Emotional Awareness and Expression Therapy (EAET) for Migraine
Study Details
Study Description
Brief Summary
The goal of this feasibility study is to test the effect of a new behavioral intervention, Emotional Awareness and Expression Therapy (EAET), as a possible new treatment for people living with migraine.
The main questions it aims to answer are:
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Can EAET lower the frequency and severity of migraine attacks?
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What are the elements that can explain EAET's effect?
Requirements from Participants:
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Participants will engage in 8 weekly online sessions via zoom (sessions are 2 hours long). Each session has a lecture, in-class exercises, discussion, and weekly assignments.
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Each participant is required to fill out questionnaires before the first session, after the last session of the treatment, and at a 3-month follow-up after treatment.
Participants will benefit from a new and promising intervention that can significantly help with their migraines at no cost.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Migraine is a debilitating disorder that affects many people worldwide. Despite the new migraine medications and the recommended complementary interventions for migraine, most people living with migraine are not migraine-free and continue to experience debilitating headaches. Chronic stress and past traumatic experiences are known to contribute to the development of migraine and to the transition from episodic to chronic migraine. Although current behavioral interventions focus on "calming down" the body and mind, a different approach is to help individuals identify and express difficult emotions, release emotionally difficult experiences, and acquire new skills to help manage interpersonal relationships. Emotional Awareness and Expression Therapy (EAET) is a new intervention that focuses on this approach and has shown promising results in patients with different chronic pain conditions. In this research, the investigators will test how effective EAET is in people living with migraine.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Emotional Awareness and Expression Therapy (EAET) In this experimental arm, participants are required to attend 8 online sessions, and fill out questionnaires before treatment, immediately after treatment, and at a 3-month follow-up. |
Behavioral: Emotional Awareness and Expression Therapy
Each EAET session will use an educational lecture, discussion, in-class experiential exercises, and homework assignments. During sessions, participants will be encouraged to identify their stressors and experience and express their avoided or suppressed emotions, using exercises such as emotional disclosure, role playing, and the "empty chair" technique. Participants will be given homework assignments to complete between sessions, including expressive writing, identification of stressors and avoided emotions, and healthy communication skills practice. The planned topics of the EAET sessions include the emotions-stress-pain model, expressing and experiencing emotions (anger, sadness, hurt, etc.), letting go/forgiveness of self and others, and healthy communication, including assertiveness and intimacy.
|
Outcome Measures
Primary Outcome Measures
- Number of migraine days in a month at baseline. [1 month before the treatment.]
Headache diary self report measure. Participants will record their migraine frequency on a daily basis for 1 month.
- Change in the number of migraine days in a month after treatment compared to baseline. [8 weeks after commencement of treatment.]
Participants will record their migraine frequency on a daily basis for 1 month immediately after treatment. A change in a number of migraine days will be evaluated by comparing migraine frequency after the intervention to baseline. A lower number of migraine days in a month after treatment will indicate the effectiveness of the treatment in reducing migraine frequency.
Secondary Outcome Measures
- Migraine effects on quality of life at baseline. [1 week before the treatment.]
Quality of life will be evaluated using the Migraine Specific Quality of Life (MSQL) questionnaire. The minimum value is 14, and the maximum value is 84. A higher total value indicates a better quality of life.
- Change in migraine effects on quality of life after treatment compared to baseline. [8 weeks after commencement of treatment.]
Changes in migraine-specific quality of life will be evaluated by comparing the MSQL scores after the treatment to baseline. A higher score after treatment will indicate the effectiveness of treatment in increasing quality of life.
- Change in migraine effects on quality of life at 3 month followup compared to baseline. [3 months after the end of the treatment.]
Changes in migraine-specific quality of life will be evaluated by comparing the MSQL scores at a 3-month follow-up to baseline. A higher score in the 3-month follow-up will indicate the long-term effectiveness of treatment in increasing quality of life.
- Allodynia levels at baseline. [1 week before the treatment.]
Allodynia will be evaluated using the allodynia questionnaire. The minimum value is 0 and the maximum value is 24. Values 0-2 indicate no allodynia, 3-5 mild allodynia, 6-8 moderate allodynia, and 9 or higher: severe allodynia.
- Change in allodynia after treatment compared to baseline. [8 weeks after commencement of treatment.]
A change in the allodynia score will be evaluated by comparing the allodynia questionnaire score after treatment to baseline. A lower allodynia score after treatment will indicate the effectiveness of treatment in reducing symptoms of allodynia.
- Change in allodynia at 3 months followup compared to baseline. [At 3 months followup after the end of treatment.]
A change in allodynia score will be evaluated by comparing the allodynia questionnaire score at 3 months follow-up to baseline. A lower allodynia score at follow-up will indicate a long-term effectiveness of treatment in reducing symptoms of allodynia.
- Anxiety levels at baseline. [1 week before treatment]
Anxiety will be measured using the Patient Reported Outcome Measurement Information System (PROMIS) short anxiety questionnaire. The minimum value is 8 and the maximum value is 40. A higher score on this test indicates higher levels of anxiety.
