In collaboration with Payame Noor University and Iranian Health Psychology Association

Document Type : Scientific Research

Authors

1 M.A, Department of General Psychology, Payame Noor University, Pakdasht Center, Tehran, Iran

2 Associate Professor, Department of Counseling and Educational Psychology, Payame Noor University, Tehran, Iran

Abstract

Objective: The purpose of this study was to determine the effectiveness of stress management training based on cognitive-behavioral approach on reducing emotional problems, sleep quality and intensity of pain experience in women with chronic tension headaches. Method: According to the random assignment of subjects and control comparison group, the research method is semi-experimental. The statistical population included all female clients suffering from chronic tension headaches to the specialized pain clinic of Khatam Al Anbia Hospital in Tehran in 2022, among whom 34 people were selected by convenience sampling and randomly assigned to two groups. 17 people were tested and controlled. In order to collect data, the chronic pain rating questionnaire (Van Kuroff et al., 1990), the sleep quality questionnaire (Bois et al., 1989) and the emotional regulation difficulties questionnaire (Gratz and Romer, 2004) were used. The experimental group received stress management therapy based on the cognitive-behavioral approach for two and a half months in 10  sessions 60-minutes.  Data analysis was done with descriptive statistics, statistical assumptions test and multivariate covariance analysis with SPSS version 26. Results: The results show that there is a significant difference between the subjects of the experimental and control groups in terms of the post-test of the dependent variables (emotional dysregulation score - sleep quality - intensity of pain experience) with the pre-test control. The effect size shows that 69.5% of the difference between the two groups is related to the experimental program. he results of multivariate covariance analysis (MANCOVA) show that stress management training based on cognitive-behavioral theory (by controlling the effect of the pre-test as a confounding factor on the post-test) reduces the emotional dysregulation score (F=53.819, 000) P=0.0 and η=0.650), increased sleep quality (F=4.876, P=0.035 and η=0.444) and decreased intensity of pain experience (F=2.303, P=0.004 and η=0.377) had a significant effect. Conclusion: Stress management treatment based on cognitive-behavioral theory was effective and efficient in reducing emotional problems, sleep quality and intensity of pain experience in women with chronic tension headache. Stress management training based on cognitive-behavioral theory improves adaptive strategies and reduces the use of maladaptive strategies in female patients with headache and helps these people to reduce self-blame and blame others for suffering from the disease. This treatment can replace the control of positive emotions with negative emotions by informing and helping people's cognitive reconstruction. The cognitive-behavioral model helps the sick person to reduce negative emotional strategies and cope with pain and headache disease by correcting misplaced interpretations, guiding negative self-talk, correcting and reconstructing illogical thinking and ineffective and defective cognitions. and this cognitive reconstruction and reinterpretation of the pain and the existing situation causes less transfer of sensory-motor information of the headache and finally the perceived pain decreases.

