One-Day Intervention for Depression and Impairment in Migraine Patients
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 and Migraine Education, will
      result in greater improvements in depressive symptoms and functioning impairment in patients
      with comorbid migraine and depression than a similar one-day group workshop with Migraine
      Education only.
    

Detailed description: 
      Adults with comorbid depression and migraine will be randomized to a 1-day (6-hour) workshop
      of Acceptance and Commitment Training + Migraine Education (ACT-ME) or Migraine Education
      only (MEO). The intervention delivered to both study arms will be identical except for the
      addition of the ACT component delivered in the ACT-ME condition, thereby allowing an estimate
      of the specific additive effect of the psychotherapy. Measures of acceptance and behavioral
      avoidance, theoretically important mechanisms of change, will be used to test intervention
      components by examining whether these processes are uniquely affected by the ACT-ME
      intervention and whether they account for observed treatment effects. The central hypothesis
      is that the ACT-ME treatment will lead to significantly greater reduction in depression
      (HRSD) and disability (WHO-DAS, WHOQOL, and HDI) at follow-up compared to the MEO treatment.
      ACT-ME participants also are expected to demonstrate reductions in behavioral avoidance and
      enhanced acceptance, which mediate treatment effects. Treatment gains are expected to be
      maintained through the 6-month follow-up.

      Aim 1: To examine the efficacy of a 1-day ACT-ME intervention compared to MEO for treating
      depression in patients with comorbid depression and migraine.

      Hypothesis 1: At 3- and 6-month follow-up, ACT-ME will be more efficacious than MEO as
      assessed by: 1) a significantly greater decline on the Hamilton Rating Scale for Depression
      (HRSD) total score; 2) a significantly higher proportion of participants showing 50% or
      greater decline on the HRSD; and 3) a significantly higher proportion of participants no
      longer meeting depression criteria on SCID-IV.

      Aim 2: To examine the efficacy of a 1-day ACT-ME intervention compared to MEO on functioning
      in patients with comorbid depression and migraine.

      Hypothesis 2: At 3- and 6-month follow-up, compared to the MEO group, participants in the
      ACT-ME group will exhibit significantly greater improvement in functioning (measured by World
      Health Organization Disability Assessment Schedule-Total Score; WHO-DAS) and quality of life
      (measured by World Health Organization Quality of Life Total; WHO-QOL), and greater decline
      in headache-related disability (measured by Headache Disability Inventory; HDI).

      Aim 3: To determine whether changes in acceptance-based coping and behavioral avoidance will
      mediate the changes in depressive symptoms and disability.

      Hypothesis 3: Increases in acceptance-based coping and reductions in behavioral avoidance
      will mediate relations between treatment group and 1) decline in depressive symptoms as
      measured by the HRSD and 2) disability, as measured by the WHO-DAS and HDI. Acceptance and
      Behavioral Avoidance will be measured using the Acceptance and Action Questionnaire and
      Chronic Pain Acceptance Questionnaire.
    

Intervention name(s): ACT-ME; Migraine Education Only
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 1 hour discussion about migraine education (ME) and 5 hours of group therapy based on Acceptance and Commitment Therapy (ACT). Migraine education covers topics including migraine symptoms, 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.; 6 hour discussion of migraine education only (MEO). This will involve educating participants about migraine, its natural course, its prodromal symptoms and triggers for symptom worsening, risk for migraine chronification, how to use abortive migraine medications, medication overuse headache, medical and psychological treatments of migraine, migraine comorbidity, and menstrual migraine.
Other intervention name(s): Acceptance and Commitment Training Plus Migraine Education; Illness Management
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Acceptance and Commitment Therapy (ACT); Depression; Illness Management; Behavioral Treatment; Impairment