Effectiveness of Acceptance and Commitment Therapy in cognitive emotion regulation strategies, headache-related disability, and headache intensity in patients with chronic daily headache

Background: Chronic daily headache is a serious disease, causing significant problems such as disability. It is characterized by pain localized to the head (headache) and headaches occurring on 15 or more days per month for more than 3 months (> 180 days per year). Programs for pain and health improvement in patients with painful diseases, such as headache, are not still fully developed. Acceptance and commitment therapy (ACT) is a new psychotherapy, which appears to be effective in the treatment of chronic pain.

Objectives: This study aimed to examine the effectiveness of ACT in cognitive emotion regulation strategies, headache-related disability, and headache intensity in patients with chronic daily headaches.

Methods: In the current study, a semi-experimental method was applied. The study was conducted at Shahid Beheshti Governmental hospital of Kashan, Iran in 2016. The sample consisted of 40 patients with chronic daily headache, who were selected via convenience sampling. The participants were randomly allocated into medical treatment as usual (MTAU) and ACT groups (20 samples per group) via block randomization. The ACT group received eight 90-minute weekly treatments, based on the ACT protocol. The cognitive emotion regulation questionnaire (CERQ), diary of headache severity, and headache-related disability inventory (HDI) were administered at pretreatment, posttreatment, and three-month follow-up in both groups.

Results: In the current study, no significant differences were found between the groups in terms of demographic variables (P >0.05). In the ACT group, the mean (SD) scores of emotional and functional aspects of headache disability were 26.87 ± 10.11 and 28.50 ± 9.04, respectively before the intervention, which decreased to 17.75 ± 8.32 and 18.12 ± 9.42 after the intervention and 21.37 ±8.53 and 21.37 ± 9.87 in the follow-up, respectively (P < 0.05). In addition, the mean (SD) score of nonadjustment cognitive emotion regulation strategies was 54.31 ± 10.02 at pretreatment, which significantly reduced to 44.43 ± 7.7 at posttreatment and 49.78 ± 9.1 in the follow-up (P < 0.05). Furthermore, the mean (SD) score of adjustment cognitive emotion regulation strategies was 61.43± 12.02 in the pretest, which significantly increased to 72.06 ± 8.66 in the posttest and 69.62 ± 11.84 in the follow-up (P < 0.05). The mean score of headache intensity decreased from 6.40 ± 1.19 to 5.00 ± 1.09, compared to the pretest (P < 0.05); however, there was

no significant difference between the groups in the follow-up (P > 0.05).

Conclusions: The results of the present study suggested that ACT is an effective treatment for reducing nonadjustment cognitive emotion regulation strategies, headache-related disability, and headache intensity and improving adjustment emotion regulation strategies in patients with chronic daily headache.