Depression, Automatic Thoughts, Alexithymia, and Assertiveness in Patients With Tension-type Headache
Basak Yücel MD
From the Departments of Psychiatry, University of Istanbul
Department of Anesthesiology, Division of Algology, University of Istanbul
Search for more papers by this authorSüleyman Özyalçín MD
Department of Anesthesiology, Division of Algology, University of Istanbul
Search for more papers by this authorNilüfer Alçalar PhD
From the Departments of Psychiatry, University of Istanbul
Search for more papers by this authorAysen Yücel MD
From the Departments of Psychiatry, University of Istanbul
Department of Anesthesiology, Division of Algology, University of Istanbul
Search for more papers by this authorBasak Yücel MD
From the Departments of Psychiatry, University of Istanbul
Department of Anesthesiology, Division of Algology, University of Istanbul
Search for more papers by this authorSüleyman Özyalçín MD
Department of Anesthesiology, Division of Algology, University of Istanbul
Search for more papers by this authorNilüfer Alçalar PhD
From the Departments of Psychiatry, University of Istanbul
Search for more papers by this authorAysen Yücel MD
From the Departments of Psychiatry, University of Istanbul
Department of Anesthesiology, Division of Algology, University of Istanbul
Search for more papers by this authorAbstract
Objective.—The role of psychological factors related to headache has long been a focus of investigation. The aim of this study was to evaluate depression, automatic thoughts, alexithymia, and assertiveness in persons with tension-type headache and to compare the results with those from healthy controls.
Methods.—One hundred five subjects with tension-type headache (according to the criteria of the International Headache Society classification) and 70 controls were studied. The Beck Depression Inventory, Automatic Thoughts Scale, Toronto Alexithymia Scale, and Rathus Assertiveness Schedule were administered to both groups. Sociodemographic variables and headache features were evaluated via a semistructured scale.
Results.—Compared with healthy controls, the subjects with headache had significantly higher scores on measures of depression, automatic thoughts, and alexithymia and lower scores on assertiveness. Subjects with chronic tension-type headache had higher depression and automatic thoughts scores than those with episodic tension-type headache.
Conclusions.—These findings suggested that persons with tension-type headache have high depression scores and also may have difficulty with expression of their emotions. Headache frequency appears to influence the likelihood of coexisting depression.
REFERENCES
- 1 Arena JG, Andrasik F, Blanchard EB. The role of personality in the etiology of chronic headache. Headache. 1985; 25: 296-301.
- 2 Puca FM, Antonaci F, Genco S, Savarese MA, Piazzolla G, Prudenzano MP. Psychologic factors in chronic headache: assessment by means of the SCL-90-R inventory. Cephalalgia. 1989; 9: 33-51.
- 3 Merikangas KR, Stevens DE, Angst J. Headache and personality: results of a community sample of young adults. J Psychiatr Res. 1993; 27: 187-196.
- 4 Marazziti D, Toni C, Pedri S, et al. Headache, panic disorder and depression: comorbidity or a spectrum? Neuropsychobiology. 1995; 31: 125-129.
- 5 Guidetti V, Galli F, Fabrizi P, et al. Headache and psychiatric comorbidity: clinical aspects and outcome in an 8-year follow-up study. Cephalalgia. 1998; 18: 455-462.
- 6 Hatch JP, Schoenfeld LS, Boutros NN, Seleshi E, Moore PJ, Cyr-Provost M. Anger and hostility in tension-type headache. Headache. 1991; 31: 302-304.
- 7 Shulman BH. Psychiatric aspects of headache. Med Clin North Am. 1991; 75: 707-715.
- 8 Beck AT, Rush AJ, Shaw BF, et al. Cognitive Therapy of Depression. An Overview. 1st ed. New York, NY: Guilford Press; 1984: 1-33.
- 9 Lefebvre MF. Cognitive distortion and cognitive errors in depressed psychiatric and low back pain patients. J Consult Clin Psychol. 1981; 49: 517-525.
- 10 Sifneos PE. The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychother Psychosom. 1973; 22: 255-262.
- 11 Acklin MW, Alexander G. Alexithymia and somatization. A Rorschach study of four psychosomatic groups. J Nerv Ment Dis. 1988; 176: 343-350.
- 12 Nemiah JC, Sifneos PE. Psychosomatic illness: a problem in communication. Psychother Psychosom. 1970; 18: 154-160.
- 13 Taylor GJ, Parker JD, Bagby RM, Acklin MW. Alexithymia and somatic complaints in psychiatric out-patients. J Psychosom Res. 1992; 36: 417-424.
