Psychosomatik der Kopfschmerzen

Headaches are subdivided into primary and secondary headaches according to the classification of the International Headache Society. While primary headaches represent the disease itself, secondary headaches are a manifestation as symptoms of another primary disease. This results in different therapeutic approaches so that secondary headaches are initially treated according to the actual cause of the headache. In contrast primary headaches have no further causes and necessitate fundamentally different treatment in comparison to secondary headaches. The psychosomatics integrate somatic procedures with psychiatric and social processes. This integration forms the basis of the biopsychosocial model which has the great advantage of being able to offer several approaches to psychiatric processes and accomanying alterations. For primary headaches psychotherapeutic strategies and modifications in the social environment of the patient can be applied in addition to medicinal (i.e. biological somatic) treatment procedures, in order to be able to positively influence the underlying disease. This article presents the most important primary headache diseases, migraine and tension-type headache and demonstrates treatment options which can be used in accordance with the biopsychosocial model presented.     

Social problem‐solving,perceived stress,depression and life‐satisfaction in patients suffering from tension type and migraine headaches

This study aimed at investigating social problem solving, perceived stress, depression, and life‐satisfaction in patients with tension type and migraine headaches. Forty‐nine migraine and 42 tension type headache patients (n = 91) consenting to participate were compared to a total of 49 matched healthy control group. Participants filled in a questionnaire consisting self‐report measures of problem solving, perceived stress, depression and life satisfaction. They were also asked about headache duration, frequency, pain severity, psychiatric treatment and sense of control in one's life. T‐tests, chi‐square, analysis of variance, logistic regression analysis and Pearson product moment correlation coefficient procedures were used to analyze the data. Tension type headache patients reported having had more frequent headaches than the migraine patients but migraine patients reported having had more intense pain than the tension type headache patients. Instances of psychiatric treatment were more common among tension type headache patients than the migraine and the control group. Compared to the healthy controls, headache patients displayed a deficiency in problem solving, higher levels of perceived stress and depression. Levels of problem solving skills in headache patients were related inversely to depression, perceived stress and the number of negative life events but problem solving skills of headache patients was related positively to life‐satisfaction. The findings from this study suggested that cognitive behavioral problem solving therapy or training might be a viable option for reducing levels of stress and depression, and to increase life‐satisfaction in patients suffering from primary headache.     

Autogenic Feedback in the Treatment of Two Children with Migraine Headache

Autogenic feedback was used to treat two subjects, ages 12 to 14, suffering form migraine headache. A multiple baseline across subjects design was used to evaluate treatment outcome. Marked improvement was displayed on all three measures of headache activity for both subjects by the end of treatment and was maintained throughout the follow-up period. These results are comparable to those obtained when similar procedures are applied to chronic adult headache sufferers and suggest that continued investigation is warranted.     

Reliability of headache diagnosis

The literature on diagnosis of head pain associated with psychological factors indicates that these diagnoses rely almost exclusively on self-report criteria. The reliability of self-report criteria for diagnosis of headache has not been previously reported. The present study investigated the reliability of headache diagnosis based on the criteria suggested by the Ad Hoc Committee on Classification of Headache. The results indicated modest rater agreement. It was concluded that the headache literature may be confounded by unreliable diagnostic procedures. Improved methods of classifying headache types using self-report, behavioral, and physiological measures during pain-free and headache states are required before adequate reliability of headache classification can be achieved. It is suggested that reliable and valid measurement and classification would eliminate much of the confusion currently existing in the headache literature.     

Reliability and standardization in the assessment of self-reported headache pain

The efficacy of a treatment intervention for head pain is typically evaluated by self-reported data. Self-monitoring schedules used to collect these data vary extensively across studies. The present article reviews conceptual and methodological problems with these self-report inventories. In addition, the most promising procedure was implemented in a study designed to measure the reliability of self-reported headache pain levels. One-hundred twenty-four college students self-monitored headache pain over an 8-week period. Three objective procedures were used to detect inaccurate recording. Subjects were also asked, in a post-experimental questionnaire, to subjectively rate the degree to which they complied with the experimenters' instructions regarding the self-monitoring procedures. Forty percent of the subjects were found to be noncompliant based on the detection techniques. However, responses to the postexperimental questionnaire indicated this to be a conservative estimation of noncompliance. There was no consistent difference between the postexperimental questionnaire for the subjects detected and those not detected. Results are discussed with relation to the need for researchers to adopt a standard methodology for (1) measuring self-reported headache pain and (2) reporting reliability data.Portions of these data were presented at the meeting of the Association for Advancement of Behavior Therapy, Chicago, November 1978.     

