In this review, the effectiveness of behavioral and pharmacological treatments for pediatric migraine was quantitatively summarized following the meta-analytic approach outlined by Hedges and Olkin (1985). A first meta-analysis based on treatment outcome within treatment conditions revealed that thermal biofeedback and interventions combining biofeedback and progressive muscle relaxation seem to be significantly more efficacious than other behavioral treatment modalities, psychological and drug placebo, and the more commonly used prophylactic drug regimens. Though there is some evidence suggesting good effectiveness of propranolol, the lack of systematic data precludes more definitive conclusions. A second meta-analysis that included only studies providing data on the comparison between control versus active treatment conditions replicated the initial findings only partially. In the light of the relative small number of studies that met basic inclusion requirements, the methodological flaws of many studies, and the under-representation of certain treatment types, conclusions regarding differential effectiveness of the treatment types have to be drawn with caution. Overall, our findings clearly demonstrate the need for direct comparisons between behavioral and pharmacological treatments and the need for more theory-driven research in order to determine the most promising treatment approaches for pediatric migraine.
Objective
Heightened sensitivity toward social rejection has been implicated in eating disorders (ED) and personality disorder (PD). This study examined the effect of a cognitive bias modification training (CBM‐I) targeting the interpretation of ambiguous social situations in individuals with comorbid ED and PD.
Method
A total of 128 participants [33 with ED and PD, 22 with ED‐only, 22 with PD‐only, and 51 healthy controls (HC)] were recruited from a hospital and university settings, and included in the final analyses. The participants were randomly assigned to a CBM‐I task with benign resolutions or a control task with neutral resolutions in a counterbalanced order in two sessions using a within‐subject design. Interpretation bias toward social stimuli was measured using the ambiguous sentence completion task before and after completing the assigned task.
Results
The CBM‐I task increased benign and decreased negative interpretations with large effect sizes in the diagnostic groups, and with a moderate effect size in the HC group. Participants' anxiety levels were also reduced after the task. The size of the change in negative interpretation was positively associated with baseline negative affect, and negatively associated with baseline positive affect.
Discussion
The results suggest that modifying interpretation bias has the potential as a transdiagnostic target of treatment for ED and PD, and a fully powered clinical trial with consecutive sessions would be warranted.
Public Significance
Participants with eating disorders and/or personality disorder, and healthy controls completed a single session of a cognitive training intervention targeting rejection sensitivity. The training produced a large decrease in negative interpretation in the diagnostic groups, and a moderate effect in healthy controls. The findings indicate that training for positive processing of social information may be of value to augment treatment in conditions such as eating disorders and personality disorder, in which there are high levels of rejection sensitivity.
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