Brief Behavioral Intervention for Comorbid Migraine and Depression
Condition: Migraine; Depression
MeSH terms: Migraine Disorders; Depression; Depressive Disorder
Study type: Interventional

Summary: 
      The purpose of this research study is to examine whether a one-day group workshop,
      integrating principles from Acceptance and Commitment Therapy with Migraine Education, will
      result in improvements in depressive symptoms and functioning impairment in patients with
      comorbid migraine and depression.
    

Detailed description: 
      Migraine affects approximately 35 million US residents (Bigal & Lipton, 2009) and is
      associated with excruciating headache and marked functional impairment. Epidemiological and
      clinical research has shown that people with migraine suffer from psychiatric disorders at a
      disproportionately higher rate than individuals without. Depression, in particular, is 3-5
      times more common in migraine patients than in non-migraineurs. The comorbidity of depression
      and migraine is a major health concern as it results in poorer prognosis, remission rate, and
      response to treatment. In addition, an increase in the severity of migraine is associated
      with a parallel rise in the severity and treatment resistance of comorbid depression.

      Recent research in behavioral medicine suggests that the pain experience per se does not
      necessarily lead to depression or impairment. Instead, it is the preoccupation with avoiding
      aversive stimuli associated with pain (i.e., activities, places, movements) that results in
      depression and disability (e.g., McCracken et al., 2005). Therefore, given that patients with
      migraine and/or depression exhibit more avoidance behaviors and lower activity levels than
      healthy controls (e.g., Stronks et al., 2004), an intervention aimed at optimizing
      willingness and acceptance and minimizing behavioral avoidance may be beneficial at improving
      both their depression and migraine and, consequently, their daily functioning.

      Acceptance and Commitment Therapy (ACT) is an empirically based behavioral therapy that
      incorporates acceptance and mindfulness strategies with behavioral change strategies. ACT (in
      group and in individual settings) is effective in treating psychiatric disorders commonly
      associated with migraine, including depression, anxiety, and stress (e.g., Hayes, 2001) as
      well as chronic illnesses like pain and diabetes (Dahl et al, 2004; Gregg et al., 2006).
      Importantly, ACT resulted in positive long-term outcomes even when presented in brief form.
      For example, a two-day ACT workshop, in a group setting, led to improvements in depression
      and distress experienced by parents of children diagnosed with autism and these gains were
      retained 3 months later. Parents also exhibited a reduction in avoidance behaviors
      (Blackledge & Hayes, 2006).
    

Intervention name(s): ACT-IM
Intervention type(s): Behavioral
Intervention description(s): 1 hour discussion about migraine management (IM) and 5 hours of group therapy based on Acceptance and Commitment Therapy (ACT). IM covers symptoms and triggers for worsening of migraine symptoms, how to use migraine medications, medication overuse headache, etc. The ACT intervention includes: 1) Behavioral Change Training and; 2) Mindfulness and Acceptance Training emphasizing new ways of managing troubling thoughts, feelings, and physical sensations.
Other intervention name(s): Acceptance and Commitment Therapy; Illness Management
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Acceptance and Commitment Therapy (ACT); Depression; Illness Management; Behavioral treatment; Impairment