Keywords

Main Subjects

Abotalebi H, yazdchi N, akbarinejhad H. (2022). Effectiveness of Mindfulness-based Cognitive Therapy on Resilience and Intensity of Pain Experience of Women With Chronic Headache. JAP; 13 (1) :1-13. (in Persian)
Agako, A., Donegan, E., McCabe, R. E., Frey, B. N., Streiner, D., & Green, S. (2021). The role of emotion dysregulation in cognitive behavioural group therapy for perinatal anxiety: Results from a randomized controlled trial and routine clinical care. Journal of affective disorders292, 517–525.
Aliyari Khanshan Vatan, F., Ahadi, H., Kalhornia Golkar, M., & Sedaghat, M. (2022). The Effectiveness of Cognitive-Behavioral Therapy in Anxiety and Distress Tolerance in Patients with Coronary Heart Diseases. Iranian Journal of Rehabilitation Research8(3), 54-65. (in Persian)
Argmand, S. A., Mirzaeian, B., & Baghbanian, S. M. (2022). Comparison of the Effectiveness of Pharmacotherapy and Cognitive-Behavioral Stress Management and Their Combination on Distress Tolerance and Headache Reduction in Patients with Tension Headache. Caspian Journal of Pediatrics24(1). (in Persian)
Banaeian A, Jabalameli S. (2021). Evaluation the Contribution of Cognitive Emotion Regulation Strategies and Alexithymia in Prediction of Pain Indices in Patients with Migraine. JAP; 12 (3) :1-15. (in Persian)
Bardeen, J. R., Kumpula, M. J., & Orcutt, H. K. (2013). Emotion regulation difficulties as a prospective predictor of posttraumatic stress symptoms following a mass shooting. Journal of anxiety disorders27(2), 188-196.
Bayat, B., Tavakoli, B. A. H., & Baradaran, N. G. (2022). The Effectiveness of Cognitive-Behavioral Stress Management in Improving Rumination and Psychological Distress in Women Experiencing Marital Infidelity. Applied Family Therapy Journal (AFTJ)3(1), 207-222. (in Persian)
Bernstein, E., & McNally, R. J. (2018). Exercise as a buffer against difficulties with emotion regulation: A pathway to emotional wellbeing. Behaviour Research and Therapy, 29-36.
Chen, W. L., & Chun, C. C. (2019). Association between emotion dysregulation and distinct groups of non-suicidal self-injury in Taiwanese female adolescents. International journal of environmental research and public health16(18), 3361.
Dewald, J. F., Meijer, A. M., Oort, F. J., Kerkhof, G. A., & Bögels, S. M. (2010). The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep medicine reviews14(3), 179-189.
Elron, E., Davidovits, M., & Eidlitz Markus, T. (2022). Headache in Pediatric and Adolescent Patients With Chronic Kidney Disease and After Kidney Transplantation: A Comparative Study. Journal of Child Neurology37(6), 497-504.
Enomoto, K., Kugo, M., Fukui, S., & Sasaki, J. (2022). Cognitive behavioral therapy for an individual suffering from chronic pain with overactivity and sleep disturbance: A case report. Clinical Case Reports10(5), e05838.
Hasler, G., Buysse, D. J., Gamma, A., Ajdacic, V., Eich, D., Rossler, W., & Angst, J. (2005). Excessive daytime sleepiness in young adults: a 20-year prospective community study. Journal of Clinical Psychiatry66(4), 521-529.
Hsu, L. M., Lane, T. J., Wu, C. W., Lin, C. Y., Yeh, C. B., Kao, H. W., & Lin, C. P. (2021). Spontaneous thought-related network connectivity predicts sertraline effect on major depressive disorder. Brain Imaging and Behavior15(4), 1705-1717.
Huber, F. A., Toledo, T. A., Newsom, G., & Rhudy, J. L. (2022). The relationship between sleep quality and emotional modulation of spinal, supraspinal, and perceptual measures of pain. Biological Psychology, 108352.
imani, S., Alkhaleel, Y., & shokri, O. (2019). The relationship between dysfunctional attitudes and Social Anxiety Disorder in adolescents (students): the mediating role of Emotion Regulation. Journal of Educational Psychology Studies16(33), 1-28. doi:10.22111/jeps.2019.4467. (in Persian)
