The e-diaries evaluated in this research would prove a useful tool in clinical trials of behavioral treatment for headaches.

Using multiple extinction contexts in combination with other methods of attenuating renewal (e.g., context similarity) may provide a means to reduce the risk of renewal of fear.

Objective: Traditionally, the standard advice to individuals suffering from migraine and tension-type headache was that the best way to prevent headaches is to avoid the triggers. This advice has been challenged in recent years and the Trigger Avoidance Model of Headache has been proposed, which suggests that one pathway to developing a headache disorder is by avoiding triggers resulting in trigger sensitization. The objective of the study was to evaluate a novel intervention for primary headache comprising a new approach to trigger management that includes exposure to some triggers with the goal of trigger desensitization (learning to cope with triggers [LCT]) integrated into a cognitive-behavioral therapy (CBT) program (LCT/CBT). Method: The study was a randomized controlled trial comparing LCT/ CBT to the same treatment program but using the traditional approach to trigger management of encouraging trigger avoidance (avoid/CBT), and to a waiting-list/treatment-as-usual control condition (WL/ TAU). Adults suffering from primary headache (88 female/35 male) were allocated to the three conditions. Results: The three groups significantly differed from baseline to posttreatment on the primary outcome measure of attack frequency, and LCT/CBT significantly differed from WL/TAU but Avoid/CBT did not. Similar results were obtained on the secondary outcome measures, and treatment gains were maintained at 4-and 12-month follow-up. Conclusions: The results suggest the value of using LCT as a component of a CBT program but were not conclusive as the direct comparisons between the two treatment conditions failed to reach statistical significance. The findings support a study of LCT/CBT with a larger sample.

ObjectivesThe present paper proposed and tested a methodology for reducing individual's threat response to compassion‐imagery, by increasing their levels of state attachment‐security.DesignA total of 68 University students (63% female, mean age = 25) completed an experimental study, where they were randomly assigned to either a 10‐min attachment‐prime (to enhance attachment‐security) or an interpersonal skills module (control condition).MethodsParticipants completed a compassion‐focused imagery exercise before and after the manipulation, to determine the effects of the attachment‐prime. To measure the effects of the manipulation on individual's threat response, heart rate variability data were collected at baseline and during both compassion exercises.ResultsAs predicted, individuals who reported higher levels of anxious and avoidant attachment styles were more likely to display a threat response (decreases in heart rate variability), to the first compassion‐focused imagery. After receiving an attachment‐prime, heart rate variability increased suggesting that individual's experienced greater self‐soothing responses and decreased threat responses to the second compassion‐focused imagery.ConclusionsThe present findings suggest that individuals with insecure attachments are likely to require additional support increasing their attachment‐security, before they can successfully engage in compassion‐based exercises or therapies.Practitioner points Compassion‐based exercises may result in fear and consequently avoidance in some populations of individuals. Threat responses to compassion can be reduced by using attachment‐based techniques. Research findings will help inform and broaden the clinical applicability of compassion‐based therapies.