John G. Arena

Psychometric properties of the SUNYA revision of the psychosomatic symptom checklist

The Psychosomatic Symptom Checklist (PSC), a questionnaire assessing psychosomatic symptoms, was administered to two separate samples of college students. For Sample 1 (N=698),the questionnaire was readministered to three separate subsets at intervals of either 1 week (N=143),4 weeks (N=74),or 8 weeks (N=48).Each subset of subjects recompleted the PSC on only one of the three retest intervals. Based on the initial administration an analysis of the normative data revealed a mean total score of 23.7, suggesting a relatively low degree of psychosomatic symptoms in this group. Although total scores decreased slightly over time, test-retest correlations remained high (r>0.80, P<0.0001).Individual item correlations varied and also decreased across time; however, the majority of correlations was greater than r=0.50 throughout. Sample 2 (N=249)completed the PSC, Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI-X), and Rathus Assertiveness Scale (RAS), and intercorrelations were computed between these measures. This analysis revealed little overlap between the psychosomatic complaints assessed by the PSC and other commonly used measures of psychological distress. Finally, a factor analysis revealed one major factor on which all but 2 of the 17 questionnaire items loaded significantly. These results suggest that the PSC is sensitive to psychosomatic distress and remains reliable over time.

Reliability of psychophysiological assessment.

Abstract In order to assess the reliability of psychophysiological recording, 15 subjects were assessed on multiple response measures (forehead EMG and forearm flexor EMG, heart rate, skin resistance level, hand surface temperature and cephalic vasomotor response), under multiple stimulus conditions (baseline, self-control, cognitive and physical Stressors), on multiple occasions (Days 1, 2, 8 and 28). Three forms of reliability coefficients were computed for each response measure: coefficients on absolute scores, coefficients on change scores from baseline to stressful conditions and coefficients on percent change from baseline. Only frontal EMG appeared to have consistently high absolute reliability coefficients, with hand surface temperature having high reliability if sessions are repeated within 1 week. Heart rate was less consistently reliable. Treating the responses as relative measures did not increase their reliability; indeed, hand surface temperature was completely unreliable when examined in this fashion. Implications of this study for behavioral medicine, biofeedback and anxiety-based disorders research, as well as Langs tripartite response system model of fear and emotion, are discussed.

Psychophysiology of recurrent headache: Methodological issues and new empirical findings*

Traditional accounts of headache attribute migraine to an unstable vasomotor system and tension to prolonged contraction of skeletal muscles. Investigations of the psychophysiology of headache testing these assumptions have produced conflicting results, however. Review of investigations conducted since 1970 reveals that certain methodological shortcomings may account, in part, for this confusion. Data are reported for a study which attempted to control these methodological deficiencies. Headache subjects, diagnosed as migraine, tension, or combined migraine and tension, were compared to nonheadache control participants who were matched on the basis of sex, income, marital status, age, and life events. All subjects were exposed to a variety of experimental conditions (rest, self-control, and stress) while physiological recordings were obtained for forehead and forearm EMG, temporal artery blood flow, hand surface temperature, heart rate, and skin resistance level. No main effects for groups were found for any measures, and group by condition interactions revealed no consistent pattern of results. The data do not support the traditional notions of headache.

Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or, the machines may be necessary some time of the time

Abstract Two studies are reported in which patients with chronic headache, who did not improve significantly as a result of a 10-session, 8-week relaxation training program, were subsequently treated with biofeedback. For the tension headache sufferers, 36% of the relaxation non-responders showed significant improvement with frontal EMG biofeedback training. For those with vascular headaches, 44% of the relaxation non-responders showed significant improvement with thermal biofeedback. Vascular headache patients with combined migraine and tension symptoms did better than those with only migraine. Psychological test scores significantly differentiated successful vs non-successful biofeedback responders.

Relaxation training for tension headache: Comparative efficacy and cost-effectiveness of a minimal therapist contact versus a therapist-delivered procedure

This study compared the clinical utility and cost-effectiveness of a standard, therapist-delivered relaxation treatment of tension headache to a comparable procedure administered with minimal therapist contact and based chiefly at home. Both procedures were highly effective and nearly equivalent for reducing headache complaints, as assessed by measures of headache index, intensity, frequency, and of medication consumption. The minimal contact, home-based treatment was shown to be more cost-effective when relating total amount of therapist contact to headache improvement. These findings suggest that the home-based relaxation treatment may constitute a viable, low-cost alternative to the more typical, but expensive, clinic-based procedures in the treatment of tension headache.

Four process studies in the behavioral treatment of chronic headache.

Abstract Four studies of ‘process’ variables in the behavioral treatment of chronic headache are examined. No relation between headache activity-level reduction and therapist variables such as level of experience (study 1) or warmth, competence or helpfulness as perceived by the patient (Study 2) was found from treatments using relaxation training and/or biofeedback. A significant relation was found, however, between regularity of relaxation practice at home (Study 4) and headache-activity reduction and between regularity of showing some degree of hand warming in thermal biofeedback treatment for vascular headache and headache activity-level reduction (Study 3). Finally, no relation was found between changes in EMG and headache activity-level for tension-headache sufferers treated with frontal EMG biofeedback.

Personality and Chronic Headache

Publisher Summary This chapter presents the features and characteristics of individuals that are associated with chronic headache. It also presents comparisons made among four different diagnostic groups of headache sufferers and nonheadache controls on a variety of personality measures; the relation of personality factors to headache activity in an untreated population suffering from chronic headache; and an examination of the ability of these various measures to predict the outcome of psychological treatment of headache. Patients with chronic headache, as a group, are more psychologically distressed and show more deviant personality characteristics than nonheadache sufferers do. Years of suffering chronic headache leads to personality changes, but the personality deviations predispose the individual to headache.

A Bio‐psycho‐social Investigation of Headache Activity in a Chronic Headache Population *

SYNOPSIS

Psychophysiological responses as predictors of response to behavioral treatment of chronic headache

A battery of psychophysiological responses including forehead EMG, skin temperature, skin resistance level and heart rate, measured under several conditions including baseline, self-relaxation, and self-control, and stresses such as mental arithmetic and cold pressor, was collected on patients with three types of headache prior to any treatment. With this battery we can predict from 31.5 to 70.2% of the variance in posttreatment headache activity level scores for patients treated with relaxation and biofeedback. Moreover, we can correctly classify as successful or unsuccessful, after either relaxation training or biofeedback training, from 72.7 to 89.7% of subsamples based on headache type and treatment regimen.

The Headache Symptom Questionnaire: Discriminant classificatory ability and headache syndromes suggested by a factor analysis

A brief Headache Symptom Questionnaire was administered to 129 chronic headache Sufferers. The questionnaire accurately classified 68.42% of headache subjects in their proper diagnostic category, comparable to, but statistically less accurate than, the 86.4% agreement between expert headache diagnosticians using clinical interviews. Results of a factor analysis of the Headache Symptom Questionnaire lend support for their being two commonly accepted global headache categories—vascular/migraine and muscle contraction—and one headache dimension concerned with duration of headache pain. Combined migraine-muscle contraction headache was found to be related more to migraine than to muscle contraction headache, and cluster headaches emerged as a separate clinical entity, not loading positively on any factor and loading negatively on all three.