and change in migraine specific quality of life scores). The addition of combined β blocker and behavioural migraine management (−3.3 migraines/30 days, 95% confidence interval −3.2 to −3.5), but not the addition of β blocker alone (−2.1 migraines/30 days, −1.9 to −2.2) or behavioural migraine management alone (−2.2 migraines migraines/30 days, −2.0 to −2.4), improved outcomes compared with optimised acute treatment alone (−2.1 migraines/30 days, −1.9 to −2.2). For a clinically significant (≥50% reduction) in migraines/30 days, the number needed to treat for optimised acute treatment plus combined β blocker and behavioural migraine management was 3.1 compared with optimised acute treatment alone, 2.6 compared with optimised acute treatment plus β blocker, and 3.1 compared with optimised acute treatment plus behavioural migraine management. Results were consistent for the two secondary outcomes, and at both month 10 (the primary endpoint) and month 16. Conclusion The addition of combined β blocker plus behavioural migraine management, but not the addition of β blocker alone or behavioural migraine management alone, improved outcomes of optimised acute treatment. Combined β blocker treatment and behavioural migraine management may improve outcomes in the treatment of frequent migraine. Trial registration Clinical trials NCT00910689.

A Randomized Clinical Trial of Two Telephone-Delivered, Mental Health Interventions for HIV-Infected Persons in Rural Areas of the United States

Through December 2003, more than 55,300 persons were living in small towns and rural areas of the United States at the time of their AIDS diagnosis. Many HIV-infected rural persons experience elevated levels of depression, suicidal ideation, and anxiety. This research tested if two telephone-delivered, mental health interventions could facilitate the adjustment efforts of persons living with HIV/AIDS in rural areas of the United States. Participants (N=299) were recruited through AIDS service organizations in 13 states and assigned to a Usual Care Condition (n=107), an 8-session Information Support Group Intervention (n=84), or an 8-session Coping Improvement Group Intervention (n=108). Participants completed self-administered surveys at pre-intervention, post-intervention, and 4- and 8-month follow-ups. ANCOVA revealed that no treatment condition produced reductions in the main outcome measures of depressive and psychological symptoms; however, Information Support participants received significantly more support from friends at 4- and 8-month follow-ups and reported fewer barriers to health care and social services at 4-month follow-up compared to participants in the other two conditions. Telephone-delivered, information-support groups have potential to increase perceptions of support and reduce barriers to health care and social services in this population, but the practical significance of these intervention-related changes is limited.

Moderation and mediation in the psychological and drug treatment of chronic tension-type headache: the role of disorder severity and psychiatric comorbidity.

ABSTRACT We evaluated two putative moderators of treatment outcome as well as the role of Headache Management Self‐Efficacy (HMSE) in mediating treatment outcomes in the drug and non‐drug treatment of chronic tension‐type headache (CTTH). Subjects were 169 participants (M = 38 yrs.; 77% female; M headache days/mo. = 22) who received one of four treatments in the treatment of CTTH trial (JAMA, 2001; 285: 2208–15): tricyclic antidepressant medication, placebo, (cognitive‐behavioral) stress‐management therapy plus placebo, and stress‐management therapy plus antidepressant medication. Severity of CTTH disorder and the presence of a psychiatric (mood or anxiety) disorder were found to moderate outcomes obtained with the three active treatments and with placebo, as well as to moderate the role of HMSE in mediating improvements. Both moderator effects appeared to reflect the differing influence of the moderator variable on each of the three active treatments, as well as the fact that the moderator variables exerted the opposite effect on placebo than on the active treatments. HMSE mediated treatment outcomes in the two stress‐management conditions, but the pattern of HMSE mediation was complex, varying with the treatment condition, the outcome measure, and the moderator variable. Irrespective of the severity of the CTTH disorder HMSE fully mediated observed improvements in headache activity in the two stress‐management conditions. However, for patients with a mood or anxiety disorder HMSE only partially mediated improvements in headache disability, suggesting an additional therapeutic mechanism is required to explain observed improvements in headache disability in the two stress‐management conditions.

Disjunction Errors in Qualitative Likelihood Judgment

Probability theory requires that the disjunction of two events be judged at least as likely as either of those events. Two studies are described which imply that violations of this requirement are very common. The data also show that subjects do not commit disjunction errors because they misinterpret the disjunctive statement “A or B” to mean “A or B, but not both.” Instead, the pattern of errors is consistent with a judgment process describable as averaging. These results provide support for a “signed combination model of qualitative likelihood judgment.” This model generalizes a previous one which applied to judgments concerning conjunctive events (J. F. Yates and B. W. Carlson, 1986,

Donor retention as a function of donor reactions to whole-blood and automated double red cell collections.

BACKGROUND: Although reactions to whole‐blood (WB) donation are known to decrease donor retention, potential effects of reactions to automated double red cell (2RBC) donation upon retention have not been investigated.

Anchoring and adjustment in judgments under risk.

This article examines anchoring and adjustement in the assignment of minimum selling prices to three-outcome gambles.

Writing from Sources: A Structure-Mapping Model.

The purpose of this study was to test assumptions of a structure-mapping model of writing from sources based on Gentners (1983) structure-mapping model of analogical reasoning. Subjects read 2 passages organized either similarly or dissimilarly and presented in 1 of 2 orders. Subjects then wrote a comparison-contrast essay about the passages. Results showed that subjects used the first passage as a base. This base influenced both the global and local structure of the essays. Results also showed that subjects reading similarly organized passages wrote essays with better organization but inferior linguistic quality as compared with subjects reading dissimilarly organized passages

Fear of blood draws, vasovagal reactions, and retention among high school donors

We previously demonstrated that fear of having blood drawn is one of the strongest known predictors of vasovagal reactions among high school blood donors. This report examines the combined effects of donor fear and experience of vasovagal reactions on repeat donation attempts among high school blood donors.

All Things in Moderation, Including Tests of Mediation (at Least Some of the Time)

Seeking to explain the processes by which one construct causes another is a staple of psychological research. This is typically done with statistical procedures using observations of the hypothesized cause, mediator, and effect. Unfortunately, interpretations of mediation are generally weak on internal validity when using this approach. As an alternative, a causal chain approach has been advocated, but that approach is often impractical. In this article, a third method that involves measuring or manipulating a moderator is described. The core of the argument for a moderation approach hinges on the recognition that mediation refers to a mechanism or process that might be blocked or enhanced via a moderator. Thus, finding interactions with manipulations, variables, or constructs that might affect the efficiency, rate, or operation of a mechanism, or the links to or from the mechanism, implies that mechanism is involved in determining the relationship between a cause and an effect. Examples and implications regarding the potential use as well as the advantages and disadvantages of the approach for applied researchers are described.

Predicting asthma in individual patients.

The degree to which asthma attacks were related to seven environmental variables was determined for each of 17 individuals. Using stepwise regression procedures, cladosporium mold, ragweed pollen, and a change in temperature were significant predictors of asthma attacks in 5 of 17 individuals. The information provided by these analyses could prove useful in helping some individuals manage their asthma.