Implicit associations in tension-type headaches: a cognitive analysis based on stress reactivity processes.

OBJECTIVE: To determine whether tension-type headache (TTH) patients display stronger associations between negative events and headache-related information than headache-free controls. BACKGROUND: Generally, stress/diathesis models are common in clinical research and in the context of TTHs specifically. Data involving stress reactivity processes are compatible with such models. However, it would be of interest to tap the associative cognitive processes that likely mediate such relations. METHODS: In the present study, we selectively recruited individuals who do (n = 19) and do not (n = 19) suffer from episodic TTHs. We examined implicit associations between negative evaluations and headache-related information through the use of an implicit association test. RESULTS: As hypothesized, TTH patients displayed associations between negative evaluations and headache-related information, whereas the control group did not. CONCLUSIONS: These data provide initial support for a plausible cognitive model for the occurrence of TTHs among predisposed individuals.

Development and psychometric validation of an eating disorder-specific health-related quality of life instrument.

OBJECTIVE: Health-related quality of life (HRQOL) has been used increasingly as an outcome measure in clinical research. Although the generic quality of life instruments has been used in previous research, disease-specific instruments offer greater sensitivity and responsiveness to change than generic instruments. No such disease-specific instrument is currently available that applies to eating-disordered samples. METHOD: The current article reports on the development and validation of the Eating Disorders Quality of Life (EDQOL) instrument, a disease-specific HRQOL self-report questionnaire designed for disordered eating patients. RESULTS: The EDQOL demonstrates excellent psychometric properties. CONCLUSION: The application of the EDQOL as an outcome measure in eating disorder research is considered.

Guidelines for trials of behavioral treatments for recurrent headache, first edition: American Headache Society Behavioral Clinical Trials Workgroup.

Guidelines for design of clinical trials evaluating behavioral headache treatments were developed to facilitate production of quality research evaluating behavioral therapies for management of primary headache disorders. These guidelines were produced by a Workgroup of headache researchers under auspices of the American Headache Society. The guidelines are complementary to and modeled after guidelines for pharmacological trials published by the International Headache Society, but they address methodologic considerations unique to behavioral and other nonpharmacological treatments. Explicit guidelines for evaluating behavioral headache therapies are needed as the optimal methodology for behavioral (and other nonpharmacologic) trials necessarily differs from the preferred methodology for drug trials. In addition, trials comparing and integrating drug and behavioral therapies present methodological challenges not addressed by guidelines for pharmacologic research. These guidelines address patient selection, trial design for behavioral treatments and for comparisons across multiple treatment modalities (eg, behavioral vs pharmacologic), evaluation of results, and research ethics. Although developed specifically for behavioral therapies, the guidelines may apply to the design of clinical trials evaluating many forms of nonpharmacologic therapies for headache.

Outcome measurement in behavioral headache research: headache parameters and psychosocial outcomes.

The experience of pain is complex and includes multiple dimensions or aspects, such as sensory and affective (among others). Headache includes not only pain, but also associated symptoms that can further diversify the relevant dimensions. Subjective ratings of head pain, sampled daily, have come to be regarded as the "gold standard" in behavioral headache research. Primary measures of headache include the attack frequency or headache days per month. Secondary measures of headache may include headache activity/index, headache duration, peak headache severity, and/or frequency of severe headaches per month. Secondary measures of disability and quality of life include Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT), Headache Disability Inventory (HDI). Secondary nonheadache measures include medication consumption, psychiatric symptoms, stress and coping, treatment satisfaction and preference, side effects, and others. Researchers should include not only primary measures of headache, but also secondary measures, disability and quality of life, and nonheadache measures. All measures should be clearly defined and reported. A baseline period that is adequate for each measure needs inclusion and a minimum of 4 weeks is recommended for primary headache measures. Specific suggestions for future research directions are provided.

Posttraumatic stress and depressive symptoms in a college population one year after the September 11 attacks: the effect of proximity.

As a follow-up to our earlier report [Behav. Res. Ther., in press] on the level of posttraumatic stress symptoms (PTSS), depressive symptoms, and frequency of diagnoses of probable posttraumatic stress disorder (PTSD) among college students at three public universities (Albany, NY, Augusta, GA, and Fargo, ND) resulting from the September 11, 2001. Terrorist attacks, we surveyed comparable groups of students (total, n = 1313) from these three institutions in the weeks following the first anniversary (2002) of the attacks. We found proximity effects (Albany higher than Augusta which was higher than Fargo) for PTSS and depressive symptoms but not for frequency of diagnoses of probable PTSD. Within the Albany site data, proximity of county of residence to New York City (NYC) also showed a proximity effect on PTSS. Although depressive symptoms were significantly different in 2002 versus 2001, the arithmetic differences in PTSS or in frequency of diagnoses of probable PTSD were not significant. The September 11 attacks continued to exert a psychic toll on college students even a year later.