The relationship between frontalis muscle activity and self-reports of headache pain

The relationship between levels of frontalis muscle activity and self-reports of pain was evaluated in two studies. In Study I frontalis muscle activity and self-reports of pain collected during biofeedback treatment of muscular contraction headache clients were correlated. In Study II frontalis EMG activity was increased and decreased using biofeedback techniques while concurrent reports of headache pain were recorded. The results of Study I indicated a significant relationship between EMG activity and reported headache pain for only two of the five subjects studied. The biofeedback procedures in Study II were associated with reliable increases and decreases in EMG activity. Concordance between EMG and pain reports occurred only during the EMG increase condition. Overall correlations were significant for one of the 2 subjects. The results suggest that EMG activity may not be sufficient to account for pain reports in all chronic headache clients, and variables other than EMG activity may be influencing reports of pain in some patients.     

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Abstract

EMG-biofeedback assisted relaxation training was used in the treatment of tension headache. Two groups of subjects were treated with either a “standard biofeedback” method, or a “biofeedback with generalization training” method. The latter included procedures which were aimed at maximizing voluntary control of frontal muscle activity in the absence of external feedback, as well as the ability to use the self-regulation skills in every-day life. The results indicated that only the “standard biofeedback” group showed evidence of increased relaxation abilities. However, these greater achievements were not accompanied by comparable superiority regarding headache decreases. These results are discussed and some hypothetical explanations are put forward.     

SOCIAL VALIDATION: THE EVOLUTION OF STANDARDS OF COMPETENCY FOR TARGET BEHAVIORS

The use of social validation procedures has become widespread in recent years. Although most researchers have used social validation procedures to select target behaviors and to evaluate whether the changes produced by a treatment program should be considered socially useful, little attention has been focused upon using the social validation process to determine the optimal levels for target behaviors. This paper suggests several ways in which social validation procedures can be employed in order to select when and how much to change target behaviors.     

Greeting skills: A systematic review of the literature

Individuals with disabilities often demonstrate difficulty in social communication skills such as greetings. Studies have shown that deficits in greetings may negatively affect social interactions and vocational opportunities. Therefore, previous research has evaluated a variety of teaching procedures to increase greetings for individuals with disabilities with varying efficacy. This review of the literature provides an overview of studies to date in which greetings were taught to individuals with intellectual disabilities. A variety of teaching procedures were identified, and implications of those procedures are discussed. Results suggest that multiple teaching procedures may be effective; however, component analyses, further replication, and modified generalization procedures are necessary. Implications for future researchers include identifying a technological definition of greetings and evaluating effective teaching procedures and generalization strategies. Implications for practitioners include teaching one greeting type at a time, limiting the number of social skills taught simultaneously, identification of effective teaching procedures and generalization considerations.     

If Empowerment Is the Goal...: Affirmative Action and social Interaction

The goal of affirmative action policies is to empower formerly disenfranchised groups. But what if the procedures used to implement these policies activate a set of social psychological processes that prevent the occurrence of productive social interactions between target-group and non-target-group members? With that question in mind, a conceptual model is developed which focuses on the potential effects of affirmative action procedures on social interactions between members of policy target and nontarget groups. To conceptualize these potential effects of procedures, the concept of a policy schema is introduced. Special attention is paid to the conditions under which beliefs about procedures contained in policy schemas will influence patterns of interactions between target-group and non-target-group members. With that as background, a call is made for more complete analyses of the social psychology of affirmative action.     

Cognitive-behavioral therapy versus temporal pulse amplitude biofeedback training for recurrent headache

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.     

DIFFERENTIAL RESPONSE PATTERNS TO THE CONTROL CONDITION BETWEEN TWO PROCEDURES TO ASSESS SOCIAL REINFORCERS FOR CHILDREN WITH AUTISM

Historically, reinforcer assessment procedures focus primarily on identifying nonsocial reinforcers (e.g., tangibles and edibles). Far less empirical attention has been allocated to the systematic identification of social consequences that function as reinforcers. This discrepancy is problematic given that social consequences are commonly incorporated into behavioral treatment programs without systematic evaluation of their efficacy. In this study, two methodologies (a single operant and a concurrent choice) were used to assess social reinforcers for children with autism. Results highlighted differences in response allocation to the control condition between procedures. Specifically, responding occurred in the control condition of the single‐operant procedure but not in the concurrent‐operant procedure. These differences highlight the need for further evaluation of procedures to assess social reinforcers. Copyright © 2013 John Wiley & Sons, Ltd.     

The roles of self‐discrepancy and social support in young females' decisions to undergo cosmetic procedures

• Advertising appeals emphasizing unrealistic body images are increasingly linked to depression, loss of self‐esteem, and unhealthy eating habits. Understanding the motivation of young and vulnerable populations to undergo cosmetic procedures can help modify marketing and public policy practices. Using a multidisciplinary approach, this paper confirms the motivating role of self‐concept discrepancy in young women seeking cosmetic procedures. It also reveals conflicting moderating influences of different types of social support on the relationship between self‐discrepancy and choice of cosmetic procedures. Our findings show that family‐based social support attenuates the effect of perceived actual‐ideal self‐discrepancy on the choice of cosmetic procedures, while social support from friends amplifies this effect. Actual‐ought discrepancy appears to negatively affect the propensity for cosmetic procedures. Discussion of the findings and implications for public policy and marketing managers are presented.

