Kenneth A. Holroyd

The hierarchical factor structure of the coping strategies inventory

The structure of coping was examined in three studies by means of Wherrys approach to hierarchical factor analysis. A hierarchical model with three levels was identified that included eight primary factors, four secondary factors, and two tertiary factors. The eight primary factors (problem solving, cognitive restructuring, emotional expression, social support, problem avoidance, wishful thinking, self-criticism, and social withdrawal) identified dimensions of coping found in previous empirical research and theoretical writing. The emergence of the four secondary and two tertiary factors provided empirical support for two theoretical hypotheses concerning the structure of coping. Support for the constructs of problem- and emotion-focused coping hypothesized by Lazarus was obtained at the secondary level, and support for the constructs of approach and avoidance coping hypothesized by many theorists was obtained at the tertiary level. These findings suggest that both formulations may describe the structure of coping, albeit at different levels of analysis.

Cognitive control of tension headache

This study assessed the effectiveness of a cognitively oriented stress coping training program designed to provide skills for coping with daily life stresses as a treatment for tension headache. Thirty-one community residents with chronic tension headaches were assigned to stress-coping training (N =10),to biofeedback training (N =11),or to a waiting-list control group (N =10).Treatment procedures were accompanied by counterdemand instructions designed to minimize the influence of implicit demands for improved performance. Although only the biofeedback training group showed reductions in frontalis electromyographic activity, only the stress-coping training group showed substantial improvement on daily recordings of headache. These results were interpreted as providing support for a cognitive approach to the treatment of tension headache. Questions concerning the part played by nonspecific treatment factors in biofeedback training were also raised.

Pharmacological versus non-pharmacological prophylaxis of recurrent migraine headache: a meta-analytic review of clinical trials

&NA; In order to generate information about the relative effectiveness of the most widely used pharmacological and non‐pharmacological interventions for the prophylaxis of recurrent migraine (i.e., propranolol HCl and combined relaxation/thermal biofeedback training), meta‐analysis was used to integrate results from 25 clinical trials evaluating the effectiveness of propranolol and 35 clinical trials evaluating the effectiveness of relaxation/biofeedback training (2445 patients, collectively). Meta‐analysis revealed substantial, but very similar improvements have been obtained with propranolol and with relaxation/biofeedback training. When daily recordings have been used to assess treatment outcome, both propranolol and relaxation/biofeedback have yielded a 43% reduction in migraine headache activity in the average patient. When improvements have been assessed using other outcome measures (e.g., physician/therapist ratings), improvements observed with each treatment have been about 20% greater. In both cases, improvements observed with propranolol and relaxation/biofeedback have been significantly larger than improvement observed with placebo medication (14% reduction) or in untreated patients (no reduction). Meta‐analysis thus revealed substantial empirical support for the effectiveness of both propranolol and relaxation/biofeedback training, but revealed no support for the contention that the two treatments differ in effectiveness. These results suggest that greater attention should be paid to determining the relative costs and benefits of widely used pharmacological and non‐pharmacological treatments.

Psychosocial correlates and impact of chronic tension-type headaches.

Objectives.– To examine the psychosocial correlates of chronic tension‐type headache and the impact of chronic tension‐type headache on work, social functioning, and well‐being.

Status and trends of mobile-health applications for iOS devices: A developer's perspective

Modern smart mobile devices offer media-rich and context-aware features that are highly useful for electronic-health (e-health) applications. It is therefore not surprising that these devices have gained acceptance as target devices for e-health applications, turning them into m-health (mobile-health) apps. In particular, many e-health application developers have chosen Apples iOS mobile devices such as iPad, iPhone, or iPod Touch as the target device to provide more convenient and richer user experience, as evidenced by the rapidly increasing number of m-health apps in Apples App Store. In this paper, the top two hundred of such apps from the App Store were examined from a developers perspective to provide a focused overview of the status and trends of iOS m-health apps and an analysis of related technology, architecture, and user interface design issues. The top 200 apps were classified into different groups according to their purposes, functions, and user satisfaction. It was shown that although the biggest group of apps was medical information reference apps that were delivered from or related to medical articles, websites, or journals, mobile users disproportionally favored tracking tools. It was clear that m-health apps still had plenty of room to grow to take full advantage of unique mobile platform features and truly fulfill their potential. In particular, introduction of two- or three-dimensional visualization and context-awareness could further enhance m-health apps usability and utility. This paper aims to serve as a reference point and guide for developers and practitioners interested in using iOS as a platform for m-health applications, particular from the technical point of view.

