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Client variables and the behavioral treatment of recurrent tension headache: A metaanalytic review

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Abstract

Meta-analysis revealed that in studies evaluating behavioral treatments for tension headaches, the treatment outcome has varied with the client samples (e.g., age, gender, referral source) that have been used but not with the treatment procedures (e.g., type of behavioral intervention, length of treatment, whether or not efforts were made to facilitate transfer of training) or the research designs (e.g., internal validity, explicitness of diagnostic criteria) that have been used. Mean client age proved the best predictor of treatment outcome, accounting for 30% of the outcome variance following behavior therapy. Significantly poorer outcomes have also been reported in recent studies than were reported in early studies. These findings suggest that (1) outcomes obtained with behavioral interventions have been less dependent upon the treatment variables that have been the primary focus of research attention than upon characteristics of client samples and (2) behavioral interventions may be less effective in reducing headache activity than has previously been assumed.

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References

  • Andrasik, F., and Holroyd, K. A. (1980a). A test of specific and nonspecific effects in the biofeedback treatment of tension headache.J. Consult. Clin. Psychol. 48: 575–586.

    Google Scholar 

  • Andrasik, F., and Holroyd, K. A. (1980b). Reliability and concurrent validity of headache questionnaire data.Headache 20: 44–46.

    Google Scholar 

  • Bakal, D. A. (1982).The Psychobiology of Chronic Headache, Springer, New York.

    Google Scholar 

  • Benson, H. (1975).The Relaxation Response, William Morrow, New York.

    Google Scholar 

  • Bernal, G. A. (1982). A study of the differential effectiveness of biofeedback and hypnosis for the treatment of tension headaches.Proceedings of the Biofeedback Society of America 13th Annual Meeting, pp. 31–33.

  • Bernstein, D. A., and Borkovec, T. D. (1973).Progressive Relaxation Training: A Manual for the Helping Professions, Research Press, Champaign, Ill.

    Google Scholar 

  • Blanchard, E. B., and Andrasik, F. (1982). Psychological assessment and treatment of headache: Recent developments and emerging issues.J. Consult. Clin. Psychol. 50: 859–879.

    Google Scholar 

  • Blanchard, E. B., Andrasik, F., Ahles, T. A., Teders, S. J., & O'Keefe, D. (1980). Migraine and tension headache: A meta-analytic review.Behav. Ther. 11: 613–631.

    Google Scholar 

  • Blanchard, E. B., Andraski, E. B., Andrasik, F., Neff, D. F., Jurish, S. E., and O'Keefe, D. (1981). Social validation of the headache diary.Behav. Ther. 12: 711–715.

    Google Scholar 

  • Blanchard, E. B., Andrasik, F., Neff, D. F., Arena, J. G., Ahles, T. A., Jurish, S. E., Pallmeyer, T. P., Saunders, N. L., Teders, S. J., Barron, K. D., and Rodichok, L. D. (1982a). Biofeedback and relaxation training with three kinds of headache: Treatment effects and their prediction.J. Consult. Clin. Psychol. 50: 562–575.

    Google Scholar 

  • Blanchard, E. B., Andrasik, F., Neff, D. F., Teders, S. J., Pallmeyer, T. P., Arena, J. G., Jurish, S. E., Saunders, N. L., Ahles, T. A., and Rodichok, L. D. (1982b). Sequential comparisons of relaxation training and biofeedback in the treatment of three kinds of chronic headache or, the machines may be necessary some of the time.Behav. Ther. 20: 469–481.

    Google Scholar 

  • Blanchard, E. B., Andrasik, F., Evans, D. D., Neff, D. F., Appelbaum, K. A., and Rodichok, L. D. (1985). Behavioral treatment of 250 chronic headache patients: A clinical replication series.Behav. Ther. 16: 308–327.

    Google Scholar 

  • Borgeat, F., Hade, B., Larouche, L. M., and Bedwani, C. N. (1980). Effect of therapist's active presence on EMG biofeedback training of headache patients.Biofeed. Self-Regul. 5: 275–282.

    Google Scholar 

  • Bruhn, P., Olesen, J., and Melgaard, B. (1979). Controlled trial of EMG biofeedback in muscle contraction headache.Ann. Neurol. 6: 34–36.

    Google Scholar 

  • Budzynski, T. H., Stoyva, J., and Adler, C. (1970). Feedback induced muscle relaxation: Application tension headache.J. Behav. Ther. Exp. Psychiat. 1: 205–211.

