A randomized clinical trial of targeted cognitive behavioral treatment to reduce catastrophizing in chronic headache sufferers.
This randomized clinical trial (RCT) examined the efficacy of a cognitive-behavioral treatment (CBT) specifically targeted toward reducing pain catastrophizing for persons with chronic headache. Immediate treatment groups were compared with wait-list control groups. Differential treatment gains based on the order of presentation of 2 components of CBT (cognitive restructuring and cognitive/behavioral coping) and the role of catastrophizing in treatment outcome were examined. Thirty-four participants enrolled in a 10-week group treatment and 11 completed a wait-list self-monitoring period. Participants reported significant reductions in catastrophizing and anxiety and increased self-efficacy compared with wait-list control subjects, and these were maintained at follow-up. Although we did not find overall differences in the reduction of headache frequency or intensity compared with wait-list control subjects, calculation of clinical significance on headache indicators suggest that approximately 50% of treated participants showed meaningful changes in headache indices as well. Order of treatment modules was not related to gains during treatment or at follow-up; however, almost all changes occurred during the second half of treatment, suggesting that duration of treatment participation is important.


CONCLUSIONS
Cognitive-behavioral treatment targeting reduction of catastrophizing for chronic headache pain reduced negative cognitive and affective variables associated with recurrent headache, increased headache management self-efficacy, and in half of the participants, produced clinically meaningful reductions in headache indicators. Length of treatment is an important factor to consider when providing CBT for chronic pain.
Thorn
Beverly E
BE
Psychology Department, The University of Alabama, Tuscaloosa, Alabama 35487-0348, USA. bthorn@as.ua.edu
Pence
Laura B
LB
Ward
L Charles
LC
Kilgo
Gary
G
Clements
Kristi L
KL
Cross
Tony H
TH
Davis
Amber M
AM
Tsui
Patricia W
PW
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D020773:Headache Disorders / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016896:Treatment Outcome