Johnson, B. N., McKernan, L. C., & Bruehl, S. (2022). A Theoretical Endogenous Opioid Neurobiological Framework for Co-occurring Pain, Trauma, and Non-suicidal Self-injury. Current pain and headache reports26(6), 405–414.
Kamonseki, D. H., Lopes, E. P., van der Meer, H. A., & Calixtre, L. B. (2022). Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis. Disability and Rehabilitation44(10), 1780-1789.
Kamonseki, D. H., Lopes, E. P., van der Meer, H. A., & Calixtre, L. B. (2022). Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis. Disability and Rehabilitation44(10), 1780-1789.
Kazemini, E., Rezai, D. S., & Montajabian, Z. (2021). The effectiveness of positive psychotherapy on the perception of pain in people with chronic tension headaches. (in Persian)
Klan, T., Bräscher, A. K., Klein, S., Diezemann‐Prößdorf, A., Guth, A. L., Gaul, C., & Witthöft, M. (2022). Assessing attack‐related fear in headache disorders—Structure and psychometric properties of the Fear of Attacks in Migraine Inventory. Headache: The Journal of Head and Face Pain62(3), 294-305.
Kolbadi nejad M, Asadi J, Pourasghar arabi M, Aghaei M. (2021). Comparison the effectiveness of Cognitive-Behavioral therapy and Cognitive-Behavioral Hypnotherapy on Resiliency and sleep quality of women with Fibromyalgia syndrome. Rooyesh 2021; 10 (3) :21-34. (in Persian)
Lee, J., & Hur, M. H. (2022). The Effects of Aroma Essential Oil Inhalation on Stress, Pain, and Sleep Quality in Laparoscopic Cholecystectomy Patients: A Randomized Controlled Trial. Asian Nursing Research16(1), 1-8.
Lindsäter, E., Axelsson, E., Salomonsson, S., Santoft, F., Ljótsson, B., Åkerstedt, T., ... & Hedman-Lagerlöf, E. (2021). The mediating role of insomnia severity in internet-based cognitive behavioral therapy for chronic stress: Secondary analysis of a randomized controlled trial. Behaviour research and therapy136, 103782.
Maschi, M. S., Sodagar, S., Jomehri, F., Hosseinzadeh Taghvai, M., & Forootan, M. (2020). Effects of Cognitive-Behavioral Therapy on Pain Intensity and Stress Coping Styles in Patients With Gastric Wound. Journal of Arak University of Medical Sciences23(6), 860-871. (in Persian)
Matamala-Gomez, M., Bottiroli, S., Sances, G., Allena, M., De Icco, R., … & Tassorelli, C. (2022). Facial expressions modulate pain perception in patients with chronic migraine. Cephalalgia: an international journal of headache42(8), 739–748.
McGeary, D. D., Resick, P. A., Penzien, D. B., McGeary, C. A., Houle, T. T., Eapen, B. C., ... & Peterson, A. L. (2022). Cognitive behavioral therapy for veterans with comorbid posttraumatic headache and posttraumatic stress disorder symptoms: a randomized clinical trial. JAMA neurology.
Meheli, S., Sinha, C., & Kadaba, M. (2022). Understanding People With Chronic Pain Who Use a Cognitive Behavioral Therapy–Based Artificial Intelligence Mental Health App (Wysa): Mixed Methods Retrospective Observational Study. JMIR Human Factors9(2), e35671.
moheb N, nasirzadeh H, livarjani S, baba pour kheirodin J, moosavi Z. (2021). Comparison between effectiveness of dialectical behavioral therapy and emotional schema therapy on pain severity and performance limitation in people who suffering of tension headache. 12 (2) :104-120. (in Persian)
Murphy, J. L., Cordova, M. J., & Dedert, E. A. (2022). Cognitive behavioral therapy for chronic pain in veterans: Evidence for clinical effectiveness in a model program. Psychological Services19(1), 95.
Nagouri, I., Bagri, D. R., & Sharma, J. N. (2022). Epidemiology and Characteristics of Chronic Daily Headaches in Children. Indian Journal of Pediatrics89(2), 210-210.
Noghabi, F; and Ziari, M. (2022). Effectiveness of cognitive-behavioral intervention on the sleep quality of patients saved from acute myocardial infarction. Research project of Tehran University of Medical Sciences. (in Persian)
Nourisaeed, A., Ghorban Shiroudi, S., & Salari, A. (2022). The Effectiveness of Cognitive-Behavioral Therapy on Perceived Stress and Coping Skills in Patients after Myocardial Infarction. Clinical Psychology and Personality19(2), 81-90. doi:
