Elsevier

The Journal of Pain

Volume 8, Issue 12, December 2007, Pages 938-949
The Journal of Pain

Original report
A Randomized Clinical Trial of Targeted Cognitive Behavioral Treatment to Reduce Catastrophizing in Chronic Headache Sufferers

https://doi.org/10.1016/j.jpain.2007.06.010Get rights and content
Under an Elsevier user license
open archive

Abstract

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

Perspective

Cognitive-behavioral treatment targeting reduction of catastrophizing for chronic headache pain reduced negative cognitive and affective variables associated with recurrent headache, increased headache management self-efficacy, and in half of the participants, produced clinically meaningful reductions in headache indicators. Length of treatment is an important factor to consider when providing CBT for chronic pain.

Key words

Headache
pain
cognitive behavioral therapy
catastrophizing
randomized clinical trial
psychosocial

Cited by (0)

Supported in part by National Institute on Neurological Disorders and Stroke grant R-15 NS 42323, awarded to Dr. Thorn.