Daily Frustration, Cognitive Coping and Coping Efficacy in Adolescent Headache: A Daily Diary Study

Objective.— To investigate both concurrent and prospective relationships between daily frustration, cognitive coping and coping efficacy on the one hand and daily headache occurrence on the other.
Methods.— Eighty-nine adolescents aged 13-21 completed an online daily diary for 3 weeks. Data were analyzed using multilevel modeling.
Results.— Daily frustration of goal pursuits was significantly related to both same day and next day headache occurrence. Coping efficacy beliefs were significantly related to lower next day headache occurrence (no same day relationship was found). None of the cognitive coping strategies used in response to daily frustration were related to headache occurrence on the same or next day.
Conclusions.— Daily frustration to goal pursuit is suggested to be an important stressor contributing to concurrent and prospective headache occurrence. Furthermore, the extent to which adolescents believe in their ability to cope also appears to influence experience of subsequent headache. Further prospective studies are necessary to confirm these findings and to further unravel the possibly reciprocal relations between these factors. These findings offer useful insights into the dynamic interplay between daily stressful experiences and headache in youths.     

Influence of Quality of Life and Stress Coping Behaviour on Headaches in Adolescent Male Students: an Explorative Study

Quality of life (QL) and stress coping behaviour were evaluated in 194 adolescent male students, and related to their headache complaints. Negative correlations were found between headache duration and intensity versus satisfaction with autonomy, and between headache intensity versus satisfaction with the home situation. Both headache duration and intensity were found to correlate positively with depressive stress coping behaviour. Further, positive correlations were found between palliative and avoidant stress coping strategies versus headache intensity. Our findings suggest that active rather than passive stress coping strategies are effective in reducing headache intensity. In addition, this study indicates the relevance of focussing future research into headaches in adolescents on the home situation.     

The occurrence of recall bias in pediatric headache: a comparison of questionnaire and diary data

OBJECTIVE: To investigate whether children and adolescents can recall prior headache complaints accurately and to study whether age, gender, headache severity, preferred coping strategies, depression, somatization, and trait anxiety are related to recall errors, causing recall bias. METHODS: A retrospective headache questionnaire and a prospective 4-week headache diary were filled out by 181 children aged 9 to 16 years who experienced headache at least weekly. In addition, several other questionnaires were administered, measuring coping strategies, depression, somatization, and trait anxiety. Headache frequency, intensity, and duration, as scored on the questionnaire and the diary, were compared using Wilcoxon tests. Regression analyses were performed to study whether age, gender, headache severity, preferred coping strategies, depression, somatization, and trait anxiety can predict the size of differences between the diary and the questionnaire. RESULTS: Compared with the diary, headache intensity and headache duration were overestimated on the questionnaire. At group level, median headache frequency as measured by the diary and the questionnaire was equal. Regarding headache frequency and headache intensity, age and headache severity were statistically related to errors in recall. For headache frequency, depression was also predictive of the size of recall error. CONCLUSIONS: Recall errors occur when children are asked to report their headaches on a retrospective questionnaire. As compared to a prospective diary, pain complaints are evaluated more negatively on a questionnaire. Other factors such as age, depression, and headache severity influence the way children and adolescents recall their headaches. To minimize bias, the use of a diary when studying recurrent headache complaints in children is recommended.     

Diabetes mellitus in adolescents: a comprehensive approach to outpatient care.

A comprehensive approach to care of adolescents with diabetes mellitus requires knowledge of the unique characteristics of juvenile diabetes during this development period, appropriate medical goals, and awareness of the numerous psychologic and social problems encountered. Involvement of other health professionals is frequently needed. Successful adjustment of the adolescent to having diabetes includes absence of "maladaptive" coping mechanisms, realistic future goals, and acceptance of responsibility for self-care.     

