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Martino Cinnera A, Morone G, Bisirri A, Lucenti T, Rotundo M, Monaci S, Berton C, Paoluzzi M, Iosa M, Ciancarelli I. Headaches treatment with EMG biofeedback: a focused systematic review and meta-analysis. Eur J Phys Rehabil Med 2023; 59:697-705. [PMID: 37823248 PMCID: PMC10797640 DOI: 10.23736/s1973-9087.23.07745-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 06/20/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION The aim of this paper was to present an up-to-date evaluation of the efficacy of EMG-biofeedback (EMG-BFB) for primary headaches and to address possible mediators of outcome. EVIDENCE ACQUISITION PubMed, Scopus, Embase and Pedro databases were searched from inception to May 1, 2023. All randomized controlled trials (RCT) studies using an EMG-BFB to treat headache have been included in this systematic review. The current systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and was registered in the PROSPERO database (CRD42022312827). Methodological quality was assessed through the Risk of Bias tool 2 (RoB 2). The effect sizes and 95% confidence interval (CI) were calculated by random-effect models on frequency, intensity, and duration variables. Egger regression and the Begg-Mazumdar rank correlation test were used for publication bias. EVIDENCE SYNTHESIS A total of 3059 articles were identified through the database searches. 29 articles, involving 1342 participants, met the inclusion criteria for the systematic review; of them, 4 were included in the meta-analysis. Ten studies reported a significant improvement in the EMG-BFB group with respect to the control group. Meta-analyses show a reduction in the intensity of attacks in patients subjected to EMG-BFB (ES 0.21 [(95% CI=-0.02; 0.44), P value=0.07] based on 293 patients). CONCLUSIONS EMG-BFB represents a non-pharmacological approach to headache treatment as shown via qualitative synthesis, despite not impressive results, this technique can be particularly useful in paediatric or in adult patients who cannot undergo drug therapies. Quantitative synthesis revealed a promising effect in the intensity of headaches attacks. Moreover, no significant effect was found about the effectiveness of EMG-BFB in the reduction of frequency and durations of headache attacks. Future studies with new multimodal technologic assessment and following RCT guidelines can unmask the potentiality of EMG-BFB in the treatment of headache.
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Affiliation(s)
- Alex Martino Cinnera
- Scientific Institute for Research, Hospitalization and Health Care, IRCCS Santa Lucia Foundation, Rome, Italy -
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy -
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, L'Aquila, Italy
| | | | - Tommaso Lucenti
- Scientific Institute for Research, Hospitalization and Health Care, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Mattia Rotundo
- Scientific Institute for Research, Hospitalization and Health Care, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Simone Monaci
- Scientific Institute for Research, Hospitalization and Health Care, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Claudia Berton
- Scientific Institute for Research, Hospitalization and Health Care, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Michela Paoluzzi
- Territorial Rehabilitation Department, ASL Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
| | - Marco Iosa
- Department of Psychology, Sapienza University, Rome, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Territorial Rehabilitation Department, ASL Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
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Basbaum AI, Jensen TS, Keefe FJ. Fifty years of pain research and clinical advances: highlights and key trends. Pain 2023; 164:S11-S15. [PMID: 37831954 PMCID: PMC10787538 DOI: 10.1097/j.pain.0000000000003058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/31/2023] [Indexed: 10/15/2023]
Abstract
ABSTRACT This article highlights advances in basic science preclinical pain research, clinical research, and psychological research occurring over the 50 years since the International Association for the Study of Pain was founded. It presents important findings and key trends in these 3 areas of pain science: basic science preclinical research, clinical research, and psychological research.
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Affiliation(s)
- Allan I. Basbaum
- Department of Anatomy, University California San Francisco, San Francisco, CA USA 94158
| | - Troels. S Jensen
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University Hosital, DK, 8200 Aarhus N, Denmark
| | - Francis J. Keefe
- Duke Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA 27705
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Meuret AE, Rosenfield D, Millard MM, Ritz T. Biofeedback Training to Increase P co2 in Asthma With Elevated Anxiety: A One-Stop Treatment of Both Conditions? Psychosom Med 2023; 85:440-448. [PMID: 36961348 PMCID: PMC10238676 DOI: 10.1097/psy.0000000000001188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
OBJECTIVE Anxiety is highly prevalent in individuals with asthma. Asthma symptoms and medication can exacerbate anxiety, and vice versa. Unfortunately, treatments of comorbid anxiety and asthma are largely lacking. A problematic feature common to both conditions is hyperventilation. It adversely affects lung function and symptoms in asthma and anxiety. We examined whether a treatment to reduce hyperventilation, shown to improve asthma symptoms, also improves anxiety in asthma patients with high anxiety. METHOD One hundred twenty English- or Spanish-speaking adult patients with asthma were randomly assigned to either Capnometry-Assisted Respiratory Training (CART) to raise P co2 or feedback to slow respiratory rate (SLOW). Although anxiety was not an inclusion criterion, 21.7% met clinically relevant anxiety levels on the Hospital Anxiety and Depression Scale (HADS). Anxiety (HADS-A) and depression (HADS-D) scales, anxiety sensitivity (Anxiety Sensitivity Index [ASI]), and negative affect (Negative Affect Scale of the Positive Affect Negative Affect Schedule) were assessed at baseline, posttreatment, 1-month follow-up, and 6-month follow-up. RESULTS In this secondary analysis, asthma patients with high baseline anxiety showed greater reductions in ASI and PANAS-N in CART than in SLOW ( p values ≤ .005, Cohen d values ≥ 0.58). Furthermore, at 6-month follow-up, these patients also had lower ASI, PANAS-N, and HADS-D in CART than in SLOW ( p values ≤ .012, Cohen d values ≥ 0.54). Patients with low baseline anxiety did not have differential outcomes in CART than in SLOW. CONCLUSIONS For asthma patients with high anxiety, our brief training designed to raise P co2 resulted in significant and sustained reductions in anxiety sensitivity and negative affect compared with slow-breathing training. The findings lend support for P co2 as a potential physiological target for anxiety reduction in asthma. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT00975273 .
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Affiliation(s)
- Alicia E. Meuret
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
| | - Mark. M. Millard
- Baylor Martha Foster Lung Care Center, Baylor University Medical Center, Dallas, Texas, USA
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA
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Efficacy of Heart Rate Variability Biofeedback for Somatic Symptom Disorder: A Pilot Randomized Controlled Trial. Psychosom Med 2023; 85:61-70. [PMID: 36201761 DOI: 10.1097/psy.0000000000001143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patients with somatic symptom disorder (SSD) often receive targeted intervention only after a long duration of illness. Moreover, the reported effect sizes of interventions for SSD are small. Therefore, improvement and evaluation of interventions are needed. Preliminary evidence suggests autonomic imbalance, for example, lower heart rate variability (HRV) in SSD. HRV biofeedback (HRV-BF) as a method for self-regulation shows initial positive effects in chronic pain and functional syndromes. The aim of this study was to evaluate the efficacy of a brief HRV-BF intervention for SSD. METHODS Of a total of 50 participants with SSD ( Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ) who were recruited and randomly assigned to four sessions of HRV-BF ( n = 25) or autogenic training (AT; n = 25), 49 participants were analyzed (female, 77.6%; mean [standard deviation] age = 45.3 [14.4] years). The primary outcomes were somatic symptom severity (Screening for Somatoform Disorders, numeric rating scale) and HRV. Secondary outcomes were psychological characteristics of SSD (e.g., the Somatic Symptom Disorder 12 scale, health concerns, emotion regulation). The data were collected before and after intervention and were analyzed with repeated-measures analyses of variance and post hoc t tests. RESULTS Symptom severity improved after both, HRV-BF and AT. Standard Deviation of the NN Interval and psychological symptoms improved significantly more strongly in the HRV-BF than in the AT group (e.g., Standard Deviation of the NN Interval: ηp2 interaction = 0.10, p = .047). CONCLUSIONS The improvements in somatic symptoms, but specifically in cognitive-affective symptoms and autonomic regulation, suggest that HRV-BF with only four sessions is a potentially useful intervention option for SSD. Thus, adding this short HRV-BF intervention to existing psychological treatments for SSD may be promising.Trial Registration : German Clinical Trial Register identifier DRKS00017099 ( https://www.drks.de ).
