One-day behavioral treatment for patients with comorbid depression and migraine: a pilot study

The efficacy of stress-oriented psychotherapeutic interventions, such as acceptance and commitment therapy and mindfulness, has been shown to be poor.

“the efficacy of stress-oriented psychotherapeutic interventions, such as acceptance and commitment therapy and mindfulness, has been shown to be poor [8–18]”

Brief ACT has yielded positive long-term outcomes in patients with co-morbidity.

“When presented as a brief intervention, ACT has produced positive long-term outcomes in those with co-morbidity [4, 5].”

ACT increased quality of life, levels of functioning, psychological well-being, quality of social relationships, and reduced disability in migraine patients.

“With respect to quality of life, ACT has been shown to increase quality of life [99,103,104], levels of functioning [103], psychological well-being and the quality of social relationships [104], as well as to reduce disability [99,101,103,104].”

Migraine-related symptoms, such as depression and disability, were found to be decreased by ACT.

“Migraine-related symptoms, such as depression and disability, were also found to be decreased by ACT [103].”

ACT seems to reduce affective distress, anxiety, and depression in migraine patients.

“Regarding emotional variables, ACT seems to reduce affective distress [109], as well as levels of anxiety and depression [99,103,104].”

People with chronic medical conditions can benefit from ACT by reducing their stress and improving.

“People with chronic medical conditions can benefit from ACT by reducing their stress and improving [25, 26].”

In a small, uncontrolled pilot trial, 77% of participants in the ACT-ED arm remitted from depression compared to only 8% of those in TAU.

“For example, in a small, uncontrolled pilot trial, patients with co-occurring depression and migraine were assigned to a 1-day ACT plus Education (ACT-ED) group workshop or to Treatment as Usual (TAU). Promising results were found with 77% of the participants in the ACT-ED arm remitting from depression compared to only 8% of those in TAU [12].”

Current evidence on the efficacy of psychological interventions remains limited and unsatisfactory.

“Current evidence on the efficacy of psychological interventions remains limited and unsatisfactory [8–18]”

Qualitative feedback from a majority of participants in the migraine study indicated that the initial appeal of the study was that it was presented as a "workshop" to improve quality of life, rather than as a "therapy", making it nonthreatening or stigmatizing.

“Importantly, qualitative feedback from a majority of the participants indicated that the initial appeal of the study was that it was presented as a “workshop” to improve quality of life, rather than as a “therapy”, making it nonthreatening or stigmatizing.”

Existing Acceptance and Commitment Therapy studies for headache are afflicted with methodological limitations, weakening the evidence for ACT's efficacy.

“However, existing studies are afflicted with methodological limitations, weakening the evidence for ACT's efficacy.”

The intervention's effects improved qualitatively at each follow-up visit, similar to other ACT trials.

“The effects of the intervention qualitatively improved at each follow-up visit akin to other ACT treatment trials [5, 9].”

ACT-ED was more efficacious than TAU for treating depression and disability in migraine patients.

“These results complement those of a previous report showing higher efficacy of ACT-ED than TAU for treating depression and disability in migraine patients [103].”

Antidepressant intake did not moderate the effects of ACT on depression severity at 3-month follow-up in migraine patients.

“Antidepressant intake did not moderate the effects of the treatment on depression severity at the 3-month follow-up [103].”

The ROB evaluation revealed 12 studies of low quality, 5 of moderate quality, and 4 of high quality.

“The ROB evaluation revealed that 12 studies were of low quality [93,94,95,98,101,102,103,105,106,107,108,109], 5 were of moderate quality [91,92,96,103,111], and 4 were high quality [97,99,100,110].”

ACT interventions have been associated with improvements in mental health, medical, and behavioral outcomes, and overall functioning and quality of life.

“ACT interventions have been associated with improvements in mental health, medical, and behavioral outcomes, and overall functioning and quality of life (e.g., [79, 80]).”

In a 1-day ACT-ED intervention for patients with comorbid depression and migraine, participants exhibited significantly greater improvements in depressive symptoms, general functioning, and migraine-related disability at 3 months compared to TAU.

“At the 3-month follow up, participants in the ACT-ED condition exhibited significantly greater improvements in depressive symptoms, general functioning, and migraine-related disability.”

The one-day ACT workshop produced sustained reductions in anxiety on the BAI over 12 weeks, but this effect did not extend to anxiety measured by the STAI.

“Consistent with our previous findings [33, 34], the one-day ACT workshop yielded sustained reductions in anxiety as measured by our primary outcome, the BAI, sustained over 12 weeks [20], although this finding was not robust enough to extend to anxiety as measured by the STAI.”

Most participants in the migraine study admitted that they would not have presented to specialized mental health care.

“Furthermore, most admitted that they would not have presented to specialized mental health care.”

There are also two small RCTs of ACT for headache.

“There are also two small RCTs of ACT for headache. 16,65”