Emotional approach coping and self‐efficacy moderate the effects of written emotional disclosure and relaxation training for people with migraine headaches

Abstract

Objectives-We tested whether emotional skills and headache management self-efficacy (HMSE) moderated effects of written emotional disclosure (WED) compared to control writing and a different intervention, relaxation training (RT).Design/Methods-Undergraduates with migraine headaches reported emotional approach coping (EAC) and HMSE; were randomized to WED, RT, or control; and assessed on health measures at baseline and 3-month follow-up.Results-Greater EAC predicted improvement following WED compared to RT and control, whereas low HMSE predicted improvement following both WED and RT, compared to control.Conclusions-Emotional skill may specifically-and low health management self-efficacy may generally-predict positive responses to WED.Written emotional disclosure (WED) has modest benefits for people with health problems, but personality differences likely moderate its effects. Also, comparing WED to another intervention can test whether moderators are specific to WED or general to various interventions. Relaxation training (RT) may be an ideal comparison intervention.We hypothesized that having emotional skills predicts benefits of WED, but may be irrelevant for RT. In contrast, being low in self-efficacy to manage health problems may predict benefits of both interventions. We tested these two moderators on the effects of WED, RT, and neutral control writing in young adults with migraine headaches. Methods Participants and ProceduresNinety undergraduates (80 women; age M=21.4; 59% European American, 19% African American, 22% other) reporting migraines at least once per month, came individually to the lab, had a diagnostic interview to confirm migraines, and completed baseline moderator and health measures. They were randomized into groups and conducted four, 20-minute lab sessions over two weeks. Follow-up assessments were scheduled at 1 and 3 months.The WED group was instructed to write about facts and feeling about a stressful experience, and to try to write about the same topic repeatedly, create a narrative, and relate the stressor to their lives. The RT group listened to 20-minute sections of an audiotape that trained participants , 2000). Outcome measures were headache frequency (number of days in the last month with a headache), pain severity rated on the McGill Pain Questionnaire-short form (Melzack, 1987), functional and emotional disability rated on the 25-item Headache Disability Inventory (Jacobson, Ramadan, Aggarwal, & Newman, 1994), and negative and positive affect for the past month rated on the Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988). Data Analytic ApproachEight-two participants (91%) provided outcome data (58: both follow-ups; 17: 1-month only; 7: 3-month only); 8 dropped without follow-up. Groups did not differ in who lacked complete follow-up data (11 WED, 10 RT, 11 TMC). We analyzed the final available outcomes using intent-to-treat analyses (replacing the eight missing outcomes with baseline values). To test moderation, we examined interaction terms (m...

The match–mismatch model of emotion processing styles and emotion regulation strategies in fibromyalgia

“…Perhaps our assessment of cognitive reappraisal was too emotionfocused for people with alexithymia to be able to benefit from it; that is, the questions referred to changing one's thoughts when experiencing emotions, whereas knowing when and which emotions are experienced is one of the main difficulties in alexithymia. Our findings, therefore, should not be generalized to broader interventions that use cognitive reappraisal, such as cognitive-behavioral therapy, which may be beneficial for people with alexithymia [25,26]. Regardless of the specific reasons, the present study did not find evidence to indicate the benefits or drawbacks of cognitive reappraisal in general, nor as a particularly beneficial or harmful strategy for alexithymic people or those high in affect intensity.…”

“…Eliciting emotions in alexithymic individuals may, therefore, result in an increase in confusion and physiological stress, which has been shown experimentally in a study of women with fibromyalgia in an interview context [22]. Consistent with this, alexithymia is typically associated with poorer outcomes of interventions that encourage emotional disclosure and processing [23,24], but with better outcomes of interventions that are externally focused and use cognitive and behavioral techniques [25][26][27]. This suggests that among people with alexithymia, cognitive reappraisal (match) is associated with better adjustment than emotion expression (mismatch).…”

Randomized controlled trial of expressive writing for psychological and physical health: the moderating role of emotional expressivity

“…Of particular interest were moderators related to emotional expressivity as research findings have been inconsistent on whether lower emotional expressiveness predicts better or worse outcomes from the writing paradigm (Austenfeld & Stanton, 2004; Kraft et al, 2008; Lu & Stanton, 2009; Lumley, 2004; Páez et al, 1999; Solano et al, 2003; Stanton et al, 2000). Moderators assessed included emotional expressivity, stressor-specific emotional processing, and dispositional ambivalence over emotional expression.…”

“…Within the emotion group at the second session, higher baseline expressive coping about the parent’s disorder was significantly associated with lower heart rate, skin conductance and hostility during emotional expression. In a related line of research, 80 undergraduate women with migraine headaches (Kraft, Lumley, D’Souza, & Dooley, 2008) were assigned to expressive writing or relaxation technique exercises. Higher dispositional emotional approach coping predicted improvement in headache frequency and disability for the expressive writing group, but not the control group.…”

Recent evidence supports emotion-regulation interventions for improving health in at-risk and clinical populations

“…Thus, although expressive writing is generally considered efficacious, there exists considerable between-study variability in the treatment effects of expressive writing and suggests that the benefits of this procedure may be specific to certain individuals, procedural aspects, or contexts or all [18]. In addition to the main effects of the expressive writing procedure on psychological and physical outcomes, recent work in this area has also explored the parameters of expressive writing [19], including the moderating effects of individual differences [20][21][22].…”