Copyright © 2009 John Wiley & Sons, Ltd.     

Social skills: A review of cognitive-behavioral training procedures with children

Thirty-one studies utilizing cognitive-behavioral procedures to train social skills were reviewed. The review was organized around six methodological issues: (a) age of subjects; (b) training procedures; (c) outcome measures; (d) research design; (e) evidence for generalization; and (f) social validation. Suggestions for future applied research are discussed, such as investigations regarding developmental changes in socially skilled behavior, increased use of multiple dependent measures, more intensive programming for generalization, and the establishment of the social importance of the effects of social skills training programs.     

Parents' Empathic Responses and Pain and Distress in Pediatric Patients

We investigated the relationship between parents' empathic responses prior to their children undergoing cancer treatment procedures and children's pain/distress during the procedures. We hypothesized: (1) parents' empathic distress would be positively associated with children's pain/distress, (2) parents' empathic concern would be negatively associated with children's pain/distress; and (3) parents' enduring dispositions and social support would be associated with their empathic responses. Parents completed: (1) measures of dispositions and perceived social support several weeks before their children underwent the procedures, and (2) state measures of empathic distress and empathic concern just before the procedures. Empathic distress was positively associated with children's pain; empathic concern was negatively associated with children's pain/distress. Predictions about dispositions and social support were also substantially confirmed.     

AN EXPERIMENTAL ANALYSIS OF “SPILLOVER” EFFECTS ON THE SOCIAL INTERACTION OF BEHAVIORALLY HANDICAPPED PRESCHOOL CHILDRENsp1

The effects of prompting and social reinforcement directed to target subjects on their social behavior and that of peers who never received prompting and reinforcement for positive social behavior, were examined. In a combined reversal and multiple-baseline design, three behaviorally handicapped preschool boys who exhibited divergent social behavior repertoires and varied histories with social reinforcement events, were sequentially exposed to intervention conditions in order to investigate “spillover” of treatment effects. Prompting and reinforcement increased positive social behavior and decreased negative social behavior emitted by all target subjects. The results also demonstrated a “spillover” effect on two target subjects, who at various times were not under intervention, and on the peers as well. The findings suggest that: (a) the direct and indirect effects of intervention procedures may be enhanced by designing treatment based on the social repertoire and reinforcement histories of the subjects; and (b) the treatment “spillover” effect may be increased by applying procedures to two children at once, rather than to one at a time.     

Assessing the social acceptability of the functional analysis of problem behavior

Although the clinical utility of the functional analysis is well established, its social acceptability has received minimal attention. The current study assessed the social acceptability of functional analysis procedures among 10 parents and 3 teachers of children who had recently received functional analyses. Participants completed a 9-item questionnaire, and results suggested that functional analysis procedures were socially acceptable.     

Making social psychology experimental: a conceptual history, 1920-1970

The historical emergence of a field devoted to the experimental investigation of effects identified as "social" required a radical break with traditional conceptions of the social. Psychological experimentation was limited to the investigation of effects that were proximal, local, short-term, and decomposable. A viable accommodation to these constraints occurred in the closely related programs of Moede's experimental crowd psychology and Floyd Allport's experimental social psychology. Later, Kurt Lewin attempted to provide a different conceptual foundation for the field by drawing on certain precepts of Gestalt psychology and the philosophy of scientific experimentation developed by Ernst Cassirer. These ideas were poorly understood and were soon replaced by a methodological regime in which a new generation of statistical procedures and experimental design shaped implicit conceptions of the social in social psychological experiments through such procedures as randomization and the additive combination of variables.     

The Headache Symptom Questionnaire: Discriminant classificatory ability and headache syndromes suggested by a factor analysis

A brief Headache Symptom Questionnaire was administered to 129 chronic headache Sufferers. The questionnaire accurately classified 68.42% of headache subjects in their proper diagnostic category, comparable to, but statistically less accurate than, the 86.4% agreement between expert headache diagnosticians using clinical interviews. Results of a factor analysis of the Headache Symptom Questionnaire lend support for their being two commonly accepted global headache categories—vascular/migraine and muscle contraction—and one headache dimension concerned with duration of headache pain. Combined migraine-muscle contraction headache was found to be related more to migraine than to muscle contraction headache, and cluster headaches emerged as a separate clinical entity, not loading positively on any factor and loading negatively on all three.This research was supported in part by Grant NS-15235 from the National Institute of Neurological and Communicative Disorders and Stroke.