@article{4d90076bfd2648acb50d6c327171724f,
title = "Mechanisms of change in posttraumatic headache–related disability: A mediation model",
abstract = "Objective: To explore whether the association between change in headache management self-efficacy and posttraumatic headache–related disability is partially mediated by a change in anxiety symptom severity. Background: Many cognitive–behavioral therapy treatments for headache emphasize stress management, which includes anxiety management strategies; however, little is currently known about mechanisms of change in posttraumatic headache–related disability. Increasing our understanding of mechanisms could lead to improvements in treatments for these debilitating headaches. Methods: This study is a secondary analysis of veterans (N = 193) recruited to participate in a randomized clinical trial of cognitive–behavioral therapy, cognitive processing therapy, or treatment as usual for persistent posttraumatic headache. The direct relationship between headache management self-efficacy and headache-related disability, along with partial mediation through change in anxiety symptoms was tested. Results: The mediated latent change direct, mediated, and total pathways were statistically significant. The path analysis supported a significant direct pathway between headache management self-efficacy and headache-related disability (b = −0.45, p < 0.001; 95% confidence interval [CI: −0.58, −0.33]). The total effect of change of headache management self-efficacy scores on change in Headache Impact Test-6 scores was significant with a moderate-to-strong effect (b = −0.57, p = 0.001; 95% CI [−0.73, −0.41]). There was also an indirect effect through anxiety symptom severity change (b = −0.12, p = 0.003; 95% CI [−0.20, −0.04]). Conclusions: In this study, most of the improvements in headache-related disability were related to increased headache management self-efficacy with mediation occurring through change in anxiety. This indicates that headache management self-efficacy is a likely mechanism of change of posttraumatic headache–related disability with decreases in anxiety explaining part of the improvement in headache-related disability.",
keywords = "anxiety, disability, headache, posttraumatic, self-efficacy, veteran",
author = "{for the Consortium to Alleviate PTSD} and Nabity, {Paul S.} and Reed, {David E.} and McGeary, {Cindy A.} and Houle, {Timothy T.} and Jaramillo, {Carlos A.} and Resick, {Patricia A.} and Eapen, {Blessen C.} and Litz, {Brett T.} and Jim Mintz and Penzien, {Donald B.} and Keane, {Terence M.} and Stacey Young-McCaughan and Peterson, {Alan L.} and McGeary, {Donald D.}",
note = "Funding Information: This research was supported by Consortium to Alleviate PTSD (CAP) award numbers W81XWH‐13‐2‐0065 from the US Department of Defense, Defense Health Program, Psychological Health and Traumatic Brain Injury Research Program (PH/TBI RP), and I01CX001136‐01 from the US Department of Veterans Affairs, Office of Research & Development, Clinical Science Research & Development Service. Funding Information: reports research funding from the Department of Defense (DoD), the Department of Veterans Affairs (VA), and The National Institutes of Health (NIH). reports research funding from the DoD, VA, and NIH. reports research funding from the DoD, VA, and NIH. reports research funding from the DoD and NIH and serves on the editorial boards of the American Society of Anesthesiology and the American Headache Society. reports research funding from the DoD and VA. reports receiving research and consultation support from the DoD, VA, NIH, and the Department of Justice; royalties from therapist manuals, and paid honoraria for lectures and training workshops. reports research funding from the DoD and VA. reports research funding from the DoD, VA, and NIH. reports research funding from the DoD, VA, and NIH. reports research funding from the DoD, VA, NIH, and Salisbury Foundation for Research and Education. reports research funding from the DoD, VA, and NIH. reports research funding from the DoD, VA, and NIH. reports research funding from the DoD, VA, NIH, the Bob Woodruff Foundation (BWF), the Texas Veterans and Family Alliance (TV&FA), and the Navy SEAL Foundation. reports research funding from the DoD, VA, and NIH. Paul S. Nabity David E. Reed Cindy A. McGeary Timothy T. Houle Carlos A. Jaramillo Patricia A. Resick Blessen C. Eapen Brett T. Litz Jim Mintz Donald B. Penzien Terence M. Keane Stacey Young‐McCaughan Alan L. Peterson Donald D. McGeary Publisher Copyright: {\textcopyright} 2023 American Headache Society.",
year = "2023",
month = mar,
doi = "10.1111/head.14480",
language = "English (US)",
volume = "63",
pages = "410--417",
journal = "Headache",
issn = "0017-8748",
publisher = "Wiley-Blackwell",
number = "3",
}