Predictors of disability in migraineurs referred to a tertiary clinic: neck pain, headache characteristics, and coping behaviors

OBJECTIVE: The aim of this retrospective study was to determine if neck pain, select headache characteristics, and migraine-related coping response predicted disability in migraineurs referred to a tertiary headache clinic. METHODS: Patients seeking treatment at a neurology-based headache clinic were included if they met diagnostic criteria for migraine with or without aura according to the International Headache Society (1.1, 1.2). Subjects completed a self-report headache history form and a detailed headache and neurologic examination. The headache history form assessed: 1)weekly headache frequency; 2) number of weekly severe headaches; 3) presence of migraine-related neck pain; 4) photophobia; 5) phonophobia; 6) headache duration; 7) vomiting; 8) monthly headache-free days; and 9) behavioral coping style. Disability was assessed using a self-report inventory (HIT-6). RESULTS: Self-reported headache severity, frequency, and headache-free days were strongly associated with disability. The presence of neck pain during migraine and one's coping response to migraine significantly predicted disability independent of headache characteristics. CONCLUSIONS: These data suggest the need for prospective research exploring the causal mechanisms by which neck pain and coping response influence disability and underscores the importance of multidisciplinary approaches to headache management.     

Stress and coping styles in Japanese nursing students

The objective of this investigation was to examine the stress and coping styles in Japanese nursing students. The principal measures of the stress and coping styles were the General Health Questionnaire (GHQ)‐12 and Brief Coping Orientations to Problems Experienced scale. In a cross‐sectional analysis, 1324 students completed the anonymous self‐administered questionnaires including the scales earlier. Feeling stress, living with family, not eating breakfast every day, having no regular exercise and poor sleep were associated with GHQ responder (psychological distressed group). The most commonly reported source of stress was taking examinations, followed by relationships with friends, engaging in clinical practice and presenting reports. The three most common coping styles adopted by the nursing students were acceptance, self‐distraction and using instrumental support. By logistic regression analysis of coping styles with GHQ responder, self‐blame, active coping, acceptance and behavioural disengagement were highly associated with GHQ responder. The nursing school educators as well as students should be aware of stress management strategies (e.g. using active coping and avoiding self‐blame) that may help prevent depression.     

Psychosocial factors associated with chronic pain in adolescents

A number of psychosocial factors have been associated with the onset, exacerbation and/or maintenance of chronic pain in adolescents. The present study was conducted to evaluate the relative importance of vulnerability, reinforcement, and modeling. We compared 222 adolescents with chronic pain and no documented physiological etiology (headache, back, limb and abdominal pain) with 148 controls and their (respectively 183 vs. 127) parents. Analyses showed that adolescents with chronic pain are more vulnerable in terms of neuroticism, negative fear of failure, and (less) experienced social acceptance. Contrary to our expectations, the chronic pain group experienced less reinforcement for their pain behavior by both parents and peers than the control group. While the number of pain models was higher in the chronic pain group, no differences were found between their parents and those of the adolescents without chronic pain in pain experience, pain parameters, and pain coping. Regression analyses on the contribution of psychosocial factors to chronic pain and its parameters sustained the positive relation between vulnerability, (less) pain reinforcement, pain models and coping with pain. Furthermore, we also found evidence that gender differences have to be taken into account.     

Humor: a coping response for student nurses

This qualitative study describes various situations that elicited a humorous coping response in student nurses assigned to a state psychiatric hospital. The research question asked was: Under what circumstances do student nurses choose to use humor as a coping method? Forty-three senior student nurses enrolled in a north-central United States university were invited to participate anonymously in the study. A content analysis of 38 narratives describing humorous situations was conducted and the emergent categories were evaluated for compatibility with Lazarus's theory of stress and coping. Novel and bizarre behaviors, novel and bizarre thoughts, negative evaluations of self and role, perceived threats to physical well-being, and wit were common antecedents fostering tension in the form of anxiety, frustration, fear, and puzzlement. Students used cognitive appraisal and humorous coping to mediate the stressful person-environment relations for positive outcomes. The cognitive and behavioral efforts to manage these emotions in a humorous manner were identified.     

