Access Type

Open Access Thesis

Date of Award

January 2012

Degree Type


Degree Name




First Advisor

Mark A. Lumley


Chronic headache (HA), a common condition among young adults, is exacerbated by stress. Arousal reducing techniques, such as relaxation training (RT), are moderately effective as stress-management techniques. Suppression of negative emotions, such as anger, has also been shown to worsen stress and pain. Previously, our laboratory found that an innovative 3-session, group-based anger awareness and expression training (AAET) intervention was comparable to group relaxation training (RT) in improving outcomes in HA, and both treatments were more beneficial than no intervention. However, it is likely that individuals respond differently to these interventions. A person's baseline emotion regulation abilities, assertiveness, and ambivalence over emotional expression likely influence their response to these interventions. Therefore, secondary analyses were conducted to explore how alexithymia and it's facets (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking), ambivalence over anger expression, and assertiveness, moderated the effects of AAET, RT, compared with each other and no intervention.

A sample of 127 young adults with chronic HA were randomized to 1 of the 3 conditions (AAET, RT, or no-intervention control), and headache frequency, severity, and duration, physical symptoms, and affect were assessed at baseline and 6-week follow-up. Results indicated that AAET is beneficial at reducing headache symptoms, physical health problems, and anxiety for individuals who have difficulty identifying feelings and difficulty describing feelings, whereas RT has very minimal benefits for these individuals. In contrast, externally oriented thinking predicted greater physical symptoms after AAET compared to RT. Results also demonstrated that AAET is beneficial at reducing headache severity for individuals who are ambivalent over anger expression. Furthermore, AAET was effective at increasing positive affect for individuals who have a high baseline levels of assertiveness, but not useful for individuals with low assertiveness. These findings suggest that a brief, group-based intervention that incorporates anger awareness and expression skills can be beneficial for a subset of individuals with chronic HA.

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