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Stubberud A, Buse DC, Kristoffersen ES, Linde M, Tronvik E. Is there a causal relationship between stress and migraine? Current evidence and implications for management. J Headache Pain 2021; 22:155. [PMID: 34930118 PMCID: PMC8685490 DOI: 10.1186/s10194-021-01369-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background The purpose of this narrative review is to examine the literature investigating a causal relationship between stress and migraine and evaluate its implications for managing migraine. Methods PubMed, PsycINFO and CINAHL were searched from 1988 to August 2021, identifying 2223 records evaluating the relationship between stress and migraine. Records were systematically screened. All potentially relevant records were thematically categorized into six mechanistic groups. Within each group the most recent reports providing new insights were cited. Results First, studies have demonstrated an association of uncertain causality between high stress loads from stressful life events, daily hassles or other sources, and the incidence of new-onset migraine. Second, major stressful life events seem to precede the transformation from episodic to chronic migraine. Third, there is some evidence for changes in levels of stress as a risk factor for migraine attacks. Research also suggests there may be a reversed causality or that stress-trigger patterns are too individually heterogeneous for any generalized causality. Fourth, migraine symptom burden seems to increase in a setting of stress, partially driven by psychiatric comorbidity. Fifth, stress may induce sensitization and altered cortical excitability, partially explaining attack triggering, development of chronic migraine, and increased symptom burden including interictal symptom burden such as allodynia, photophobia or anxiety. Finally, behavioral interventions and forecasting models including stress variables seem to be useful in managing migraine. Conclusion The exact causal relationships in which stress causes incidence, chronification, migraine attacks, or increased burden of migraine remains unclear. Several individuals benefit from stress-oriented therapies, and such therapies should be offered as an adjuvant to conventional treatment and to those with a preference. Further understanding the relationship between stress, migraine and effective therapeutic options is likely to be improved by characterizing individual patterns of stress and migraine, and may in turn improve therapeutics.
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Affiliation(s)
- Anker Stubberud
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway. .,National Advisory Unit on Headaches, Department of Neurology, St. Olavs Hospital, Trondheim, Norway.
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Mattias Linde
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Headaches, Department of Neurology, St. Olavs Hospital, Trondheim, Norway
| | - Erling Tronvik
- Department of Neuromedicine and Movement Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Headaches, Department of Neurology, St. Olavs Hospital, Trondheim, Norway
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Orendáčová M, Kvašňák E. Effects of Transcranial Alternating Current Stimulation and Neurofeedback on Alpha (EEG) Dynamics: A Review. Front Hum Neurosci 2021; 15:628229. [PMID: 34305549 PMCID: PMC8297546 DOI: 10.3389/fnhum.2021.628229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
Transcranial alternating current stimulation (tACS) and neurofeedback (NFB) are two different types of non-invasive neuromodulation techniques, which can modulate brain activity and improve brain functioning. In this review, we compared the current state of knowledge related to the mechanisms of tACS and NFB and their effects on electroencephalogram (EEG) activity (online period/stimulation period) and on aftereffects (offline period/post/stimulation period), including the duration of their persistence and potential behavioral benefits. Since alpha bandwidth has been broadly studied in NFB and in tACS research, the studies of NFB and tACS in modulating alpha bandwidth were selected for comparing the online and offline effects of these two neuromodulation techniques. The factors responsible for variability in the responsiveness of the modulated EEG activity by tACS and NFB were analyzed and compared too. Based on the current literature related to tACS and NFB, it can be concluded that tACS and NFB differ a lot in the mechanisms responsible for their effects on an online EEG activity but they possibly share the common universal mechanisms responsible for the induction of aftereffects in the targeted stimulated EEG band, namely Hebbian and homeostatic plasticity. Many studies of both neuromodulation techniques report the aftereffects connected to the behavioral benefits. The duration of persistence of aftereffects for NFB and tACS is comparable. In relation to the factors influencing responsiveness to tACS and NFB, significantly more types of factors were analyzed in the NFB studies compared to the tACS studies. Several common factors for both tACS and NFB have been already investigated. Based on these outcomes, we propose several new research directions regarding tACS and NFB.
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Affiliation(s)
- Mária Orendáčová
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
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Common Factors in Biofeedback Administered by Psychotherapists. Appl Psychophysiol Biofeedback 2021; 46:151-159. [PMID: 33527224 DOI: 10.1007/s10484-021-09504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Common factors are nonspecific therapeutic elements common across different varieties of psychotherapy. In a recent study, 68 expert psychotherapy researchers with a variety of allegiances collectively rated biofeedback as being negatively associated with many common factors (Tschacher et al. in Clin Psychol Psychother 21(1):82-96, 2014), including the therapeutic alliance. However, it seems implausible that biofeedback could benefit so many people while being incompatible with the therapeutic alliance and other common factors. The present study investigated the experiences of biofeedback clients who participated in a brief heart rate variability biofeedback protocol in order to explore the potential roles of common factors in biofeedback. The results of this study offer preliminary evidence that many common factors-including therapeutic alliance, self-efficacy expectation, mastery experiences, provision of explanatory scheme, mindfulness, and even cognitive restructuring-may play a role in biofeedback outcomes. Future research on this topic should include mediation and moderation models investigating the role of specific common factors on outcome and process studies to help determine what clinician behaviors are most helpful. Deeper investigation of common factors in biofeedback may benefit future biofeedback research and practice and address the concerns of colleagues outside of the biofeedback community who believe that biofeedback is at odds with common factors.
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Heartrate variability biofeedback for migraine using a smartphone application and sensor: A randomized controlled trial. Gen Hosp Psychiatry 2021; 69:41-49. [PMID: 33516964 PMCID: PMC8721520 DOI: 10.1016/j.genhosppsych.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/24/2020] [Accepted: 12/08/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Although hand temperature and electromyograph biofeedback have evidence for migraine prevention, to date, no study has evaluated heartrate variability (HRV) biofeedback for migraine. METHODS 2-arm randomized trial comparing an 8-week app-based HRV biofeedback (HeartMath) to waitlist control. Feasibility/acceptability outcomes included number and duration of sessions, satisfaction, barriers and adverse events. Primary clinical outcome was Migraine-Specific Quality of Life Questionnaire (MSQv2). RESULTS There were 52 participants (26/arm). On average, participants randomized to the Hearthmath group completed 29 sessions (SD = 29, range: 2-86) with an average length of 6:43 min over 36 days (SD = 27, range: 0, 88) before discontinuing. 9/29 reported technology barriers. 43% said that they were likely to recommend Heartmath to others. Average MSQv2 decreases were not significant between the Heartmath and waitlist control (estimate = 0.3, 95% CI = -3.1 - 3.6). High users of Heartmath reported a reduction in MSQv2 at day 30 (-12.3 points, p = 0.010) while low users did not (p = 0.765). DISCUSSION App-based HRV biofeedback was feasible and acceptable on a time-limited basis for people with migraine. Changes in the primary clinical outcome did not differ between biofeedback and control; however, high users of the app reported more benefit than low users.