Primary headache and sleep disturbances in adolescents

OBJECTIVE: The aim of the present study was to assess sleep patterns and the prevalence of sleep problems in adolescents with primary headaches using a validated sleep screening instrument, as well as to test the association between headache and pain features and adolescent sleep behaviors. BACKGROUND: Sleep disturbance is a common complaint that has long been associated with primary headaches, but there exists limited evidence of the headache-sleep relationship among teens. METHODS: Sixty-nine adolescents aged 13 to 17 years (M= 14.7; SD= 1.4) were evaluated for headaches at 2 pediatric neurology departments (90% migraine; 10% tension-type headache diagnoses). Participants completed the School Sleep Habits Questionnaire and a standardized questionnaire regarding headache characteristics. RESULTS: Sleep complaints were prevalent among adolescents with headaches including insufficient total sleep (65.7%), daytime sleepiness (23.3%), difficulty falling asleep (40.6%), and night wakings (38%). Statistically significant relationships between headache characteristics (eg, frequency, pain intensity) and teen sleep behaviors also emerged. CONCLUSIONS: Our findings provide further support for an association between headache and sleep disturbances among adolescents with primary headaches. This information may provide further understanding of the nature and course of the patient's headache experience, as well as facilitate treatment planning to include recommendations for promoting good sleep hygiene.     

A mother’s reflections of living with an adolescent drug abuser: A case report

Background: Mothers of adolescents with substance abuse problems experience significant distress as a result of the adolescent’s behaviours. Methods: Using an interpretative phenomenological methodology, this paper describes the lived experience of a mother coping with an adolescent who has a drug use problem in the form of a case report. Results: The mother experienced a range of psychosocial challenges in trying to cope with her son’s behaviour and her own emotional distress. This included a desperate cry for help in the form of an attempt at suicide which ultimately led her to obtain the support she required to attend to her distress. Conclusion: The findings are discussed in relation to the literature with the intention to draw attention to the importance of coping support for mothers affected by adolescent substance abuse.     

Recurrent Tension Headache in Adolescents Treated with Self-Help Relaxation Training and a Muscle Relaxant Drug

Forty-eight adolescents suffering from recurrent tension headache participated in a controlled trial conducted in a high school setting. During the first treatment phase self-help relaxation training was compared with a waiting-list group. Following this phase a pharmacological regimen consisting of a muscle relaxant (chlormezanone) and placebo was superimposed on relaxation therapy in a double-blind crossover design. Each treatment phase encompassed a 5-week period. In addition to the evaluation of headache complaints, psychological distress among students was measured with respect to their experience of somatic complaints, depressive, anxiety and stress symptoms. Although self-help relaxation training significantly decreased the severity and annoyance of adolescents' headache besides their somatic complaints, the clinical improvement of headache was modest. The addition of chlormezanone did not help those who were nonresponders to self-help relaxation training. Finally, a set of pretreatment variables consisting of baseline headache severity and annoyance, experience of anxiety and daily life stress among adolescents could predict outcome of self-help relaxation therapy.     

Do's and Don'ts In Working With Adolescents

The adolescent must be considered by the physician as a human being who is at a particular stage of life where he/she is examining his/her own life style, where he/she is questioning the societal values of adults, where he/she is feeling the frustration of having ideas and interests which are either not heard or for some reason cannot be pursued. In most situations these young people are interested in resolving their problems, whether physical, psychological or both. Indeed, in many adolescents the line between physical and psychological problems is very thin. Even in situations where a clear cut diagnosis can be made, failure to look at how the adolescent is coping with school and/or work, reacting and interacting with peers and family, understanding pubertal onset, coping with reality etc. may result in future problems which could have been prevented had the adolescent been encouraged to look at that situation early. As physicians we must be careful not to treat adolescents as overgrown children or immature adults.     

Headache and neck or shoulder pain - frequent and disabling complaints in the general population

Objective - to describe the prevalences of reported headache and neck or shoulder pain as unspecified complaints, and to explore the consequences of these complaints measured as unfitness for work.

Design - self-administered questionnaire as part of a general health screening.

Setting - all persons aged between 20 and 56 years, in the municipality of Tromsø were invited. Of 29026 invited, 21826 attended, and of these 20026 answered the questionnaire. Some 17700 answered the questions on headache, and 17650 on neck or shoulder pain.

Results - 6.0% of the males reported weekly or more frequent headache, and 15.4% reported neck or shoulder pain. The corresponding prevalences in women were 13.1% and 24.9%. This female preponderance was present also among subjects expressing the complaints daily or monthly. The prevalences of reported neck or shoulder pain increased significantly with age, while the prevalences of reported headache were not influenced by age. Of the subjects with weekly headache, as many as 30% of both sexes reported being »seriously hampered or unable to perform ordinary work«.