Propranolol in the management of recurrent migraine : a meta-analytic review

SYNOPSIS

Self-Administered Cognitive Behavior Therapy for Moderate to Severe Irritable Bowel Syndrome: Clinical Efficacy, Tolerability, Feasibility

BACKGROUND & AIMS Given the limitations of conventional therapies and restrictions imposed on newer pharmacologic agents, there is an urgent need to develop efficacious and efficient treatments that teach patients behavioral self-management skills for relieving irritable bowel syndrome (IBS) symptoms and associated problems. METHODS Seventy-five Rome II diagnosed IBS patients (86% female) without comorbid gastrointestinal disease were recruited from local physicians and the community and randomized to either 2 versions of cognitive behavior therapy (CBT) (10-session, therapist-administered CBT vs 4-session, patient-administered CBT) or a wait list control (WLC) that controlled for threats to internal validity. Final assessment occurred 2 weeks after the 10-week treatment phase ended. Outcome measures included adequate relief from pain and bowel symptoms, global improvement of IBS symptoms (CGI-Improvement Scale), IBS symptom severity scale (IBS SSS), quality of life (IBSQOL), psychological distress (Brief Symptom Inventory), and patient satisfaction (Client Satisfaction Scale). RESULTS At week 12, both CBT versions were significantly (P < .05) superior to WLC in the percentage of participants reporting adequate relief (eg, minimal contact CBT, 72%; standard CBT, 60.9%; WLC, 7.4%) and improvement of symptoms. CBT-treated patients reported significantly improved quality of life and IBS symptom severity but not psychological distress relative to WLC patients (P < .0001). CONCLUSIONS Data from this pilot study lend preliminary empirical support to a brief patient-administered CBT regimen capable of providing short-term relief from IBS symptoms largely unresponsive to conventional therapies.

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 multi-center evaluation of the McGill Pain Questionnaire: results from more than 1700 chronic pain patients

&NA; We argue that the conflicting results reported in previous studies examining the factor structure of the McGill Pain Questionnaire Pain Rating Index (PRI) can be explained by differences in the patient samples and statistical analyses used across studies. In an effort to clarify the factor structure of the PRI, 3 different factor models were compared using confirmatory factor analysis in 2 samples of low‐back pain patients (N = 1372) and in a third sample of patients suffering from other chronic pain problems (N = 423). A 4‐factor model, similar to those obtained in previous studies where multiple criteria were used to determine the number of factors extracted, best explained covariation among PRI subclasses. However, relatively high interfactor correlations (approximately two‐thirds of the variance explained by the best fitting factor structure was common variance) cast doubt on the discriminant validity of PRI subscales; examination of relationships between the PRI and MMPI subscales also failed to provide evidence of the discriminant validity or clinical utility of PRI subscales. Reducing the information from the 10 PRI sensory subclasses to a single subscale score may seriously limit the usefulness of the PRI. Alternate methods of using PRI data are suggested.

Client Variables and the Behavioral Treatment of Recurrent Tension Headache: A Meta- Analytic Review

Meta-analysis revealed that in studies evaluating behavioral treatments for tension headaches, the treatment outcome has varied with the client samples (e.g., age, gender, referral source) that have been used but not with the treatment procedures (e.g., type of behavioral intervention, length of treatment, whether or not efforts were made to facilitate transfer of training) or the research designs (e.g., internal validity, explicitness of diagnostic criteria) that have been used. Mean client age proved the best predictor of treatment outcome, accounting for 30% of the outcome variance following behavior therapy. Significantly poorer outcomes have also been reported in recent studies than were reported in early studies. These findings suggest that (1) outcomes obtained with behavioral interventions have been less dependent upon the treatment variables that have been the primary focus of research attention than upon characteristics of client samples and (2) behavioral interventions may be less effective in reducing headache activity than has previously been assumed.