    Google Scholar 

  • Budzynski, T. H., Stoyva, J. M., Adler, C. S., and Mullaney, D. J. (1973). EMG biofeedback and tension headache: A controlled outcome study.Psychosom. Med. 35: 484–496.

    Google Scholar 

  • Campbell, D. T., and Stanley, J. C. (1963).Experimental and Quasi-Experimental Designs for Research, Rand McNally, Chicago.

    Google Scholar 

  • Carrobles, J. A. I., Cardona, A., and Santacreu, J. (1981). Shaping and generalization procedures in the EMG-biofeedback treatment of tension headaches.Br. J. Clin. Psychol. 20: 49–56.

    Google Scholar 

  • Chesney, M. A., and Shelton, J. L. (1976). A comparison of muscle relaxation and electromyogram biofeedback treatments for muscle contraction headache.J. Behav. Ther. Exp. Psychiatr. 7: 221–225.

    Google Scholar 

  • Cohen, J. (1977).Statistical Power Analysis for the Behavioral Sciences, rev. ed., McGraw Hill, New York.

    Google Scholar 

  • Cooper, H. M. (1979). Statistically combining independent studies: A meta-analysis of sex differences in conformity research.J. Personal. Soc. Psychol. 37: 131–145.

    Google Scholar 

  • Cox, D. J., Freundlich, A., and Meyer, R. G. (1975). Differential effectiveness of electromyograph feedback, verbal instructions and medication placebo with tension headaches.J. Consult. Clin. Psychol. 43: 892–898.

    Google Scholar 

  • Cram, J. R. (1980). EMG biofeedback and the treatment of tension headaches: A systematic analysis of treatment components.Behav. Ther. 11: 699–710.

    Google Scholar 

  • Daly, E. J., Donn, P. A., Galliher, M. J., and Zimmerman, J. S. (1983). Biofeedback applications to migraine and tension headaches: A double-blind outcome study.Biofeed. SelfRegul. 8: 135–152.

    Google Scholar 

  • Diamond, S., and Montrose, D. (1984). The value of biofeedback in the treatment of chronic headache: A four-year retrospective study.Headache 24: 5–18.

    Google Scholar 

  • Diamond, S., Mediana, J., Diamond-Falk, J., and DeVeno, T. (1979). The value of biofeedback in the treatment of chronic headache: A five-year retrospective study.Headache 19: 90–96.

    Google Scholar 

  • Epstein, L. H., and Abel, G. G. (1977). An analysis of biofeedback training effects for tension headache patients.Behav. Ther. 8: 37–47.

    Google Scholar 

  • Eysenck, H. J. (1978). An exercise in mega-silliness.Am. Psychol. 33: 517.

    Google Scholar 

  • Figueroa, J. L. (1982). Group treatment of chronic tension headaches: A comparative treatment study.Behav. Modif. 6: 229–239.

    Google Scholar 

  • Fiske, D. W. (1983). The meta-analytic revolution in outcome research.J. Consult. Clin. Psychol. 51: 65–70.

    Google Scholar 

  • Frances, A., and Clarkin, J. (1981). Review of “The Benefits of Psychotherapy”.Hosp. Commun. Psychiat. 32: 807–808.

    Google Scholar 

  • Glass, G. V. (1976). Primary, secondary, and meta-analysis of researchEducat. Res. 5: 3–8.

    Google Scholar 

  • Glass, G. V., and Kliegl, R. M. (1983). An apology for research integration in the study of psychotherapy.J. Consult. Clin. Psychol. 51: 28–41.

    Google Scholar 

  • Glass, G. V., McGaw, B., and Smith, M. L. (1981).Meta-Analysis in Social Research, Sage, Beverly Hills, Calif.

    Google Scholar 

  • Hart, J. D. (1982). EMG biofeedback and relaxation training in the treatment of tension headache: A psychophysiological evaluation.Proceedings of the Biofeedback Society of America 13th Annual Meeting, pp. 102–104.

  • Hart, J. D., and Chichanski, K. A. (1981). A comparison of frontal EMG biofeedback and neck EMG biofeedback in the treatment of muscle-contraction headache.Biofeed. Self Regul. 6: 63–74.

