Nabity Paul S, Reed David E, McGeary Cindy A, Houle Timothy T, Jaramillo Carlos A, Resick Patricia A, Eapen Blessen C, Litz Brett T, Mintz Jim, Penzien Donald B, Keane Terence M, Young-McCaughan Stacey, Peterson Alan L, McGeary Donald D
Department of Psychiatry and Behavioral Sciences, University of Texas Health Science at San Antonio, San Antonio, Texas, USA.
Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA.
Headache. 2023 Mar;63(3):410-417. doi: 10.1111/head.14480. Epub 2023 Mar 10.
To explore whether the association between change in headache management self-efficacy and posttraumatic headache-related disability is partially mediated by a change in anxiety symptom severity.
Many cognitive-behavioral therapy treatments for headache emphasize stress management, which includes anxiety management strategies; however, little is currently known about mechanisms of change in posttraumatic headache-related disability. Increasing our understanding of mechanisms could lead to improvements in treatments for these debilitating headaches.
This study is a secondary analysis of veterans (N = 193) recruited to participate in a randomized clinical trial of cognitive-behavioral therapy, cognitive processing therapy, or treatment as usual for persistent posttraumatic headache. The direct relationship between headache management self-efficacy and headache-related disability, along with partial mediation through change in anxiety symptoms was tested.
The mediated latent change direct, mediated, and total pathways were statistically significant. The path analysis supported a significant direct pathway between headache management self-efficacy and headache-related disability (b = -0.45, p < 0.001; 95% confidence interval [CI: -0.58, -0.33]). The total effect of change of headache management self-efficacy scores on change in Headache Impact Test-6 scores was significant with a moderate-to-strong effect (b = -0.57, p = 0.001; 95% CI [-0.73, -0.41]). There was also an indirect effect through anxiety symptom severity change (b = -0.12, p = 0.003; 95% CI [-0.20, -0.04]).
In this study, most of the improvements in headache-related disability were related to increased headache management self-efficacy with mediation occurring through change in anxiety. This indicates that headache management self-efficacy is a likely mechanism of change of posttraumatic headache-related disability with decreases in anxiety explaining part of the improvement in headache-related disability.
探讨头痛管理自我效能感的变化与创伤后头痛相关残疾之间的关联是否部分由焦虑症状严重程度的变化介导。
许多针对头痛的认知行为疗法强调压力管理，其中包括焦虑管理策略；然而，目前对于创伤后头痛相关残疾的变化机制知之甚少。增进我们对这些机制的理解可能会改善对这些使人衰弱的头痛的治疗。
本研究是对193名退伍军人的二次分析，这些退伍军人被招募参加一项关于持续性创伤后头痛的认知行为疗法、认知加工疗法或常规治疗的随机临床试验。测试了头痛管理自我效能感与头痛相关残疾之间的直接关系，以及通过焦虑症状变化的部分中介作用。
中介的潜在变化直接、中介和总路径具有统计学意义。路径分析支持头痛管理自我效能感与头痛相关残疾之间存在显著的直接路径（b = -0.45，p < 0.001；95%置信区间[CI：-0.58，-0.33]）。头痛管理自我效能感得分变化对头痛影响测试-6得分变化的总效应显著，效应为中度至强度（b = -0.57，p = 0.001；95% CI [-0.73，-0.41]）。还存在通过焦虑症状严重程度变化的间接效应（b = -0.12，p = 0.003；95% CI [-0.20，-0.04]）。
在本研究中，头痛相关残疾的大部分改善与头痛管理自我效能感的提高有关，且通过焦虑的变化起到中介作用。这表明头痛管理自我效能感可能是创伤后头痛相关残疾变化的一种机制，焦虑的减轻解释了头痛相关残疾改善的部分原因。