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Schmidt J, Martin A. The Influence of Physiological and Psychological Learning Mechanisms in Neurofeedback vs. Mental Imagery Against Binge Eating. Appl Psychophysiol Biofeedback 2020; 45:293-305. [PMID: 32990891 PMCID: PMC7644525 DOI: 10.1007/s10484-020-09486-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
In biofeedback research, the debate on physiological versus psychological learning has a long tradition and is still relevant today, regarding new developments of biofeedback for behavior modification. Analyzing the role of these learning mechanisms may help improving the protocols and answer the question, whether feedback of physiological functions is necessary to modify a target behavior. We explored the presence and impact of physiological (EEG changes) versus psychological learning (changes in somatic self-efficacy) in a recently developed EEG neurofeedback protocol for binge eating. The protocol targets a reduction of food-cue induced cortical arousal through regulation of EEG high beta activity. In an experimental study accompanying a randomized controlled trial, pre and post treatment EEG measurements were analyzed in a neurofeedback group (n = 18) and an active mental imagery control group without physiological feedback (n = 18). Physiological learning in terms of EEG high beta reduction only occurred in the neurofeedback group. Post treatment, participants with successfully reduced binge eating episodes (≥ 50% reduction) showed lower EEG high beta activity than unsuccessful participants (p = .02) after neurofeedback, but not after mental imagery. Further, lower EEG high beta activity at post-treatment predicted fewer binge eating episodes in neurofeedback only. In mental imagery, somatic self-efficacy predicted treatment success instead of EEG activity. Altogether, the results indicate that physiological changes serve as a specific treatment mechanism in neurofeedback against binge eating. Reducing cortical arousal may improve eating behaviors and corresponding neurofeedback techniques should therefore be considered in future treatments.
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Affiliation(s)
- Jennifer Schmidt
- HSD Hochschule Döpfer University of Applied Sciences, Waidmarkt 3 & 9, 50676, Cologne, Germany.
| | - Alexandra Martin
- Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany
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Matsuzawa Y, Lee YSC, Fraser F, Langenbahn D, Shallcross A, Powers S, Lipton R, Simon N, Minen M. Barriers to Behavioral Treatment Adherence for Headache: An Examination of Attitudes, Beliefs, and Psychiatric Factors. Headache 2019; 59:19-31. [PMID: 30367821 PMCID: PMC6344047 DOI: 10.1111/head.13429] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Nonpharmacological interventions, such as biofeedback, cognitive behavioral therapy, and relaxation techniques are Level-A evidence-based treatments for headache. The impact of these interventions is often equivalent to or greater than pharmacological interventions, with fewer side effects. Despite such evidence, the rate of participation in nonpharmacological interventions for headache remains low. Once obstacles to optimizing use of behavioral interventions, such as local access to nonpharmacological treatment and primary headache providers are traversed, identification of barriers contributing to low adherence is imperative given the high levels of disability and cost associated with treating headache disorders. In this review of factors in adults associated with underuse of nonpharmacological interventions, we discuss psychological factors relevant to participation in nonpharmacological treatment, including attitudes and beliefs, motivation for change, awareness of triggers, locus of control, self-efficacy, acceptance, coping styles, personality traits, and psychiatric comorbidities associated with treatment adherence. Finally, future prospects and approaches to optimizing treatment matching and minimizing adherence issues are addressed. METHODS An interdisciplinary team conducted this narrative review. Neuropsychologists conducted a literature search during the month of July 2017 using a combination of the keywords ("headache" or "migraine") and ("adherence" or "compliance") or "barriers to treatment" or various "psychological factors" discussed in this narrative review. Content experts, a psychiatrist, and a complementary and integrative health specialist provided additional commentary and input to this narrative review resulting in integration of additional noteworthy studies, book chapters and books. RESULTS Various psychological factors, such as attitudes and beliefs, lack of motivation, poor awareness of triggers, external locus of control, poor self-efficacy, low levels of acceptance, and engagement in maladaptive coping styles can contribute to nonadherence. CONCLUSIONS To maximize adherence, clinicians can assess and address an individual's level of treatment acceptance, beliefs that may present as barriers, readiness for change, locus of control, self-efficacy and psychiatric comorbidities. Identification of barriers to adherence as well as the application of relevant assessment and intervention techniques have the potential to facilitate adherence and ultimately improve treatment success.
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Affiliation(s)
- Yuka Matsuzawa
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
| | | | - Felicia Fraser
- Department of Physical Medicine & Rehabilitation, the MetroHealth System, Cleveland, OH, USA
| | - Donna Langenbahn
- Department of Rehabilitation Medicine, NYU Langone Health, New York, NY, USA
| | - Amanda Shallcross
- Department of Population Health, NYU Langone Health, New York, NY, USA
| | - Scott Powers
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Richard Lipton
- Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Naomi Simon
- Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | - Mia Minen
- Department of Neurology, NYU Langone Medical Center, New York, NY, USA
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Ramig L, Halpern A, Spielman J, Fox C, Freeman K. Speech treatment in Parkinson's disease: Randomized controlled trial (RCT). Mov Disord 2018; 33:1777-1791. [PMID: 30264896 PMCID: PMC6261685 DOI: 10.1002/mds.27460] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/07/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As many as 89% of people with Parkinson's disease (PD) develop speech disorders. OBJECTIVES This randomized controlled trial evaluated two speech treatments for PD matched in intensive dosage and high-effort mode of delivery, differing in subsystem target: voice (respiratory-laryngeal) versus articulation (orofacial-articulatory). METHODS PD participants were randomized to 1-month LSVT LOUD (voice), LSVT ARTIC (articulation), or UNTXPD (untreated) groups. Speech clinicians specializing in PD delivered treatment. Primary outcome was sound pressure level (SPL) in reading and spontaneous speech, and secondary outcome was participant-reported Modified Communication Effectiveness Index (CETI-M), evaluated at baseline, 1, and 7 months. Healthy controls were matched by age and sex. RESULTS At baseline, the combined PD group (n = 64) was significantly worse than healthy controls (n = 20) for SPL (P < 0.05) and CETI-M (P = 0.0001). At 1 and 7 months, SPL between-group comparisons showed greater improvements for LSVT LOUD (n = 22) than LSVT ARTIC (n = 20; P < 0.05) and UNTXPD (n = 22; P < 0.05). Sound pressure level differences between LSVT ARTIC and UNTXPD at 1 and 7 months were not significant (P > 0.05). For CETI-M, between-group comparisons showed greater improvements for LSVT LOUD and LSVT ARTIC than UNTXPD at 1 month (P = 0.02; P = 0.02). At 7 months, CETI-M between-group differences were not significant (P = 0.08). Within-group CETI-M improvements for LSVT LOUD were maintained through 7 months (P = 0.0011). CONCLUSIONS LSVT LOUD showed greater improvements than both LSVT ARTIC and UNTXPD for SPL at 1 and 7 months. For CETI-M, both LSVT LOUD and LSVT ARTIC improved at 1 month relative to UNTXPD. Only LSVT LOUD maintained CETI-M improvements at 7 months. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lorraine Ramig
- University of Colorado‐BoulderBoulderColoradoUSA
- National Center for Voice and Speech‐DenverDenverColoradoUSA
- Columbia University‐New York CityNew YorkNew YorkUSA
- LSVT Global, Inc.‐TucsonTucsonArizonaUSA
| | - Angela Halpern
- University of Colorado‐BoulderBoulderColoradoUSA
- National Center for Voice and Speech‐DenverDenverColoradoUSA
- LSVT Global, Inc.‐TucsonTucsonArizonaUSA
| | - Jennifer Spielman
- University of Colorado‐BoulderBoulderColoradoUSA
- National Center for Voice and Speech‐DenverDenverColoradoUSA
| | - Cynthia Fox
- National Center for Voice and Speech‐DenverDenverColoradoUSA
- LSVT Global, Inc.‐TucsonTucsonArizonaUSA
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Graef JE, Rief W, Nestoriuc Y, Weise C. The More Vivid the Imagination the Better: The Role of the Vividness of Imagination in Vasoconstriction Training and Vasodilatation Training. Appl Psychophysiol Biofeedback 2017; 42:283-298. [DOI: 10.1007/s10484-017-9373-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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EMG biofeedback training in adult attention-deficit/hyperactivity disorder: An active (control) training? Behav Brain Res 2017; 329:58-66. [PMID: 28442359 DOI: 10.1016/j.bbr.2017.04.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/07/2017] [Accepted: 04/11/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The present study aimed at revealing neurophysiological effects induced by electromyography (EMG) based biofeedback, considered as a semi-active control condition in neurofeedback studies, in adult attention-deficit/hyperactivity disorder (ADHD) patients. METHODS 20 adult ADHD patients trained their muscle activity in the left and right supraspinatus muscle over the course of 30 EMG biofeedback sessions. Changes induced by the EMG feedback were evaluated at a clinical and neurophysiological level; additionally, the relation between changes in EEG activity recorded at the vertex over the training course and changes of symptom severity over the treatment course were assessed in order to investigate the mechanisms underlying clinical effects of EMG biofeedback. RESULTS Participants showed significant behavioral improvements on a self-rating scale. There was a significant increase in alpha power, but no significant changes in the delta frequency range; changes in the theta and beta frequency range were not significant after adjustment for multiple comparisons. No statistically significant correlation was found between changes in EEG frequency bands and changes in ADHD symptoms. CONCLUSIONS The current results assessed by means of a single-electrode EEG constitute a starting point regarding a clearer understanding of mechanisms underlying clinical effects of EMG biofeedback. Although we did not reveal systematic effects induced by EMG feedback on brain activity it remains an open question whether EMG biofeedback induces changes in brain regions or parameters we did not gather in the present study (e.g. motor cortex).