- 14 Wise TN, Mann LS, Jani N, Jani S. Illness beliefs and alexithymia in headache patients. Headache. 1994; 34: 362-365.
- 15 Houpt JL. Chronic pain management. In: A Stoudemire, BS Fogel, eds. Principles of Medical Psychiatry. Orlando, Fla: Grune & Stratton Inc; 1987: 389-403.
- 16 Cox BJ, Kuch K, Parker JD, Shulman ID, Evans RJ. Alexithymia in somatoform disorder patients with chronic pain. J Psychosom Res. 1994; 38: 523-527.
- 17 Catchlove FH, Cohen KR, Braha RE, Demers-Desrosiers LA. Incidence and implications of alexithymia in chronic pain patients. J Nerv Ment Dis. 1985; 173: 246-248.
- 18 Voltan N. Study on validity and reliability of Rathus Assertiveness Schedule. J Psychol. 1980; 10: 23-25.
- 19 Aytar G, Inceoglu D. Research on a group of high school and university students on assertiveness and anxiety. Paper presented at: 22nd National Psychiatry Congress; 1986; Marmaris.
- 20 Jensen R, Sandrini G. Chronic tension-type headache. In: J Olesen, P Tfelt-Hansen, KMA Welch, eds. The Headaches. New York, NY: Raven Press, Ltd; 1993: 503-508.
- 21 Merskey H, Spear FG. Pain. Psychological and Psychiatric Aspects. Plymouth, London: Latimer Trend & Co Ltd; 1967: 46-54.
- 22 France RD, Krishnan KR, Houpt JL, Maltbie AA. Personality and chronic pain. In: RD France, KR Krishnan, eds. Chronic Pain. Washington, DC: American Psychiatric Press, Inc; 1988: 77-102.
- 23
Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain.
Cephalalgia. 1988; 8(suppl 7): 29-32.
10.1111/j.1468-2982.1991.tb00023.x Google Scholar
- 24 Tegin B. Cognitive disorders in depression: a research based on Beck's model. J Psychol. 1987; 6: 116-123.
- 25
Sahin NH,
Sahin N.
Reliability and validity of the Turkish version of the Automatic Thoughts Questionnaire.
J Clin Psychol. 1992; 48: 334-340.
10.1002/1097-4679(199205)48:3<334::AID-JCLP2270480311>3.0.CO;2-P CASPubMedWeb of Science®Google Scholar
- 26 Dereboy IF. A Study on Psychometric Features of Self-rating Scales for Alexithymia [dissertation]. Ankara, Turkey: University of Hacettepe; 1990.
- 27 Dereboy IF. Alexithymia. Turkish J Psychiatry. 1990; 1: 157-165.
- 28 Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4: 561-571.
- 29 Hollan SD, Kendal PC. Cognitive self-statements in depression: development of an Automatic Thoughts Questionnaire. Cog Ther Res. 1980; 4: 383-395.
- 30 Rathus AS, Nevid JS. Concurrent validity of the 30-item Assertiveness Schedule with a psychiatric population. Behav Ther. 1977; 8: 393-397.
- 31 Barolin GS. Headache and (concomitant) depression. Psychopathology. 1986; 19(suppl 2): 165-171.
- 32 Ho KH, Ong BK, Lee SC. Headache and self-assessed depression scores in Singapore University undergraduates. Headache. 1997; 37: 26-30.
- 33
Turner JA,
Romano JM.
Self-report screening measures for depression in chronic pain patients.
J Clin Psychol. 1984; 40: 909-913.
10.1002/1097-4679(198407)40:4<909::AID-JCLP2270400407>3.0.CO;2-J CASPubMedWeb of Science®Google Scholar
- 34 Haythornthwaite JA, Sieber WJ, Kerns RD. Depression and chronic pain experience. Pain. 1991; 46: 177-184.
- 35 Holroyd KA, Stensland M, Lipchik GL, Hill KR, O'Donnell FS, Cordingley G. Psychosocial correlates and impact of chronic tension-type headaches. Headache. 2000; 40: 3-16.
- 36 Verri AP, Proietti Cecchini A, Galli C, Granella F, Sandrini G, Nappi G. Psychiatric comorbidity in chronic daily headache. Cephalalgia. 1998; 18(suppl 21): 45-49.
- 37 Demjen S, Bakal DA, Dunn BE. Cognitive correlates of headache intensity and duration. Headache. 1990; 30: 423-427.