    Google Scholar 

  • Haynes, S. N., Griffin, P., Mooney, D., and Parise, M. (1975). Electromyograph biofeedback and relaxation instructions in the treatment of muscle contraction headaches.Behav. Ther. 6: 672–678.

    Google Scholar 

  • Heaton, G. (1979). Biofeedback in headache management: An evaluation of 56 patients.J. Ind. State Med. Assoc. 72: 198–199.

    Google Scholar 

  • Hedges, L. V. (1981). Distribution theory for Glass's estimator of effect size and related estimators.J. Educ. Stat. 6: 107–128.

    Google Scholar 

  • Holroyd, K. A. (1986). Recurrent headache. In K. A. Holroyd, and T. L. Career, (eds.)Self Management of Chronic Disease: Handbook of Clinical Interventions and Research, Academic Press, New York.

    Google Scholar 

  • Holroyd, K. A., and Andrasik, F. (1982). A cognitive-behavioral approach to recurrent tension and migraine headache. In Kendall, P. C. (ed.),Advances in Cognitive-Behavioral Research and Therapy, Academic Press, New York.

    Google Scholar 

  • Holroyd, K. A., and Penzien, D. B. (1938). EMG biofeedback and tension headache: Therapeutic mechanisms. In Holroyd, K. A., Schlote, B. A., and Zenz, H. (eds.),Perspectives in Research on Headache, Hogrefe, Toronto.

    Google Scholar 

  • Holroyd, K. A., Andrasik, F., and Westbrook, T. (1977). Cognitive control of tension headache.Cog. Ther. Res. 1: 121–133.

    Google Scholar 

  • Holroyd, K. A., Andrasik, F., and Noble, J. (1980). A comparison of EMG biofeedback and a credible pseudotherapy in treating tension headache.J. Behav. Med. 3: 29–39.

    Google Scholar 

  • Holroyd, K. A., Penzien, D. B., Hursey, K. G., Tobin, D. L., Rogers, L., Holm, J. E., Marcille, P. J., Hall, J. R., and Chila, A. G. (1984). Change mechanisms in EMG biofeedback training: Cognitive changes underlying improvements in tension headache.J. Consult. Clin. Psychol. 52: 1039–1053.

    Google Scholar 

  • Hutchings, D. F., and Reinking, R. H. (1976). Tension headache: What form of therapy is most effective?Biofeed. Self-Regul. 1: 183–190.

    Google Scholar 

  • Jacobson, E. (1938).Progressive Relaxation, University of Chicago Press, Chicago.

    Google Scholar 

  • Janssen, K. (1983). Differential effectiveness of EMG-feedback versus combined EMG-feedback and relaxation instructions in the treatment of tension headache.J. Psychosom. Res. 27: 243–253.

    Google Scholar 

  • Kondo, C., and Canter, A. (1977). True and false electromyographic feedback: Effect on tension headache.J. Abnorm. Psychol. 86: 93–95.

    Google Scholar 

  • Kraemer, H. C. (1982). Some statistical issues in meta-analysis. In Hartmann, D. P. (Chair),Meta-Analysis as a Quantitative Review Method: Methods, Advantages, and Limitations, Symposium conducted at the meeting of the Association for Advancement of Behavior Therapy, New York: Nov.

  • Martin, P. R., and Mathews, A. M. (1978). Tension headaches: Psychophysiological investigation and treatment.J. Psychosom. Res. 22: 389–399.

    Google Scholar 

  • Matulich, W. J., Rugh, J. D., and Perlis, D. (1978). A comparison of group and individual EMG biofeedback for tension headaches.Proceedings of the Biofeedback Society of America 9th Annual Meeting, pp. 58–61.

  • Mitchell, K. R., and Mitchell, D. M. (1971). Migraine: An exploratory treatment application of programmed behavior therapy techniques.J. Psychosom. Res. 15: 137–157.

    Google Scholar 

  • Paiva, T., Nunes, S., Moreira, A., Santos, J., Teixeira, J., and Barbosa, A. (1982). Effects of frontalis EMG biofeedback and diazepam in the treatment of tension headache.Headache 22: 216–220.

    Google Scholar 

  • Philips, C. (1977). The modification of tension headache pain using EMG biofeedback.Behav. Res. Ther. 15: 119–129.

    Google Scholar 

  • Philips, C., and Hunter, M. (1981a). The treatment of tension headache. I. Muscular abnormality and biofeedback.Behav. Res. Ther. 19: 485–498.