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Strehl U, Aggensteiner P, Wachtlin D, Brandeis D, Albrecht B, Arana M, Bach C, Banaschewski T, Bogen T, Flaig-Röhr A, Freitag CM, Fuchsenberger Y, Gest S, Gevensleben H, Herde L, Hohmann S, Legenbauer T, Marx AM, Millenet S, Pniewski B, Rothenberger A, Ruckes C, Wörz S, Holtmann M. Neurofeedback of Slow Cortical Potentials in Children with Attention-Deficit/Hyperactivity Disorder: A Multicenter Randomized Trial Controlling for Unspecific Effects. Front Hum Neurosci 2017; 11:135. [PMID: 28408873 PMCID: PMC5374218 DOI: 10.3389/fnhum.2017.00135] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
Background: Neurofeedback (NF) in children with attention-deficit/hyperactivity disorder (ADHD) has been investigated in a series of studies over the last years. Previous studies did not unanimously support NF as a treatment in ADHD. Most studies did not control for unspecific treatment effects and did not demonstrate that self-regulation took place. The present study examined the efficacy of NF in comparison to electromyographic (EMG) feedback to control for unspecific effects of the treatment, and assessed self-regulation of slow cortical potentials (SCPs). Methods: A total of 150 children aged 7–9 years diagnosed with ADHD (82% male; 43% medicated) were randomized to 25 sessions of feedback of SCPs (NF) or feedback of coordination of the supraspinatus muscles (EMG). The primary endpoint was the change in parents’ ratings of ADHD core symptoms 4 weeks after the end of treatment compared to pre-tests. Results: Children in both groups showed reduced ADHD-core symptoms (NF 0.3, 95% CI -0.42 to -0.18; EMG 0.13, 95% CI -0.26 to -0.01). NF showed a significant superiority over EMG (treatment difference 0.17, 95% CI 0.02–0.3, p = 0.02). This yielded an effect size (ES) of d = 0.57 without and 0.40 with baseline observation carried forward (BOCF). The sensitivity analysis confirmed the primary result. Successful self-regulation of brain activity was observed only in NF. As a secondary result teachers reported no superior improvement from NF compared to EMG, but within-group analysis revealed effects of NF on the global ADHD score, inattention, and impulsivity. In contrast, EMG feedback did not result in changes despite more pronounced self-regulation learning. Conclusions: Based on the primary parent-rated outcome NF proved to be superior to a semi-active EMG feedback treatment. The study supports the feasibility and efficacy of NF in a large sample of children with ADHD, based on both specific and unspecific effects. Trial Register: Current controlled trials ISRCTN76187185, registered 5 February 2009.
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Affiliation(s)
- Ute Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Pascal Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Daniel Wachtlin
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany.,Interdisciplinary Center for Clinical Trials at the University Medical Center of the Johannes Gutenberg University of MainzMainz, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of ZurichZurich, Switzerland.,Center for Integrative Human Physiology, University of ZurichZurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH ZurichZurich, Switzerland
| | - Björn Albrecht
- Child and Adolescent Psychiatry, University Medical Center GöttingenGöttingen, Germany
| | - Maria Arana
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Christiane Bach
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital LeipzigLeipzig, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Thorsten Bogen
- Landschaftsverband Westfalen-Lippe (LWL) University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University BochumHamm, Germany
| | - Andrea Flaig-Röhr
- Child and Adolescent Psychiatry, University Medical Center GöttingenGöttingen, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe UniversityFrankfurt am Main, Germany
| | - Yvonne Fuchsenberger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe UniversityFrankfurt am Main, Germany
| | - Stephanie Gest
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe UniversityFrankfurt am Main, Germany
| | - Holger Gevensleben
- Child and Adolescent Psychiatry, University Medical Center GöttingenGöttingen, Germany
| | - Laura Herde
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Tanja Legenbauer
- Landschaftsverband Westfalen-Lippe (LWL) University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University BochumHamm, Germany
| | - Anna-Maria Marx
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Benjamin Pniewski
- Landschaftsverband Westfalen-Lippe (LWL) University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University BochumHamm, Germany
| | - Aribert Rothenberger
- Child and Adolescent Psychiatry, University Medical Center GöttingenGöttingen, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials at the University Medical Center of the Johannes Gutenberg University of MainzMainz, Germany
| | - Sonja Wörz
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Martin Holtmann
- Landschaftsverband Westfalen-Lippe (LWL) University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University BochumHamm, Germany
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Stirin Tzur K, Ganzach Y, Pazy A. On the positive and negative effects of self-efficacy on performance: Reward as a moderator. HUMAN PERFORMANCE 2016. [DOI: 10.1080/08959285.2016.1192631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Martin PR. Stress and Primary Headache: Review of the Research and Clinical Management. Curr Pain Headache Rep 2016; 20:45. [DOI: 10.1007/s11916-016-0576-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Irby MB, Bond DS, Lipton RB, Nicklas B, Houle TT, Penzien DB. Aerobic Exercise for Reducing Migraine Burden: Mechanisms, Markers, and Models of Change Processes. Headache 2016; 56:357-69. [PMID: 26643584 PMCID: PMC4813301 DOI: 10.1111/head.12738] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/10/2015] [Accepted: 10/16/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Engagement in regular exercise routinely is recommended as an intervention for managing and preventing migraine, and yet empirical support is far from definitive. We possess at best a weak understanding of how aerobic exercise and resulting change in aerobic capacity influence migraine, let alone the optimal parameters for exercise regimens as migraine therapy (eg, who will benefit, when to prescribe, optimal types, and doses/intensities of exercise, level of anticipated benefit). These fundamental knowledge gaps critically limit our capacity to deploy exercise as an intervention for migraine. OVERVIEW Clear articulation of the markers and mechanisms through which aerobic exercise confers benefits for migraine would prove invaluable and could yield insights on migraine pathophysiology. Neurovascular and neuroinflammatory pathways, including an effect on obesity or adiposity, are obvious candidates for study given their role both in migraine as well as the changes known to accrue with regular exercise. In addition to these biological pathways, improvements in aerobic fitness and migraine alike also are mediated by changes in psychological and sociocognitive factors. Indeed a number of specific mechanisms and pathways likely are operational in the relationship between exercise and migraine improvement, and it remains to be established whether these pathways operate in parallel or synergistically. As heuristics that might conceptually benefit our research programs here forward, we: (1) provide an extensive listing of potential mechanisms and markers that could account for the effects of aerobic exercise on migraine and are worthy of empirical exploration and (2) present two exemplar conceptual models depicting pathways through which exercise may serve to reduce the burden of migraine. CONCLUSION Should the promise of aerobic exercise as a feasible and effective migraine therapy be realized, this line of endeavor stands to benefit migraineurs (including the many who presently remain suboptimally treated) by providing a new therapeutic avenue as an alternative or augmentative compliment to established interventions for migraine.
