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15 Aug

A pilot study of one-session biofeedback training in pediatric headache.
15 Aug

Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial.

Ohio University psychologists Holroyd, O’Donnell, Stensland, Lipchik, Cordingley and Carlson compared the effectiveness of behavioral and pharmacological therapies, singly and combined, for chronic tension headaches. Their randomized, placebo-controlled trial studied 203 adult subjects, who were randomly assigned to receive either a tricyclic antidepressant (Elavil or Pamelor); stress management therapy (relaxation and coping skills) or both together. Placebo groups were used as well.

15 Aug

Behavioral management of recurrent headache: three decades of experience and empiricism.

This fresh review and meta-analysis of the research literature on behavioral interventions for headache (chiefly relaxation, biofeedback, and stress-management) out of the University of Mississippi Medical Center’s Head Pain Center show clinically significant reductions in recurrent headache. In fact, across studies, behavioral interventions have yielded approximately 35-50% reduction in migraine and tension-type headache activity. In addition, the available evidence suggests that the level of headache improvement with behavioral interventions may rival those obtained with widely used pharmacologic therapies in representative patient samples. The article also mentions that in recent years, some attempts have been made to increase the availability and cost effectiveness of behavioral interventions through alternative delivery formats and mass communications, and suggests further integration of behavioral treatments into primary care settings, the place where the great majority of headache sufferers receive treatment.

Citation: Penzien DB, Rains JC, Andrasik F. Behavioral management of recurrent headache: three decades of experience and empiricism. Applied Psychophysiology and Biofeedback. 2002 Jun; 27 (2): pp 163-81.

15 Aug

Cognitive-behavioral therapy of pediatric headache: are there differences in efficacy between a therapist-administered group training and a self-help format?

Researchers from the University of Goettingen in Germany compared the efficacy of cognitive-behavioral training in a therapist-administered, group format, to a self-help format (no therapist) with 77 children, ages 10-14, suffering from recurrent headache. The children were randomly assigned to either the therapist CBT group (n=29), the self-help group (n=27) or a wait list condition (n=19). In both formats, the topics covered were identical (e.g., self-monitoring of headache, trigger analysis, relaxation, etc.). Sessions were 90 minutes with groups of 5 children assigned to each. The self-help groups were given a written manual in which instructions were given and homework tasks assigned. The main outcome variables were related to changes in headache intensity, duration and frequency, as assessed in a diary prior to and following training, as well as at 6-month follow-up. The children reported an equally high degree of satisfaction with the training, with no significant differences between the two conditions. In both, headaches decreased markedly from posttraining to follow-up, with 68-76% of the children reporting clinically significant improvement. There were also significant changes in self-concept and ability to cope with stress after both types of intervention. In addition, the investigators found no differences by age, gender or headache diagnosis. The study concludes that the efficacy of the two training formats is nearly identical.

Citation: Kroener-Herwig B, Denecke H. Cognitive-behavioral therapy of pediatric headache: are there differences in efficacy between a therapist-administered group training and a self-help format? Journal of Psychosomatic Research 2002 Dec;53 (6):pp. 1107-14. email: This email address is being protected from spambots. You need JavaScript enabled to view it.

15 Aug

When 45 Australian children with histories of ten or more upper respiratory tract infections were taught stress management and guided imagery, their episodes of illness were shorter and symptoms milder at the one-year follow-up than for the kids who were wait-listed. In addition, their psychological state remained improved as well. These findings were confirmed in a subsequent replication study, suggesting that psychological treatment interrupts a chronic illness cycle in children with symptoms of recurrent URTI.

Citation: Hewson-Bower B and Drummond PD, Psychological treatment for recurrent symptoms of colds and flu in children. Journal of Psychosomatic Research 2001 Jul;51(1):369-77.
15 Aug

Betsy Singh, Brian Berman, Victoria Hadhazy & Paul Creamer of the Complementary Medicine Program at the U of Maryland School of Medicine showed in a pilot study of 28 patients with fibromyalgia that a combination of patient education, meditation and qigong movement therapy significantly reduced pain, fatigue and sleeplessness. The eight weekly, 2.5 hr sessions also improved mood state, function and general health. (Alternative Therapies, March 1998, Vol 4, no. 2, pp. 67-70.)

Citation: Singh BB, Berman BM, Hadhazy VA, Creamer P. A pilot of cognitive behavioral therapy in fibromyalgia. Alternative Therapies Health Med. 1998 Mar; 4(2): 67-70.

15 Aug

Prins, Bleijenberg et al from the University Medical Center, Nijmegen, The Netherlands, compared the effects of cognitive-behavioral therapy (relaxation, guided imagery, and other self-regulatory techniques) to professionally facilitated support groups and a control group of standard care in the treatment of CFS (chronic fatigue syndrome). Of 278 patients diagnosed with CFS, 93 were randomly assigned to CBT, 94 to support groups and 91 to the control condition. Evaluations were done at the start, after 8 months, and after 14 months, to assess the severity of fatigue and degree of functional impairment. At 14 months, CBT was found to be significantly more effective than the other 2 conditions for fatigue and for functional impairment. Support groups were no more effective than the control condition.

