Differential Application of Cognitive and Behavioral Treatments for Migraine
Konecky, Olga Stephanie
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The problem. While research has demonstrated the effectiveness of behavioral and, more recently, cognitive treatments for migraine, exclusively-behavioral and cognitive treatments have not been compared. Additionally, few variables have been identified as predictors of differential treatment response. Procedure. A 2 (locus of control) X 2 (treatments) stratified block desiqn was used to investigate the interaction of locus of control with treatments for migraine, in-order to help clarify the interaction of subject variables with treatment and to compare the effectiveness of procedurally similar interventions, differing primarily with respect to treatment orientation. A total of 16 community residents, screened as suffering from migraine or combined muscle contraction-migraine headaches, were classified as either internals or externals and randomly assigned to one of two treatment conditions: behavioral self-control plus relaxation or cognitive coping plus relaxation. Multiple measures were administered over time. Findings. Results failed to support a differential treatment approach based on locus-of-control orientation or greater therapeutic efficacy for either the cognitive or behavioral treatments for migraine. Exploratory analyses did reveal that substantially more cognitive-group, rather than behavioral-group, participants reported applying treatment-related coping strategies to control headache. Pain pattern was also found to be significantly correlated with treatment outcome. Conclusions. Findings support continued investigation of the cognitive-behavioral treatment distinction in migraine research. Recommendations. Additional comparisons between more effective behavioral and cognitive treatments for miqraine, more rigorous assessment of whether group participants acquired intended treatment techniques and further investigation of the interaction of treatments with locus of control are needed. Pain location, headache frequency, headache type, and some scales of Melzack's Pain Questionnaire and Lanyon's Psychological Screening Inventory also merit rigorous investigation to see if prediction of outcome can be improved.