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Affiliation(s)
- Megan B Irby
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pediatrics, Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital Weight Control and Diabetes Research Center, Providence, RI, USA
| | - Richard B Lipton
- Department of Neurology, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Barbara Nicklas
- Department of Gerontology and Geriatric Medicine, Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Timothy T Houle
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald B Penzien
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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19
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Peck KR, Smitherman TA. Mediator Variables in Headache Research: Methodological Critique and Exemplar Using Self-Efficacy as a Mediator of the Relationship Between Headache Severity and Disability. Headache 2015; 55:1102-11. [PMID: 26247313 DOI: 10.1111/head.12633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite advances in headache medicine, there remains little research on process-related variables that mediate relations between headache and outcomes, as well as limited dissemination of optimal statistical methodology for conducting mediation analyses. The present paper thus aims to promote and demonstrate a contemporary approach to mediation analysis as applied to headache. METHODS An overview of a contemporary path-analytic approach to mediation analysis is presented, with an empirical exemplar for illustrative purposes. In the exemplar, headache management self-efficacy (HMSE) was proposed as a mediator between headache severity and disability. The sample included 907 young adults (M age = 19.03 [SD = 2.26]; 70.8% female) with primary headache. Direct and indirect effects of headache severity on headache disability through HMSE were assessed using the espoused methods. RESULTS Pain severity was positively associated with headache disability (β = 2.91, 95% confidence interval [CI; 2.62, 3.19]) and negatively associated with HMSE (β = -3.50, 95% CI [-4.24, -2.76]); HMSE was negatively associated with headache disability (β = 0.07, 95% CI [-0.09, -0.04]). A positive indirect effect of pain severity on disability through HMSE was identified (point estimate = 0.24, 95% CI [0.14, 0.34]); thus, self-efficacy mediated the association between pain severity and disability. The proposed mediation model accounted for 38% of total variance in disability (P < .001). CONCLUSIONS There is a need for theory-driven and statistically rigorous mediation analyses within the headache literature. In one exemplar application, self-efficacy partially accounted for the disability resulting from headache. We advocate for increased attention to intervening variables in headache via dissemination of contemporary mediation analyses.
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Affiliation(s)
- Kelly R Peck
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | - Todd A Smitherman
- Department of Psychology, University of Mississippi, Oxford, MS, USA
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Graef JE, Rief W, French DJ, Nilges P, Nestoriuc Y. German Language Adaptation of the Headache Management Self-Efficacy Scale (HMSE-G) and Development of a New Short Form (HMSE-G-SF). Headache 2015; 55:958-72. [PMID: 25904007 DOI: 10.1111/head.12564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to develop and validate a German version of French and colleagues' Headache Management Self-efficacy Scale and to construct an abbreviated form for use in behavioral headache research. Furthermore, the contribution of headache-specific self-efficacy to pain-related disability in German chronic headache sufferers was examined. BACKGROUND Headache-specific self-efficacy refers to an individuals' confidence that they can engage in behaviors to either prevent headache episodes or to manage headache-related pain and disability. Self-efficacy beliefs have been shown repeatedly to be positively associated with psychological well-being, effective coping, and enhanced treatment outcomes. METHODS A cross-sectional sample of 304 individuals diagnosed with either migraine, chronic tension-type headache, or a combination of 2 or more headache disorders completed the German Headache Management Self-efficacy Scale and questionnaires assessing headache activity, pain-related coping, general self-efficacy, depression, and anxiety. Responsiveness of the scale was analyzed in a longitudinal subsample of 32 inpatients undergoing headache treatment. Finally, a short form was constructed and evaluated regarding psychometric properties. RESULTS The German Headache Management Self-efficacy Scale showed good reliability (Cronbach's α = 0.87) as did the 6-item short form (Cronbach's α = 0.72). In the longitudinal sample, both versions showed a good ability to change over time (SRM= 0.52-1.16). Chronic headache patients with higher levels of self-efficacy reported lower levels of disability (r = -0.26 to -0.31). Multiple regression analyses revealed headache intensity and headache-specific self-efficacy as strongest predictors of headache-related disability (βself-efficacy = -0.21, βintensity = 0.26). CONCLUSIONS Both the 25-item version and the 6-item version appear to be valid, reliable measures of self-efficacy beliefs. These scales will allow clinicians to identify headache sufferers with low levels of headache-specific self-efficacy with the goal of enhancing this expectancy for improvement. The new short form can help accomplish this goal without adding significantly to the burden of the self-report assessment batteries used in clinical settings.
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Affiliation(s)
- Julia E Graef
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | | | - Paul Nilges
- Department of Clinical Psychology, German Red Cross Pain Centre Mainz, Mainz, Germany
| | - Yvonne Nestoriuc
- Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
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Gevensleben H, Moll GH, Rothenberger A, Heinrich H. Neurofeedback in attention-deficit/hyperactivity disorder - different models, different ways of application. Front Hum Neurosci 2014; 8:846. [PMID: 25374528 PMCID: PMC4204462 DOI: 10.3389/fnhum.2014.00846] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 10/02/2014] [Indexed: 11/22/2022] Open
Abstract
In children with attention-deficit/hyperactivity disorder (ADHD), different neurofeedback (NF) protocols have been applied, with the most prominent differentiation between EEG frequency-band (e.g., theta/beta) training and training of slow cortical potentials (SCPs). However, beyond distinctions between such basic NF variables, there are also competing assumptions about mechanisms of action (e.g., acquisition of regulation capability, generalization to daily life behavior). In the present article, we provide a framework for NF models and suppose two hypothetical models, which we call “conditioning-and-repairing model” and “skill-acquisition model,” reflecting extreme poles within this framework. We argue that the underlying model has an impact not only on how NF is applied but also on the selection of evaluation strategies and suggest using evaluation strategies beyond beaten paths of pharmacological research. Reflecting available studies, we address to what extent different views are supported by empirical data. We hypothesize that different models may hold true depending on the processes and behaviors to be addressed by a certain NF protocol. For example, the skill-acquisition model is supported by recent findings as an adequate explanatory framework for the mechanisms of action of SCP training in ADHD. In conclusion, evaluation and interpretation of NF trials in ADHD should be based on the underlying model and the way training is applied, which, in turn, should be stated explicitly in study reports.
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Affiliation(s)
- Holger Gevensleben
- Child and Adolescent Psychiatry, University Medical Center Göttingen Göttingen, Germany
| | - Gunther H Moll
- Department of Child and Adolescent Mental Health, University Hospital of Erlangen Erlangen, Germany
| | - Aribert Rothenberger
- Child and Adolescent Psychiatry, University Medical Center Göttingen Göttingen, Germany
| | - Hartmut Heinrich
- Department of Child and Adolescent Mental Health, University Hospital of Erlangen Erlangen, Germany ; Heckscher-Klinikum München, Germany
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Abstract
Individuals with chronic pain differ markedly in their physical and psychological adjustment to the pain condition. Many factors influence this adjustment process, and the nature and severity of the physical injury or illness and the degree of pain experienced cannot account fully for the impact of chronic pain. A variety of other psycho-social factors are involved, including the individual's attitudes and beliefs about his or her condition, coping skills, operant reinforcement factors, avoidance learning, and psychophysiological variables. Intervention programs that are designed to facilitate positive adjustment to chronic pain need to consider these biological, psychological, and social factors within an integrated framework. Cognitive therapy has a significant role to play in this process, in order to tackle maladaptive cognitive factors that interfere with adjustment. Evidence concerning attitudes and beliefs relevant to the pain condition and their relationship with the use of coping skills and response to pain, is reviewed.