10.22070/cpap.2021.13458.1013. (in Persian)
Pourgheisar, N., Jabalameli, S., Haghayegh, S. A., & Moghimian, M. (2023). The Comparison of the Effectiveness of Transcranial Direct Current Stimulation and Neurofeedback Therapy on Sleep Quality in the Elderly. Aging Psychology9(2), 134-121. doi10.22126/jap.2023.9067.1700. (in Persian)
Rezaei Aghoi, A (2019). Effectiveness of cognitive-behavioral treatment on emotion regulation in migraine patients. Iranian Journal of Psychology and Behavioral Sciences, 23(2), 17-26. (in Persian)
Shareh, H., and Rabati, Z (2019). The effectiveness of cognitive-behavioral therapy on self-efficacy in pain, fatigue, life expectancy and depression in patients with multiple sclerosis: a clinical trial. Iranian Journal of Psychiatry and Clinical Psychology, 26(4), 418-431. (in Persian)
Sheppes, G., Suri, G., & Gross, J. J. (2015). Emotion regulation and psychopathology. Annual review of clinical psychology11, 379-405.
Shokrgozar, A., SepahMansour, M., EmamiPour, S., & Salehi, M. (2021). Comparison of the Effectiveness of Positivist Psychotherapy with Cognitive-Behavioral Therapy on Pain Perception of Males with Chronic Low-Back Pain. Community Health Journal14(4), 45-54. (in Persian)
Sine, H., Achbani, A., & Filali, K. (2022). The effect of hypnosis on the intensity of pain and anxiety in cancer patients: a systematic review of controlled experimental trials. Cancer Investigation40(3), 235-253.
Solgi, Z., & Shafiei, H. (2022). The Effectiveness of Emotion Regulation Therapy Based on Gross's Theory on Sleep Quality and its Index in Cyberspace-Addicted Female Adolescents. Community Health Journal16(4), 59-69. (in Persian)
Sullivan, D. P., Martin, P. R., Boschen, M. J., & Bandarian-Balooch, S. (2022). Dysfunctional sleep beliefs and behaviours: Psychological factors in sleep-related headaches. Behaviour Research and Therapy153, 104094.
Tavakoli, H., Akbari, B., & Salari, A. (2020). Effectiveness of Group Cognitive-Behavioral Therapy on the Cognitive Emotion Regulation Strategies and Psychological Flexibility in Patients with Non-Cardiac Chest Pain. Yafteh22(2), 131-143. (in Persian)
Tavassoli, T., Khodaei, T., Ghasemi, P., & Nekooi, H. (2023). The Effect Of Stressful Life Events And Emotional Dysregulation On Somatization Symptoms With The Mediating Role Of Alexithymia In Nurses. Quarterly Journal of Nursing Management12(2), 0-0. (in Persian)
Torres-Ferrus, M., Gallardo, V. J., Alpuente, A., & Pozo-Rosich, P. (2020). Influence of headache pain intensity and frequency on migraine-related disability in chronic migraine patients treated with OnabotulinumtoxinA. The Journal of Headache and Pain21(1), 1-8.
Valentine, T. R., Alschuler, K. N., Ehde, D. M., & Kratz, A. L. (2022). Prevalence, co-occurrence, and trajectories of pain, fatigue, depression, and anxiety in the year following multiple sclerosis diagnosis. Multiple Sclerosis Journal28(4), 620-631.
Viero, F. T., Rodrigues, P., & Trevisan, G. (2022). Cognitive or daily stress association with headache and pain induction in migraine and tension-type headache patients: a systematic review. Expert Review of Neurotherapeutics22(3), 257-268.
Von Korff, M., Dworkin, S. F., & Le Resche, L. (1990). Graded chronic pain status: an epidemiologic evaluation. Pain40(3), 279-291.
Vrbanović, E., Zlendić, M., & Alajbeg, I. Z. (2022). Association of oral behaviours’ frequency with psychological profile, somatosensory amplification, presence of pain and self-reported pain intensity. Acta Odontologica Scandinavica, 1-7.
Wiklund, T., Molander, P., Lindner, P., Andersson, G., Gerdle, B., & Dragioti, E. (2022). Internet-Delivered Cognitive Behavioral Therapy for Insomnia Comorbid With Chronic Pain: Randomized Controlled Trial. Journal of medical Internet research24(4), e29258.