Kenneth A. Appelbaum

Cognitive behavioral treatment of a veteran population with moderate to severe rheumatoid arthritis

We compared cognitive behavioral treatment with a symptom monitoring control condition for a sample of veterans with (Stages II and III) rheumatoid arthritis. After baseline pain and sleep monitoring, physical therapist and self-report assessment ratings, patients were randomly assigned to active treatment (progressive relaxation training, thermal biofeedback, and cognitive pain management strategies), or symptom monitoring only. Posttreatment comparisons showed that the active therapy group improved, relative to the symptom monitoring controls on their perceptions of pain on the McGill Pain Questionnaire (MPQ), rated themselves as coping better with pain, reduced their pain diary ratings, and reported less difficulty with functional tasks. Treated patients also improved more on range of motion indices. No differences were found on standardized psychological tests or sleep measures. However, after 18 months, follow-up data from half of the sample showed no lasting differences between the treated and control groups.

Placebo-Controlled Evaluation of Abbreviated Progressive Muscle Relaxation and of Relaxation Combined With Cognitive Therapy in the Treatment of Tension Headache

Sixty-six tension headache patients were randomly assigned to one of four conditions for 8 weeks: (a) progressive muscle relaxation (PMR) alone; (b) PMR plus cognitive therapy (PMR + Cog); (c) pseudomeditation, a credible attention-placebo control; or (d) continued headache monitoring. A comparison of overall headache activity (headache index), derived from a daily headache diary, for 4 weeks before treatment to 4 weeks after treatment, revealed that active treatment (PMR and PMR + Cog) was superior to either control condition. Moreover, level of headache medication consumption decreased significantly for the active treatment groups. Although headache-index comparisons of the two active treatments showed no advantage for adding cognitive therapy to PMR, a measure of clinically significant change showed a trend for PMR + Cog to be superior to PMR alone.

A controlled evaluation of thermal biofeedback and thermal biofeedback combined with cognitive therapy in the treatment of vascular headache.

One-hundred-sixteen patients suffering from vascular headache (migraine or combined migraine and tension) were, after 4 weeks of pretreatment baseline headache monitoring, randomly assigned to one of four conditions: (a) thermal biofeedback with adjunctive relaxation training (TBF); (b) TBF plus cognitive therapy; (c) pseudomediation as an ostensible attention-placebo control; or (d) headache monitoring. The first three groups received 16 individual sessions over 8 weeks, while the fourth group continued to monitor headaches. All groups then monitored headaches for a 4-week posttreatment baseline. Analyses revealed that all treated groups improved significantly more than the headache monitoring group with no significant differences among the three treated groups. On a measure of clinically significant improvement, the two TBF groups had slightly higher (51%) degree of improvement than the meditation group (37.5%). It is argued that the attention-placebo control became an active relaxation condition.

The efficacy and cost-effectiveness of minimal-therapist-contact, non-drug treatments of chronic migraine and tension headache.

SYNOPSIS

Behavioral treatment of 250 chronic headache patients: A clinical replication series

The results from the behavioral treatment (relaxation and/or biofeedback) of 250 chronic headache patients are presented along with information on individual predictors of treatment outcome. Relaxation alone leads to improvement in 41% of tension headache patients while a combination of relaxation and thermal biofeedback leads to improvement in 52% of migraine and combined headache patients. Predictor variables which frequently appear include age, Trait Anxiety, and MMPI scales 1 and 3.

A Controlled Evaluation of the Addition of Cognitive Therapy to a Home‐Based Biofeedback and Relaxation Treatment of Vascular Headache

SYNOPSIS

Psychophysiological comparisons of three kinds of headache subjects during and between headache states: Analysis of post-stress adaptation periods

Twenty-eight chronic headache sufferers of three headache types (migraine, tension and combined migraine-tension) selected on the basis of explicit inclusion and exclusion criteria and matched on five demographic characteristics were assessed in a headache and non-headache state on a number of psychophysiological measures (frontalis, forearm and neck EMG; cephalic vasomotor response; hand surface temperature; heart rate and skin resistance level) and a number of stimulus conditions (baseline, self-control, cognitive and physical stressors). Results indicated no significant differences between the three headache groups or headache states on any measure during baseline condition. Analyses of post-stress adaptation periods led to the area of most significant differences, with a number of findings lending support for Sternbachs inadequate homeostatic responding hypothesis of migraine, but not tension, headache. No support was found for the sustained levels of muscle tension hypothesis of the etiology of tension headache. Implications for the etiology and treatment of headache are discussed.

The Role of Psychopathology in Chronic Headache: Cause or Effect?

SYNOPSIS

Self-regulatory treatment of headache in the elderly

We examined the utility of various combinations of relaxation, cognitive coping, and feedback in an uncontrolled series of 16 older headache patients (aged 60 to 77) diagnosed as having tension, mixed, or migraine headache. At 1-month follow-up, statistically and clinically significant reductions were observed in both overall headache activity and medication intake; 10 patients (63%) were more than 50% improved in both headache reduction and medication reduction. Female headache suffers were more improved than males. These results are inconsistent with our past findings with geriatric headache sufferers but consistent with other, more recent favorable findings. The efficacy of nondrug treatment for geriatric headache clearly warrants further attention.

What is an adequate length of baseline in research and clinical practice with chronic headache

We examined the representativeness of baseline headache diary recording periods of 1, 2, 3, and 4 weeks for three kinds of headache disorder — tension, migraine, and combined migraine and tension. For research purposes at pretreatment, 2 weeks of diary recording are preferable for tension headache, while at least 3 weeks are preferred for migraine and combined headache. At follow-up, 1 week of diary recording appears adequate for all three headache types. Recommendations are also made for clinical practice.