    Google Scholar 

  • Philips, C., and Hunter, M. (1981b). The treatment of tension headache. II. EMG “normality” and relaxation.Behav. Res. Ther. 19: 499–507.

    Google Scholar 

  • Presby, S. (1978). Overly broad categories obscure important differences between therapies.Am. Psychol. 33: 514–515.

    Google Scholar 

  • Rachman, S. J., and Wilson, G. T. (1980).The Effects of Psychological Therapy, 2nd Ed., Pergamon Press, Oxford.

    Google Scholar 

  • Rosenthal, R. (1983). Assessing the statistical and social importance of the effects of psychotherapy.J. Consult. Clin. Psychol. 51: 4–13.

    Google Scholar 

  • Schultz, J., and Luthe, W. (1959).Autogenic Training: A Psychophysiologic Approach in Psychotherapy, Vol. 1, Grune & Stratton, New York.

    Google Scholar 

  • Simon, J. (1981). Review of “The Benefits of Psychotherapy”.Am. J. Psychiat. 138: 1399–1400.

    Google Scholar 

  • Smith, M. L., Glass, G. V., and Miller, T. I. (1980).The Benefits of Psychotherapy, Johns Hopkins University Press, Baltimore.

    Google Scholar 

  • Strube, M. J., and Hartmann, D. P. (1983). Meta-analysis: Techniques, applications, and functions.J. Consult. Clin. Psychol. 51: 14–27.

    Google Scholar 

  • Tasto, D. L., and Hinkle, J. E. (1973). Muscle relaxation treatment for tension headache.Behav. Res. Ther. 11: 347–349.

    Google Scholar 

  • Teders, S. J., Blanchard, E. B., Andrasik, F., Jurish, S., Neff, D. E., and Arena, J. G. (1984). Relaxation training for tension headache: Comparative efficacy and cost-effectiveness of a minimal therapist contact versus a therapist delivered procedure.Behav. Ther. 15: 59–70.

    Google Scholar 

  • Tsushima, W. T., and Hawk, A. B. (1978). EMG biofeedback treatment of traumatic headaches: A preliminary outcome study.Am. J. Clin. Biofeedback 1: 65–67.

    Google Scholar 

  • Turner, J. A., and Chapman, C. R. (1982). Psychological interventions for chronic pain: A critical review. I. Relaxation training and biofeedback.Pain 12: 1–21.

    Google Scholar 

  • Vaccaro, D., and Feindler, E. (1980). A comparison of cognitive and behavioral control of tension headaches. Paper presented at the meeting of the Association for the Advancement of Behavior Therapy, New York, Nov.

  • VanAllen, P., Murphy, W. D., and Long, C. J. (1982). A comparison of relaxation and cognitive training procedures in the treatment of tension headaches. Paper presented at the meeting of the Association for the Advancement of Behavior Therapy, Los Angeles, Nov.

  • Wickramasekera, I. (1972). Electromyographic feedback training and tension headache: Preliminary observations.Am. J. Clin. Hypnos. 15: 83–85.

    Google Scholar 

  • Wickramasekera, I. (1973). The application of verbal instructions and EMG feedback training to the management of tension headache: Preliminary observations.Headache 13: 74–76.

    Google Scholar 

  • Wieselberg Bell, N., Abramowitz, S. I., Folkins, C. H., Spensley, J., and Hutchinson, G. L. (1983). Biofeedback, brief psychotherapy, and tension headache.Headache 23: 162–173.

    Google Scholar 

  • Williamson, D. A. (1981). Behavioral treatment of migraine and muscle-contraction headaches: Outcome and theoretical explanations. In Hersen, M., Eisler, R., and Miller, P. M. (eds.),Progress in Behavior Modification, Vol. 2, Academic Press, New York.

    Google Scholar 

  • Wilson, G. T., and Rachman, S. J. (1983). Meta-analysis and the evaluation of psychotherapy outcome: Limitations and liabilities.J. Consult. Clin. Psychol. 51: 42–53.

    Google Scholar 

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Preparation of this article was supported in part by National Institute of Mental Health Grant MH37464 to Kenneth A. Holroyd.

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Holroyd, K.A., Penzien, D.B. Client variables and the behavioral treatment of recurrent tension headache: A metaanalytic review. J Behav Med 9, 515–536 (1986). https://doi.org/10.1007/BF00845282

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