Conclusions - many people in the general population live with disabling complaints, but the numbers seeking medical care for them are far fewer. It is important to demonstrate the high prevalence of headache and neck or shoulder pain, and also to understand the complexity of the causal factors, and the reason why only a proportion of sufferers seek professional help.     

Loneliness in children and adolescents

Feeling lonely is a sad but relatively common experience for children, adolescents, and adults. When loneliness becomes a frequently occurring phenomenon, there are serious implications for emotional and physical well-being. The concept of loneliness can be described in relation to psychosocial development. Loneliness in children and adolescents is a relatively new research topic. In this paper the author reviews research for both age groups. Pediatric nurses should recognize the importance of identifying children and adolescents at high risk for the development of chronic loneliness. Nursing interventions for assisting the lonely child or adolescent are described briefly.     

Relationships of age and gender to hope and spiritual well-being among adolescents with cancer.

The purpose of this study was to examine hope and spiritual well-being, with its 2 dimensions of religious well-being and existential well-being, as they relate to age and gender among adolescents with cancer. A cross-sectional design was guided by the conceptual framework, Adolescent Psychosocial Adaptation to the Cancer Experience. A total of 78 adolescents with a diagnosis of cancer were enrolled from 2 pediatric oncology clinics. Middle adolescents (15-17 years of age) reported higher religious well-being than late adolescents (18-20 years of age). Middle-adolescent boys were more hopeful than were early adolescent boys (13- 14 years of age). Also, girls were more hopeful and reported higher spiritual well-being than age the boys. Developmental phase and/or gender may influence adolescents' levels of hope, spiritual well-being, religious well-being, and existential well-being as they cope during the cancer experience. The nurse should consider developmental phase and gender when planning interventions to foster hope and spiritual well-being in adolescents' adaptations to the cancer experience.     

Catastrophizing and pain-coping in young adults: associations with depressive symptoms and headache pain.

Cognitive and behavioral pain-coping strategies, particularly catastrophizing, are important determinants of the pain experience. Most studies of pain-coping are performed in samples of treatment-seeking patients with longstanding pain complaints. Individual differences in pain-coping styles may also significantly affect day-to-day pain and quality of life in nonclinical samples, though this has rarely been investigated. In particular, headache pain is common in the general population, and little is known about how pain-related coping affects pain and quality of life among headache sufferers from a nonclinical setting. In this study, 202 generally healthy subjects were divided into 2 groups, those who reported problem headaches and pain-free control subjects. Reports of pain-related catastrophizing and the use of active pain-coping strategies did not differ between the groups, but differential associations between pain-coping strategies and emotional functioning were observed. Specifically, within the headache group only, those reporting higher levels of pain catastrophizing and lower levels of active pain-coping showed the highest level of depressive symptoms. Further, higher catastrophizing was associated with greater headache pain and pain-related interference. These findings suggest that catastrophizing has little influence on emotional functioning in those without ongoing pain complaints and highlight the importance of coping in modulating the consequences of pain on day-to-day functioning, even in samples from nonclinical settings. Moreover, these findings indirectly suggest that interventions that increase adaptive coping and decrease catastrophizing may help to buffer some of the deleterious functional consequences of headache pain. PERSPECTIVE: This study adds to a growing literature that conceptualizes catastrophizing as a diathesis, or risk factor, for deleterious pain-related consequences. These data suggest that catastrophizing may require the presence of a pain condition before its detrimental effects are exerted.     

Headache as a Stressor: Dysfunctional versus Adaptive Coping Styles

The common stressor faced by all headache sufferers is the headache itself. Dysfunctional headache coping styles can be classified as sensitizing (hypervigilance and anticipation, catastrophizing, hyperempathy) or minimizing (alexithymia, stoic denial, anger suppression). Dysfunctional coping often takes place in an interpersonal context (theater of pain), marked by excessive pain behavior and embellishment, catastrophizing and hypervigilance in the family, stoicism and misinterpretation of pain, pain language as a substitute for emotional expression, or enabling of disability and pseudo-coping. More adaptive coping styles include balanced use of distraction and body awareness, strategic proactive coping, balanced interpersonal discussion of pain, and pain acceptance. In addition to headache-related research on coping styles, this article reviews relevant studies from neuroimaging, non-headache chronic pain disorders, and clinical experience in a comprehensive, multidisciplinary headache center.     