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Abstract
The present study tested the hypothesis that involving the partners of headache sufferers in a group cognitive-behavioural stress-coping intervention for chronic headaches would enhance treatment outcome. A treatment program in which partners were involved (PI) was compared with a standard treatment program in which partners were not included (NPI) and a no-treatment control condition (NTC). The NPI condition was effective compared to the NTC condition, but there was less evidence that the PI condition was effective. No significant differences were found between the PI and NPI conditions at posttreatment or follow-up. These results are considered in terms of the usefulness of involving partners in group headache-treatment and the manner of their involvement. In addition, the possibility that partner involvement may actually detract from treatment effectiveness is discussed in terms of its impact on motivation and personal responsibility for change.
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Wells RE, Smitherman TA, Seng EK, Houle TT, Loder EW. Behavioral and Mind/Body Interventions in Headache: Unanswered Questions and Future Research Directions. Headache 2014; 54:1107-13. [DOI: 10.1111/head.12362] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2014] [Indexed: 01/07/2023]
Affiliation(s)
- Rebecca E. Wells
- Department of Neurology; Wake Forest School of Medicine; Winston-Salem NC USA
| | | | - Elizabeth K. Seng
- Ferkauf Graduate School of Psychology; Yeshiva University; New York NY USA
- Albert Einstein College of Medicine of Yeshiva University; Bronx NY
| | - Timothy T. Houle
- Department of Anesthesiology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Elizabeth W. Loder
- Department of Neurology; Brigham and Women's Faulkner Hospital; Boston MA USA
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25
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Lee C, Crawford C, Hickey A. Mind–Body Therapies for the Self-Management of Chronic Pain Symptoms. PAIN MEDICINE 2014; 15 Suppl 1:S21-39. [DOI: 10.1111/pme.12383] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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26
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Moseley GL. Joining Forces – Combining Cognition-Targeted Motor Control Training with Group or Individual Pain Physiology Education: A Successful Treatment For Chronic Low Back Pain. J Man Manip Ther 2013. [DOI: 10.1179/106698103790826383] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Strain AC, Azevedo R, D’Mello SK. Using a false biofeedback methodology to explore relationships between learners’ affect, metacognition, and performance. CONTEMPORARY EDUCATIONAL PSYCHOLOGY 2013. [DOI: 10.1016/j.cedpsych.2012.08.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Heart Rate Variability Biofeedback Reduces Food Cravings in High Food Cravers. Appl Psychophysiol Biofeedback 2012; 37:241-51. [DOI: 10.1007/s10484-012-9197-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bohns VK, Wiltermuth SS. It hurts when I do this (or you do that): Posture and pain tolerance. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2012. [DOI: 10.1016/j.jesp.2011.05.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Hodges PW. Pain and motor control: From the laboratory to rehabilitation. J Electromyogr Kinesiol 2011; 21:220-8. [PMID: 21306915 DOI: 10.1016/j.jelekin.2011.01.002] [Citation(s) in RCA: 192] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 12/24/2010] [Accepted: 01/06/2011] [Indexed: 01/13/2023] Open
Abstract
Movement is changed in pain and is the target of clinical interventions. Yet the understanding of the physiological basis for movement adaptation in pain remains limited. Contemporary theories are relatively simplistic and fall short of providing an explanation for the variety of permutations of changes in movement control identified in clinical and experimental contexts. The link between current theories and rehabilitation is weak at best. New theories are required that both account for the breadth of changes in motor control in pain and provide direction for development and refinement of clinical interventions. This paper describes an expanded theory of the motor adaptation to pain to address these two issues. The new theory, based on clinical and experimental data argues that: activity is redistributed within and between muscles rather than stereotypical inhibition or excitation of muscles; modifies the mechanical behaviour in a variable manner with the objective to "protect" the tissues from further pain or injury, or threatened pain or injury; involves changes at multiple levels of the motor system that may be complementary, additive or competitive; and has short-term benefit, but with potential long-term consequences due to factors such as increased load, decreased movement, and decreased variability. This expanded theory provides guidance for rehabilitation directed at alleviating a mechanical contribution to the recurrence and persistence of pain that must be balanced with other aspects of a multifaceted intervention that includes management of psychosocial aspects of the pain experience.
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Affiliation(s)
- Paul W Hodges
- The University of Queensland, Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, Brisbane, Qld 4072, Australia.
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31
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Heinecke K, Weise C, Rief W. Psychophysiological effects of biofeedback treatment in tinnitus sufferers. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 48:223-39. [DOI: 10.1348/014466508x386207] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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32
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Sun-Edelstein C, Mauskop A. Alternative Headache Treatments: Nutraceuticals, Behavioral and Physical Treatments. Headache 2011; 51:469-483. [DOI: 10.1111/j.1526-4610.2011.01846.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Andrasik F, Rime C. Biofeedback. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00130-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jensen MP. Psychosocial approaches to pain management: an organizational framework. Pain 2010; 152:717-725. [PMID: 21168972 DOI: 10.1016/j.pain.2010.09.002] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 07/22/2010] [Accepted: 09/07/2010] [Indexed: 11/27/2022]
Abstract
Many different psychosocial treatments for pain have been described in the literature. All of these treatments have at least some evidence supporting their efficacy. However, each treatment is based on a theory or model that is most useful only for that particular intervention. An overarching model or framework that includes all of the factors hypothesized to play a role in the effects of these treatments would be useful for (1) understanding the similarities and differences between existing and future psychosocial pain treatments, (2) guiding the psychosocial evaluation of patients with chronic pain, and (3) giving clinicians greater flexibility for including psychosocial interventions that have proven efficacy, but that may not be explained by their preferred (but perhaps limited) model. This article proposes an initial version of such a framework, with the hope that it will increase our understanding of the role that psychosocial factors play in the experience of pain and its negative effects on functioning, and informs future research seeking to identify the common and specific factors associated with psychosocial pain treatments.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation Medicine, Box 359612, University of Washington School of Medicine, Seattle, WA 98195-6490, USA
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35
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Morley S. Efficacy and effectiveness of cognitive behaviour therapy for chronic pain: Progress and some challenges. Pain 2010; 152:S99-S106. [PMID: 21159433 DOI: 10.1016/j.pain.2010.10.042] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 10/28/2010] [Accepted: 10/28/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Stephen Morley
- Leeds Institute of Health Sciences, University of Leeds, UK
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36
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Meuret AE, Rosenfield D, Seidel A, Bhaskara L, Hofmann SG. Respiratory and cognitive mediators of treatment change in panic disorder: evidence for intervention specificity. J Consult Clin Psychol 2010; 78:691-704. [PMID: 20873904 PMCID: PMC3327286 DOI: 10.1037/a0019552] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE There are numerous theories of panic disorder, each proposing a unique pathway of change leading to treatment success. However, little is known about whether improvements in proposed mediators are indeed associated with treatment outcomes and whether these mediators are specific to particular treatment modalities. Our purpose in this study was to analyze pathways of change in theoretically distinct interventions using longitudinal, moderated mediation analyses. METHOD Forty-one patients with panic disorder and agoraphobia were randomly assigned to receive 4 weeks of training aimed at altering either respiration (capnometry-assisted respiratory training) or panic-related cognitions (cognitive training). Changes in respiration (PCO₂, respiration rate), symptom appraisal, and a modality-nonspecific mediator (perceived control) were considered as possible mediators. RESULTS The reductions in panic symptom severity and panic-related cognitions and the improvements in perceived control were significant and comparable in both treatment groups. Capnometry-assisted respiratory training, but not cognitive training, led to corrections from initially hypocapnic to normocapnic levels. Moderated mediation and temporal analyses suggested that in capnometry-assisted respiratory training, PCO₂ unidirectionally mediated and preceded changes in symptom appraisal and perceived control and was unidirectionally associated with changes in panic symptom severity. In cognitive training, reductions in symptom appraisal were bidirectionally associated with perceived control and panic symptom severity. In addition, perceived control was bidirectionally related to panic symptom severity in both treatment conditions. CONCLUSION The findings suggest that reductions in panic symptom severity can be achieved through different pathways, consistent with the underlying models.