- Change in anxiety levels after treatment compared to baseline. [8 weeks after commencement of treatment.]
A change in anxiety will be evaluated by comparing the PROMIS anxiety questionnaire score after treatment to baseline. A lower anxiety score after treatment will indicate the effectiveness of treatment in reducing anxiety.
- Change in anxiety levels at 3 months followup compared to baseline. [At 3 months followup from the end of treatment.]
A change in the anxiety will be evaluated by comparing the PROMIS anxiety questionnaire score at three months follow-up to baseline. A lower anxiety score at follow-up will indicate the long-term effectiveness of treatment in reducing anxiety.
- Depression levels at baseline. [1 week before treatment.]
Depression will be measured using the Patient Reported Outcome Measurement Information System (PROMIS) short depression questionnaire. The minimum score is 8 and the maximum score is 40. A higher score indicates a higher level of depression.
- Change in depression after treatment compared to baseline. [8 weeks after commencement of treatment.]
A Change in depression score will be evaluated by comparing the PROMIS depression questionnaire score after treatment vs. baseline. A lower score will indicate the effectiveness of treatment in relieving depression.
- Change in depression at three months followup compared to baseline. [At 3 months followup after end of treatment.]
A Change in depression score will be evaluated by comparing the PROMIS depression questionnaire score at follow-up vs. baseline. A lower score will indicate the long-term effectiveness of treatment in relieving depression.
- Emotional coping at baseline. [1 week before treatment.]
Emotional coping will be measured using the Emotional Approach Coping scale 8 (EAC-8). The minimum score is 8 and the maximum score is 32. A higher score indicates a higher emotional coping ability.
- Change in emotional coping after treatment compared to baseline. [8 weeks after commencement of treatment.]
A change in emotional coping will be evaluated by comparing the EAC-8 score after treatment vs. baseline. A higher score after treatment indicates the effectiveness of the treatment in increasing emotional coping ability.
- Change in emotional coping at three months followup compared to baseline. [At three months followup after end of treatment]
A change in emotional coping will be evaluated by comparing the EAC-8 score at follow-up compared to baseline. A higher score at followup indicates the long-term effectiveness of the treatment in increasing emotional coping ability.
- Positive and negative affect at baseline [1 week before treatment.]
The positive and negative affect will be measured using the Positive and Negative Affect Schedule (PANAS) questionnaire. Both the positive and negative affect can have a minimum score of 10 and a maximum score of 50 independently. A higher score in either measure will indicate higher levels of positive or negative affect respectively.
- Changes in positive/negative affect at the end of treatment compared to baseline [8 weeks after commencement of treatment.]
A change in positive and negative affect will be evaluated by comparing the PANAS questionnaire scores of both affects after treatment to baseline. A higher score in positive affect and a lower score in negative affect after treatment will indicate the effectiveness of treatment in improving positive affect while reducing negative affect.
- Changes in positive/negative affect at 3-months followup compared to baseline. [At 3 months followup after treatment.]
A positive and negative affect change will be evaluated by comparing the PANAS questionnaire scores of both affects at followup to baseline. A higher score in positive affect and a lower score in negative affect at follow-up will indicate the long-term effectiveness of treatment in improving positive affect while reducing negative affect.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Adults of all genders, ages 18-80.
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A diagnosis of either episodic or chronic migraine (with or without aura) by a licensed neurologist.
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A migraine disability assessment scores higher than 6.
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A stable medication regimen for a minimum of 3 months.
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Must have had migraines for at least 1 year.
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Must have a minimum of 4 migraine days per month.
Exclusion Criteria:
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Serious psychiatric disorders (e.g., schizophrenia or bipolar disorder) uncontrolled with medications.
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Active suicidal ideation.
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Risk of violent behavior.
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Untreated alcohol or substance use disorder.
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Substantial cognitive impairment.
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A diagnosis of medication overuse headaches.
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Changes in migraine medication in the past 3 months.
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Enrollment in another treatment study.
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Current involvement in health-related litigation or disability application.
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Inability to use a computer and/or smartphone.
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limited access to the internet.
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Inability to communicate in English.
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Failure to complete at least 80% of the daily diaries during the baseline 30-day diary assessment.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Dan Kaufmann | Salt Lake City | Utah | United States | 84117 |
Sponsors and Collaborators
- University of Utah
- Wayne State University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Lumley MA, Schubiner H, Lockhart NA, Kidwell KM, Harte SE, Clauw DJ, Williams DA. Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain. 2017 Dec;158(12):2354-2363. doi: 10.1097/j.pain.0000000000001036.
- Yarns BC, Lumley MA, Cassidy JT, Steers WN, Osato S, Schubiner H, Sultzer DL. Emotional Awareness and Expression Therapy Achieves Greater Pain Reduction than Cognitive Behavioral Therapy in Older Adults with Chronic Musculoskeletal Pain: A Preliminary Randomized Comparison Trial. Pain Med. 2020 Nov 1;21(11):2811-2822. doi: 10.1093/pm/pnaa145.
- IRB_00163370