Predicting disability and quality of life in a community-based sample of women with migraine headache

Migraine is a significant pain problem for almost one third of women in the United States. Little previous research has been conducted regarding the effects of migraine headache on the lives of women migraineurs. The purpose of this report is to determine the contribution of coping, depressive symptomatology, and the chronic pain experience on disability and quality of life in women with migraine. Two hundred and forty-seven women responded to a mailed survey about migraine headache, the chronic pain experience, coping, depressive symptomatology, and quality of life. Data were collected with the following: the Classification and Diagnostic Criteria for Headache Disorders, Cranial Neuralgias, and Facial Pain; the McGill Pain Questionnaire; the Chronic Pain Experience Instrument-Headache; the Coping Strategies Questionnaire; the Center for Epidemiologic Studies-Depression Scale; the Henry Ford Hospital Disability Inventory; and the Migraine-Related Quality of Life Questionnaire. Multiple regression analyses were conducted to determine the amount of variance that could be explained by selected predictor variables. Women ranged in age from 18 to 66 years and migraineurs reported suffering from migraine from 1 to 54 years. Nearly half of the migraineurs (41.5%) reported migraine headaches occurring monthly, and almost a quarter of the sample reported weekly migraines. Migraines were reported to last for several hours (53.4%). Results indicate that migraine headache pain was typically severe and throbbing, lasting for hours to days. The coping, depressive symptomatology, disability, and quality-of-life variables were all significantly correlated. Two separate regression analyses that examined predictor variables and the criterion variables, disability and quality of life, showed that a significant amount of both constructs could be explained by the predictor variables in the model tested. In the first regression analysis, depressive symptomatology, the chronic pain experience, and migraine headache pain accounted for 62.9% of the variance in disability. In the second regression analysis, 64.8% of the variance in quality of life was accounted for by depressive symptomatology, migraine headache pain, and the chronic pain experience. The variance in both outcome variables, disability and quality of life, was accounted for by similar predictor variables: depressive symptomatology, the chronic pain experience, and migraine headache pain. Further study is needed to determine specific personal and illness-related factors, pain characteristics, and coping strategies used that may predict outcomes of migraine headache such as disability, quality of life, helplessness, and other as yet unidentified effects of migraine headache.     

A comparison of the coping and restructuring components of cognitive restructuring

Cognitive restructuring can be thought of as having two goals: a coping goal, in which individuals learn to cope more effectively with a stressful situation using such means as coping self-statements, and a restructuring goal, in which individuals change their beliefs about events, so that formerly stressful situations will no longer be stressful. These two goals were contrasted in a treatment outcome study employing test-anxious subjects who were assigned (a) to a coping treatment, which taught coping self-statements to be used in a test situation, (b) to a restructuring treatment, which involved discussion of general beliefs about evaluation, or (c) to a waiting list control. Outcome measures of test anxiety, irrational beliefs, and thoughts 1 hour before a final exam each showed treatment effects. Though the treated groups did not differ from each other on these measures, the coping group showed more improvement relative to the control group. The results for the two cognitive measures, chosen to reflect the different goals of the two treatments, did not directly correspond to treatment content, suggesting that the change processes resulting from a treatment cannot be predicted from the content of the treatment procedures alone.The author wishes to thank Michael Mahoney, Thomas Borkovec, Carol Glass, Linda Craighead, and Walter Weimer for their helpful comments; Jan Cavanaugh for serving as a therapist; and John Baycer, Patty Framo, Cliff Notarius, Ro Nwranski, Andie Smith, and Al Rosenthal for assistance in various aspects of the study.     

Burnout of therapists: inevitable or preventable?

The burnout syndrome is defined as a feeling of emotional and physical exhaustion coupled with a sense of frustration and failure. The common behavioral manifestations of burnout are described and possible antecedents detailed, including unrealistic goal setting and work overload. Mechanisms for coping with or preventing burnout are discussed and grouped into organizational and personal responses. Among these are recognition of the problem, reduction of overload, and acceptance of the fact that not all patients return to normal function.