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Behavioral Self-management in an Inpatient Headache Treatment Unit: Increasing Adherence and Relationship to Changes in Affective Distress

Authors

  • F. Hoodin PhD,

    1. From the Head Pain Treatment Unit at Chelsea Community Hospital
    2. Dr. Hoodin and Ms. Wilson are also affiliated with Eastern Michigan University, Ypsilanti
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  • B.J. Brines PhD,

    1. From the Head Pain Treatment Unit at Chelsea Community Hospital
    2. Dr. Brines with the University of Michigan Medical Center, Ann Arbor
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  • A.E. Lake III PhD,

    1. From the Head Pain Treatment Unit at Chelsea Community Hospital
    2. Drs. Lake and Saper with the Michigan Head Pain and Neurological Institute, Ann Arbor
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  • J. Wilson MS,

    1. From the Head Pain Treatment Unit at Chelsea Community Hospital
    2. Dr. Hoodin and Ms. Wilson are also affiliated with Eastern Michigan University, Ypsilanti
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  • J.R. Saper MD, FACP

    1. From the Head Pain Treatment Unit at Chelsea Community Hospital
    2. Drs. Lake and Saper with the Michigan Head Pain and Neurological Institute, Ann Arbor
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Address all correspondence to Dr. F. Hoodin, Department of Psychology, Eastern Michigan University, 537 Mark Jefferson Hall, Ypsilanti, MI 48197.

Abstract

Objective.–To evaluate prospectively the contribution of a psychological self-management program to the amelioration of headache-related distress of patients with intractable migraine treated in a comprehensive, multidisciplinary, inpatient program.

Background.–Previous research has shown the effectiveness of this overall inpatient program but did not examine the relationships between the use of relaxation and other headache-related behavioral factors.

Methods.–Data from 221 admissions to a Commission on Accreditation of Rehabilitation Facilities-accredited, nationally recognized, inpatient treatment unit were analyzed for the current study. On admission and on discharge (average length of stay, 12.9 days), subjects completed a 7-day retrospective, self-report questionnaire assessing health behavior compliance and emotional factors. The intervention consisted of intensive medical therapy in addition to cognitive-behavioral treatment delivered in a group setting.

Results.–Adherence increased significantly for relaxation practice and life-style modifications of diet, exercise, and sleep regulation for headache prevention (P<.00001). Beck Depression Inventory scores decreased significantly (P<.00001), and a greater decrease in depression by the end of the program was reported by subjects who practiced relaxation most compared with those who practiced relaxation least.

Conclusions.–Low baseline adherence rates for health behavior increased significantly during the final week of inpatient treatment. Behavioral self-management variables, not headache reduction, were significantly associated with patients' reduction in affective distress.

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