The Effectiveness of Rational-Emotive Therapy in the Reduction of Muscle Contraction Headaches

By Finn, Thomas; DiGiuseppe, Raymond et al. | Journal of Cognitive Psychotherapy, January 1, 1991 | Go to article overview

The Effectiveness of Rational-Emotive Therapy in the Reduction of Muscle Contraction Headaches


Finn, Thomas, DiGiuseppe, Raymond, Culver, Clayton, Journal of Cognitive Psychotherapy


The study tested the effectiveness of RET in treating muscle contraction headaches. Thirty-five adult subjects diagnosed as muscle contraction headache sufferers completed one of four treatment conditions: Rational-Emotive Therapy (RET); Progressive muscle relaxation (PMR); Headache discussion (HAD), which discussed historical roots of symptoms and monitored cognitive responses but learned no specific coping techniques; and a Waiting list symptom monitoring group (WLC). Dependent measures consisted of data on each subject's weekly headache duration, frequency, severity, and number of headache-free days. These measures were derived from a daily headache diary. Frontalis EMG was also measured. After a treatment program of 10 weekly one-and-one-half-hour group therapy sessions, both the RET and PMR groups had significantly lower headache severity scores, headache frequency, than the HAD and WLC groups. While changes in headach duration and headache-free days were not significant, patterns of these means were consistent with the other measures showing a decrease in headache pathology. At follow-up, ratings of headache improvement done by each subject and by a significant other showed the RET group reported greater improvement than the PMR and HAD groups, which did not differ. The results suggest that RET and PMR were equally effective in the treatment of muscle contraction headaches.

An increasing number of studies have assessed the efficacy of psychological treatments in reducing pain. Many techniques are now viewed as useful in the management of pain, particularly in the treatment of muscle contraction headaches (Holyroyd et al., 1984). This type of headache, commonly referred to as a tension headache, is characterized by dull, steady pain which lasts for hours or days and is experienced by many patients as a tight band of constriction or pressure. Psychological factors, such as anxiety or tension, which lead to sustained muscle contractions in the head, neck, and shoulders are frequently described as major precipitators of muscle contraction headache pain (Bakal, 1975).

Muscle contraction headaches have been successfully treated via relaxation and biofeedback, with both techniques showing equal effectiveness (Blanchard, Andrasik, Ahles, Teders, & O'Keefe, 1980). These authors suggest that there is little need to continue direct comparison of relaxation to biofeedback techniques, although it may prove valuable to compare these established treatments to newer methods.

In addition, more cognitively oriented strategies which address the role of maladaptive cognitions in emotional distress have been utilized in the treatment of muscle contraction headaches. Holyroyd, Andrasik, and Westbrook (1977), for example, compared a cognitive treatment to standard EMG biofeedback and found that only the cognitive therapy group had significantly reduced the severity and frequency of headache symptoms. In a second study Holyroyd and Andrasik (1978) compared a cognitive self-control group to a combined cognitive and relaxation group in which subjects were not taught specific responses to stress but discussed the historical roots of their symptoms. Results showed that all groups improved relative to a symptom-monitoring control condition. The authors suggested that while the cognitive treatment for muscle contraction headaches is effective, training in specific coping strategies may not be necessary since the discussion group members seemed to devise their own coping strategies. Holyroyd and Andrasik (1978) appeared to use a combination of many cognitive techniques (e.g., those of Beck and Meichenbaum). Therefore, their study was not a test of any one cognitive technique.

Rational-Emotive Therapy (RET) has received some support in reducing self reports of anxiety (DiGiuseppe, Miller, & Trexler, 1977; Haaga & Davison, 1989; Lipsky, Kassinove, & Milier, 1980), but so far no studies have appeared that test its effectiveness in treating psychophysiological disorders. …

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