Citation: Prins JB, Bleijenberg G, Bazelmans E, Elving LD, de Boo TM, Severens JL, van de Wilt GJ, Spinhoven P, van der Meer JW. Cognitive Behaviour Therapy for Chronic Fatigue Syndrome: A Multicentre randomised controlled trial. Lancet 2001 Mar 17;357(9259):841-847
15 Aug

Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study.

Sixty patients with Chronic Fatigue Syndrome from 3 different London hospitals were randomly assigned to either cognitive behavior therapy or a relaxation therapy. Five years later, 53 of them completed questionnaires and interviews measuring their improvement in symptoms. A total of 68% of the patients who received behavior therapy, and 36% who received relaxation therapy rated themselves as much improved at the 5 year follow-up. In addition, significantly more CBT patients met the criteria for complete recovery, freedom from relapse, and steadily improved symptoms, as compared to the relaxation therapy group. The study concludes that cognitive behavior therapy can produce lasting benefits for CFS, but is not a cure.

Citation: Deale, Husain, Chalder & Wessely. Long-term outcome of cognitive behavior therapy versus relaxation therapy for chronic fatigue syndrome: a 5-year follow-up study. American Journal of Psychiatry 2001 Dec; 158 (12): pp. 2038-42.

15 Aug

Cognitive behaviour therapy appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome. A systematic review by Price and Couper for the Cochrane Library, Issue 2, 2001, looked at all randomized controlled trials of cognitive-behaviour therapy (CBT) for adults with chronic fatigue syndrome (CFS).

Although only 3 relevant trials of adequate quality were found, these studies managed to demonstrate that CBT significantly benefits physical functioning in adult out-patients with CFS, when compared to orthodox medical management. In addition, these patients found these tools highly acceptable.Cognitive behaviour therapy appears to be an effective and acceptable treatment for adult out-patients with chronic fatigue syndrome. A systematic review by Price and Couper for the Cochrane Library, Issue 2, 2001, looked at all randomized controlled trials of cognitive-behaviour therapy (CBT) for adults with chronic fatigue syndrome (CFS).

15 Aug

The September 19th issue of JAMA/b> features a systematic review of the literature on what interventions have been found to work for chronic fatigue syndrome. Nineteen databases were searched for any published or unpublished studies in any language, and the study included randomized and nonrandomized controlled trials. Of 350 studies, 44 met the inclusion criteria, including 36 randomized controlled trials. In these studies, subjects numbered from 12 to 326, with a total of 2801 participants combined. The most promising results were in cognitive behavioral therapy and graded exercise therapy. However, there were sufficient design inadequacies in many of these studies, to conclude that further investigation is warranted.

Citation: Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramirez G. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA. 2001 September 19; 286(11): 1378-9.

15 Aug

The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial.

A Norwegian research team compared the effects of attention distracting imagery, attention focusing imagery and amitriptyline (elavil and similar anti-depressants) on fibromyalgia pain in 55 women. They monitored them daily for pain in a randomized, controlled clinical trial. One group (n=17) received relaxation training and “pleasant” guided imagery designed to distract them from their pain. Another group (n=21) received relaxation training and attention imagery that focused on the "active workings of the internal pain control systems”. The control group received treatment as usual (n=17). Patients were also randomly assigned to 50-mg amitriptyline/day or placebo. The slopes of diary pain ratings over a 4-week period were used as the outcome measures. The team found significant differences of the pain-slopes between the three psychological conditions (P=0.0001). The pleasant imagery declined significantly (P<0.005) when compared with the control group (P>0.05). The attention imagery group''s slope did not. Neither was there a difference between the amitriptyline and placebo slopes (main effects, P=0.98). The study concludes that pleasant imagery is an effective intervention in reducing fibromyalgic pain during the 28-day study period. Amitriptyline had no significant advantage over placebo during the study period.

Citation: Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily fibromyalgia pain: a prospective, randomized, controlled trial. Journal of Psychiatry Research 2002 May-Jun;36(3):179-87

15 Aug

.In randomized, controlled clinical trials at Georgetown University’s Department of Psychiatry, a research team led by D.A. Williams assigned 145 patients with fibromyalgia to either (1) standard medical care that included pharmacological management of symptoms and suggestions for aerobic fitness, or (2) the same standard medical treatment plus 6 sessions of Cognitive-Behavioral treatment aimed at improving physical functioning.

Twenty-five percent of the patients receiving CBT were able to achieve clinically meaningful levels of longterm improvement in physical functioning, whereas only 12% of the patients receiving standard care achieved the same level of improvement. There were no lasting differences on pain ratings between groups.