The Role of Acceptance in Appraisal and Coping with Migraine Headaches

William H. O'Brien, Advisor Acceptance and chronic pain is an emerging topic both for research and intervention. Initial studies have demonstrated acceptance is correlated with higher quality of daily emotional, social, and physical functioning in various chronic pain populations. The purpose of the present study was to clarify the nature of the relationship between acceptance, appraisals that are common and relevant in chronic pain populations (i.e., control and catastrophizing), and coping among migraine headache sufferers, and to determine whether the relationships conform to the same pattern observed in other chronic pain populations. Seventy four participants with migraine headaches completed self report measures assessing appraisal, coping strategies, acceptance, and pain related disability. Sixty three participants also completed a 28-day daily dairy assessing headache activity, catastrophizing, control, acceptance, and coping strategies. Hierarchical regression and multilevel modeling were used to examine the relations between these variables. Overall, results indicate acceptance is a relevant construct in the experience of migraine pain. Higher levels of pain-related acceptance were associated with lower levels of catastrophizing and pain-related interference, and increased perceived control. Participants who endorsed higher levels of pain related acceptance reported engaging in a higher level of activity overall, and indicated they use fewer coping strategies. Though many of the primary hypotheses had partial support, it is clear that a different pattern of relationships was observed between acceptance, coping, and appraisal among migraine headache sufferers. Unlike previous studies with other chronic pain populations, pain severity was significantly related to many of the constructs tested. This could have important implications in developing appropriate acceptanceAppraisal, coping, and migraine iii based treatment with headache sufferers. This highlights the importance of replicating and extending research with new populations. Acceptance continues to show promise as a way of viewing pain that lessens the detrimental impact of certain types of thoughts (i.e., catastrophizing), and leads to increased participation in daily life. Appraisal, coping, and migraine iv I dedicate this to my best friend, my life partner, and my soul mate, Paul. Appraisal, coping, and migraine v ACKNOWLEDGMENTS Though much of the day to day work in dissertation is solitary, the successful completion requires the involvement, support, and encouragement of many. I appreciate the guidance given and expertise shared by the members of my dissertation committee; Robert Carels, Dara MusherEizenman, and Judy Adams. The committee’s enthusiastic contributions to this project strengthened the final product, and I was honored to have their involvement. I would also like to thank Richard Rowlands of the Bowling Green State University Human Subjects Review Board for his assistance and high level of responsiveness to my numerous questions about modifying the research protocol for online survey methodology. This project would have been so much less without the help of my dissertation advisor and mentor, William H. O’Brien. His example of what it is to be a clinical psychologist, a research-practitioner, a mentor, and a teacher, has played an important role in shaping my professional identity. I greatly appreciate his patience, consistent encouragement, and steadfast belief in me as well as my work. I am so thankful for the many supportive, loving, and forgiving friends old and new who helped me along the way. Special thanks to Monica Day, Le Reamer, Erin Foster, Lisa HoffmanKonn, Zoe Peterson, Melissa Boyer, Vanessa Williams, Cynthia Cutshall, and Maureen Kennedy. I am also so grateful for the untiring support and care of my parents, John and Carol Chiros. Finally, I give special thanks to my new friends in the Phinished.org community, who helped me power through my work from data collection to defense. Appraisal, coping, and migraine vi TABLE OF CONTENTS CHAPTER