Gender, ethnicity, self-esteem and disordered eating among college athletes.

OBJECTIVE: This study was undertaken to compare ethnic and gender differences regarding self-esteem and various disordered eating attitudes and behaviors among elite college athletes. METHOD: A total of 1445 student athletes from 11 Division I schools were surveyed using a 133-item questionnaire. RESULTS: White female athletes reported significantly lower self-esteem than Black female, Black male and White male athletes. Black female athletes' self-esteem was equal to both Black and White male athletes. White female athletes reported significantly higher drive for thinness, body dissatisfaction, and more disturbed eating behaviors than Black female and both groups of male athletes. DISCUSSION: The current study demonstrates that White female athletes appear to be most at risk for having difficulty with eating disorders. Their reporting of significantly lower self-esteem indicates that this may be a risk factor that is more characteristic of this ethnic group. Questions are raised about what factors exist in the Black female culture that protect them from low self-esteem and disordered eating attitudes and behaviors.

Studies of the vicarious traumatization of college students by the September 11th attacks: effects of proximity, exposure and connectedness.

From mid-October 2001 through the end of November 2001, we collected fairly large sets of questionnaires from undergraduates at three public universities (Albany, NY, n = 507, Augusta, GA, n = 336, Fargo, ND, n = 526 ) to assess rate of acute stress disorder (ASD) and level of ASD symptoms following the September 11th attacks, rate of current posttraumatic stress disorder (PTSD) and level of PTSD symptoms, and current level of depressive symptoms resulting from the September 11th attacks. We also gathered information on exposure to media coverage of the attacks, connectedness to the World Trade Center (WTC) and personnel there, and degree of engagement in reparative acts such as giving blood, attending vigils. We found higher levels of ASD, ASD symptoms, PTSD and PTSD symptoms as a function of geographical proximity to New York City (and within the Albany site, proximity of students' homes) and gender. Exposure (hours of TV watched) was a predictor in some instances as was connectedness to WTC victims. ASD symptoms were the strongest predictor of subsequent PTSD symptoms. Path models accounted for over 60% of the variance in PTSD symptoms.

Predictors of disordered eating in a sample of elite Division I college athletes.

OBJECTIVE: The present study sought to investigate the relationship between a number of areas of elite student-athletes' lives and disordered eating. METHOD: We surveyed 1445 elite Division I athletes at 11 different institutions and in 11 different sports. Hierarchical regression was used to indicate specific areas of the participants' collegiate experience that may be associated with disordered eating attitudes and symptomatology. RESULTS: Results demonstrate that the variables entered into each model predicted between 40.5% and 46.4% of the variance for the restriction of food, body dissatisfaction, and drive for thinness. Categories of variables that generally predicted the most variance for each dependent measure were demographics, athletic involvement, and personality. Of the 11 sports included in the analysis, wrestling and gymnastics demonstrated elevated levels of drive for thinness, food restriction, and purging behavior compared to other athletes. DISCUSSION: Findings suggest that in elite athletes gender, ethnicity, sport, and self-esteem are associated with several behaviors and attitudes indicative of disordered eating.

An evaluation of the relationship between mood and binge eating in the natural environment using ecological momentary assessment.

OBJECTIVE: Although many current theories of disordered eating focus on affective mechanisms, relatively little is known about the covariation of mood and eating in peoples' natural environments. This study examined the relationship between mood and binge eating behavior in the natural environment. METHOD: Twenty-seven college students with subclinical binge eating behavior self-monitored their mood on a handheld computer seven times daily for 2 weeks. RESULTS: On binge days, participants reported having significantly worse mood than on nonbinge days. When the trajectory of mood around the time of a binge was examined, no significant differences between prebinge and postbinge time were found when the entire binge day was examined. No mood differences were found between just prior to the binge (30-60 min prior to binge) compared with just after the binge (also within 30-60 min). A postbinge report indicated that reported mood immediately after a binge was worse than mood just prior to the binge. DISCUSSION: This study provides evidence that the affective experience of binge eating, when assessed in the natural environment, is negative. Furthermore, there was no evidence that binge eating was a response to an immediate or transient negative mood state or that binge eating provided relief from negative mood.