Vasiliou, 2017

The main behavioral treatment suggestion for headache management is the prevention of headaches via avoidance of external and internal headache triggers. Despite the wide use of avoidance in headache management, very little empirical evidence exists to support its effectiveness. Attempts at avoiding headache triggers or other internal private experiences associated with headaches, may increase trigger potency, restrict lifestyle, decrease internal locus of control, and exacerbate and maintain pain perception. New treatment approaches, such as Acceptance and Commitment Therapy (ACT), emphasize acceptance and valued-living as alternatives to avoidance. Though APA characterizes ACT as an empirically supported treatment for chronic pain, there is limited evidence for its effectiveness for headache disorders. The purpose of the present study was threefold. First, it aimed to critically evaluate the detrimental role of avoidance when dealing with head pain, and then proposed the ACT approach as an alternative to the avoidance and control of pain agenda. Second, it examined in a Randomized Controlled Trial (RCT) how an ACT-based intervention for headache sufferers decreases disability and improves quality of life, compared to a Wait List Control group (WL). Finally, it sought to examine the mechanism of ACT treatment on headache-related disability and quality of life outcomes, through ACT-theoretically-based mediators (e.g., pain acceptance, psychological inflexibility in pain, committed actions, values progress and obstruction, and mindfulness). 94 headache sufferers were randomized to either receive ACT or be in a waitlist control condition. Headache-related disability and quality of life (primary outcomes); headache severity, medical utilization and psychological distress (secondary outcomes); and ACT process measures (e.g., assessing acceptance, defusion, values, mindfulness etc.) were assessed before-treatment, at treatment-end, and at 3 and 6-month follow-ups. Results demonstrated substantial improvement in favor of ACT compared to the WL group on primary outcomes. No significant group by time differences was observed for secondary outcomes, except for depression, where ACT demonstrated significant reductions when compared to the control. When 6-month follow-up assessments were examined, ACT resulted in significant effects of time for disability, quality of life, pain severity, frequency of medical utilization, and depression. Also, the ACT group, when compared to the control group presented improvements in several ACT processes (e.g., pain acceptance, avoidance of pain, cognitive fusion, and value obstructions) at treatment-end, and at 3-month follow-up. Further, mediation analyses using a non-parametric cross product of the coefficient approach demonstrated that pain acceptance, psychological inflexibility in pain, avoidance of pain, and values progress were found to all mediate the effects of treatment on headache disability and quality of life at 3, and 6-month follow-up. Findings from this study offer new evidence for the utility and efficacy of ACT in the management of primary headaches. Also, findings provide evidence that the ACT approach indeed works via its proposed mechanisms of action. Collectively, this study has practical and translational value and suggests the use of ACT for the management of headaches.