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Affiliation(s)
- Alicia E Meuret
- Department of Psychology, Southern Methodist University, 6424 Hilltop Lane, Dallas, TX 72505, USA.
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Dynamics of Changes in Self-Efficacy and Locus of Control Expectancies in the Behavioral and Drug Treatment of Severe Migraine. Ann Behav Med 2010; 40:235-47. [DOI: 10.1007/s12160-010-9223-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ehrenborg C, Archenholtz B. Is surface EMG biofeedback an effective training method for persons with neck and shoulder complaints after whiplash-associated disorders concerning activities of daily living and pain -- a randomized controlled trial. Clin Rehabil 2010; 24:715-26. [PMID: 20562165 DOI: 10.1177/0269215510362325] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of surface electromyographic (EMG) biofeedback training as a supplement to an interdisciplinary rehabilitation programme regarding consequences for activities of daily living and pain. DESIGN A randomized controlled unblinded trial. SETTINGS The study was carried out in a pain unit at a rehabilitation centre. SUBJECTS Sixty-five people with chronic whiplash-associated disorders consecutively referred to the pain unit agreed to participate in the study. Participants were randomly assigned to either the treatment or control group. INTERVENTION All participants received interdisciplinary rehabilitation and the treatment group also had four weeks of surface EMG biofeedback training. MAIN MEASURES The Canadian Occupational Performance Measure was used at admission discharge and at six-month follow-up to register changes in activities of daily living. The Multidimensional Pain Inventory, Swedish version, was used at admission and at six-month follow-up to capture the multidimensional aspects of pain. RESULTS Sixty-two people completed the study. Both treatment and control groups improved significantly according to the Canadian Occupational Performance Measure at discharge and the results remained after six months (P<0.001). The subscale 'Interference' on the Multidimensional Pain Inventory was significantly decreased at six months for the treatment group (P<0.001). No differences were found between the two groups for activities of daily living (performance P = 0.586; satisfaction P = 0.988) at follow-up or for pain level (P = 0.914), indicating no additional effect of the surface EMG biofeedback training. CONCLUSION In this study there was no support for the effectiveness of surface EMG biofeedback training as a supplement to an interdisciplinary rehabilitation programme for people with long-lasting pain after whiplash.
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Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW. Behavioral treatments of chronic tension-type headache in adults: are they beneficial? CNS Neurosci Ther 2010; 15:183-205. [PMID: 19499626 DOI: 10.1111/j.1755-5949.2009.00077.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To assess the efficacy of behavioral treatments in patients with tension headache. Medline, Cinahl, EMBASE, and the Cochrane library were searched from inception to October 2007 and reference lists were checked. We selected randomized trials evaluating behavioral treatments (e.g., relaxation, electromyographic [EMG] biofeedback, and cognitive behavioral training) in patients with tension-type headache (TTH). We assessed the risk of bias using the Delphi list and extracted data from the original reports. A qualitative analysis was carried out. We found 44 trials (2618 patients), which were included in this review, of which only 5 studies (11.4%) were considered to have low risk of bias. Most trials lacked adequate power to show statistical significant differences, but frequently, recovery/improvement rates did not reach clinical relevance. In 8 studies, relaxation treatment was compared with waiting list conditions, and in 11 studies, biofeedback was compared with waiting list conditions, both showing inconsistent results. On the basis of the available literature, we found no indications that relaxation, EMG biofeedback, or cognitive behavioral treatment is better than no treatment, waiting list, or placebo controls.
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Affiliation(s)
- Arianne P Verhagen
- Department of General Practice, Erasmus Medical Centre University, Rotterdam, The Netherlands.
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Olsson EMG, El Alaoui S, Carlberg B, Carlbring P, Ghaderi A. Internet-Based Biofeedback-Assisted Relaxation Training in the Treatment of Hypertension: A Pilot Study. Appl Psychophysiol Biofeedback 2009; 35:163-70. [DOI: 10.1007/s10484-009-9126-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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41
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Escott D, Slade P, Spiby H. Preparation for pain management during childbirth: The psychological aspects of coping strategy development in antenatal education. Clin Psychol Rev 2009; 29:617-22. [DOI: 10.1016/j.cpr.2009.07.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 07/12/2009] [Accepted: 07/14/2009] [Indexed: 11/16/2022]
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Kang EH, Park JE, Chung CS, Yu BH. Effect of biofeedback-assisted autogenic training on headache activity and mood states in Korean female migraine patients. J Korean Med Sci 2009; 24:936-40. [PMID: 19794995 PMCID: PMC2752780 DOI: 10.3346/jkms.2009.24.5.936] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 10/10/2008] [Indexed: 11/20/2022] Open
Abstract
Biofeedback with or without combined autogenic training is known to be effective for the treatment of migraine. This study aimed to examine the effect of biofeedback treatment on headache activity, anxiety, and depression in Korean female patients with migraine headache. Patients were randomized into the treatment group (n=17) and monitoring group (n=15). Mood states including anxiety and depression, and psychophysiological variables such as mean skin temperature of the patients were compared with those of the normal controls (n=21). We found greater treatment response rate (defined as > or =50% reduction in headache index) in patients with biofeedback-assisted autogenic training than in monitoring group. The scores on the anxiety and depression scales in the patients receiving biofeedback-assisted autogenic training decreased after the biofeedback treatment. Moreover, the decrease in their anxiety levels was significantly related to the treatment outcome. This result suggests that the biofeedback-assisted autogenic training is effective for the treatment of migraine and its therapeutic effect is closely related to the improvement of the anxiety level.
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Affiliation(s)
- Eun-Ho Kang
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Eon Park
- Department of Psychiatry, Keyo Hospital, Euiwang, Korea
| | - Chin-Sang Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bum-Hee Yu
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Abstract
The aim of this study was to develop and evaluate the feasibility of a cognitive behavioural treatment for unexplained chest pain (UCP), based on the cognitive model of UCP. Ten patients were treated. The diagnosis had been made by a cardiologist two years before the start of treatment. The treatment incorporated breathing and relaxation training, identifying and challenging beliefs about the cause of UCP, behavioural experiments and problem solving for social problems. Patients improved significantly with regard to intensity and duration of chest pain, anxiety and functional limitations. Moreover, the reduction of scores for fear of bodily sensations and of credibility ratings of idiosyncratic disease related negative automatic thoughts was significant. The changes in scores for the inclination to interpret bodily sensations catastrophically almost reached the level of significance. These results suggests that therapy results may be cognitively mediated.
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Cognitive Approaches to the Treatment of Chronic Benign Headache: A Review and Critique. Behav Cogn Psychother 2009. [DOI: 10.1017/s0141347300014932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Psychological treatments of headache are becoming increasingly influenced by cognitive therapy. This paper addresses three issues relevant to the development and evaluation of cognitive therapy. 1. It is argued that current assessment measures for evaluating treatment are founded on a theory of pain which is inadequate and as a result they are not sufficient for the evaluation of cognitive therapy. 2. The assumptions on which cognitive therapy for headache is based have not been verified. Recent research indicates a degree of complexity in the relationships between cognition, emotion and pain which has yet to be assimilated. 3. It is noted that cognitive therapy for headache lacks an explicit model of pain which would facilitate the precise formulation and testing of interventions.
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Holroyd KA, Labus JS, Carlson B. Moderation and mediation in the psychological and drug treatment of chronic tension-type headache: the role of disorder severity and psychiatric comorbidity. Pain 2009; 143:213-222. [PMID: 19342174 DOI: 10.1016/j.pain.2009.02.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 02/20/2009] [Accepted: 02/20/2009] [Indexed: 11/18/2022]
Abstract
We evaluated two putative moderators of treatment outcome as well as the role of Headache Management Self-Efficacy (HMSE) in mediating treatment outcomes in the drug and non-drug treatment of chronic tension-type headache (CTTH). Subjects were 169 participants (M=38 yrs.; 77% female; M headache days/mo.=22) who received one of four treatments in the treatment of CTTH trial (JAMA, 2001; 285: 2208-15): tricyclic antidepressant medication, placebo, (cognitive-behavioral) stress-management therapy plus placebo, and stress-management therapy plus antidepressant medication. Severity of CTTH disorder and the presence of a psychiatric (mood or anxiety) disorder were found to moderate outcomes obtained with the three active treatments and with placebo, as well as to moderate the role of HMSE in mediating improvements. Both moderator effects appeared to reflect the differing influence of the moderator variable on each of the three active treatments, as well as the fact that the moderator variables exerted the opposite effect on placebo than on the active treatments. HMSE mediated treatment outcomes in the two stress-management conditions, but the pattern of HMSE mediation was complex, varying with the treatment condition, the outcome measure, and the moderator variable. Irrespective of the severity of the CTTH disorder HMSE fully mediated observed improvements in headache activity in the two stress-management conditions. However, for patients with a mood or anxiety disorder HMSE only partially mediated improvements in headache disability, suggesting an additional therapeutic mechanism is required to explain observed improvements in headache disability in the two stress-management conditions.
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Affiliation(s)
- Kenneth A Holroyd
- Psychology Department, Ohio University, 200 Porter Hall, Athens, OH 45701-2979, USA Center for Neurobiology of Stress, Connectivity and Computational Statistics Division, University of California at Los Angeles, USA
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Radat F, Lantéri-Minet M, Nachit-Ouinekh F, Massiou H, Lucas C, Pradalier A, Mercier F, El Hasnaoui A. The GRIM2005 Study of Migraine Consultation in France. III: Psychological Features of Subjects With Migraine. Cephalalgia 2009; 29:338-50. [DOI: 10.1111/j.1468-2982.2008.01718.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this analysis was to describe psychological and cognitive variables in subjects with migraine and to identify those associated with chronicity. Data were collected from 10 000 subjects during face-to-face interview. Subjects with episodic migraine ( n = 1127) or chronic daily headache ( n = 407) with migrainous features were identified using an algorithm based on the International Classification of Headache Disorders, 2nd edn classification. Data on headache impact was obtained with the Headache Impact Test-6, on psychological distress with the Hospital Anxiety and Depression Scale, on coping with the Coping Strategy Questionnaire catastrophizing score and the Brief COPE inventory, on illness perception with the Brief Illness Perception Questionnaire and on locus of control. Psychological variables associated with chronicity include perceived headache impact, psychological distress, the use of catastrophizing and avoidance coping strategies and an externalized locus of control. In conclusion, maladaptive coping strategies should be taken into account in the management of patients with migraine. Longitudinal studies will be necessary to address the causality of the relationship observed.
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Affiliation(s)
| | | | | | | | - C Lucas
- Hôpital Roger Salengro, Lille
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Oken BS. Placebo effects: clinical aspects and neurobiology. Brain 2008; 131:2812-23. [PMID: 18567924 PMCID: PMC2725026 DOI: 10.1093/brain/awn116] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 04/28/2008] [Accepted: 05/04/2008] [Indexed: 01/31/2023] Open
Abstract
Placebo effects are beneficial health outcomes not related to the relatively direct biological effects of an intervention and can be elicited by an agent that, by itself, is inert. Understanding these placebo effects will help to improve clinical trial design, especially for interventions such as surgery, CNS-active drugs and behavioural interventions which are often non-blinded. A literature review was performed to retrieve articles discussing placebo implications of clinical trials, the neurobiology of placebo effects and the implications of placebo effect for several disorders of neurological relevance. Recent research in placebo analgesia and other conditions has demonstrated that several neurotransmitter systems, such as opiate and dopamine, are involved with the placebo effect. Brain regions including anterior cingulate cortex, dorsolateral prefrontal cortex and basal ganglia have been activated following administration of placebo. A patient's expectancy of improvement may influence outcomes as much as some active interventions and this effect may be greater for novel interventions and for procedures. Maximizing this expectancy effect is important for clinicians to optimize the health of their patient. There have been many relatively acute placebo studies that are now being extended into clinically relevant models of placebo effect.
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Affiliation(s)
- Barry S Oken
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA.
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Wieselmann-Penkner K, Janda M, Lorenzoni M, Polansky R. A comparison of the muscular relaxation effect of TENS and EMG-biofeedback in patients with bruxism. J Oral Rehabil 2008. [DOI: 10.1111/j.1365-2842.2001.00748.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Martin PR, Forsyth MR, Reece J. Cognitive-behavioral therapy versus temporal pulse amplitude biofeedback training for recurrent headache. Behav Ther 2007; 38:350-63. [PMID: 18021950 DOI: 10.1016/j.beth.2006.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 10/21/2006] [Indexed: 10/22/2022]
Abstract
Sixty-four headache sufferers were allocated randomly to cognitive-behavioral therapy (CBT), temporal pulse amplitude (TPA) biofeedback training, or waiting-list control. Fifty-one participants (14M/37F) completed the study, 30 with migraine and 21 with tension-type headache. Treatment consisted of 8, 1-hour sessions. CBT was highly effective, with an average reduction in headaches from pre- to posttreatment of 68%, compared with 56% for biofeedback, and 20% for the control condition. Headaches continued to decrease to 12 month follow-up for CBT. Improvement with CBT was associated with baseline coping skills, social support, and physiological measures at rest and in response to stress, particularly TPA. Changes on some of these measures were correlated with changes in headaches. No significant predictors of response to biofeedback emerged.
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Voerman GE, Sandsjö L, Vollenbroek-Hutten MMR, Larsman P, Kadefors R, Hermens HJ. Changes in cognitive-behavioral factors and muscle activation patterns after interventions for work-related neck-shoulder complaints: relations with discomfort and disability. JOURNAL OF OCCUPATIONAL REHABILITATION 2007; 17:593-609. [PMID: 17973181 DOI: 10.1007/s10926-007-9109-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 10/15/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVES Knowledge regarding the working mechanism of an intervention is essential for obtaining a better understanding of the intervention and contributes to optimize its outcome. This study aimed at investigating whether changes in cognitive-behavioral factors and muscle activation patterns after myofeedback training and ergonomic counseling were associated with outcome, in subjects with work-related musculoskeletal neck-shoulder complaints. METHODS Seventy-nine symptomatic subjects received either myofeedback with ergonomic counseling (Mfb/EC) or ergonomic counseling alone (EC). Outcome measures discomfort and disability, and process factors catastrophizing, pain control, fear-avoidance beliefs, and muscle activation patterns were assessed at baseline, after the interventions (T0), and at 3 months follow-up (T3). Mixed modeling techniques were used for analysis. RESULTS Outcome in terms of discomfort and disability was generally comparable between both interventions. Catastrophizing was significantly reduced and fear-avoidance beliefs about work slightly increased after the interventions, but no consistent changes in muscle activation patterns were observed. Changes in discomfort were especially associated with changes in catastrophizing at T0 and T3, but R(2) was low (<0.14). Reduced catastrophizing at T0 and T3, and also reduced fear-avoidance beliefs about work at T3, were related to reduced disability (R(2) between 0.30 and 0.40). No differences between the two intervention groups were observed. CONCLUSIONS Intervention effects were generally non-specific and findings suggested that cognitive-behavioral factors underlie the outcome of these interventions rather than changes in muscle activation patterns. Emphasizing these factors during therapy may increase the beneficial outcome of occupational interventions.
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