This study evaluated the importance of modeling and performance accomplishment of behavior on enhancing headache management self-efficacy and increasing acquisition and implementation of four headache self-management behaviors: headache diary use, limiting medication overuse, relaxation, and stretching. Primary headache disordered patients (n = 51) were randomly assigned to 3 conditions: self-efficacy videotape treatment (SET; education + modeling and performance of behavior), information-only videotape treatment (IOT; education only), or no-treatment comparison (NTC). The SET group reported higher self-efficacy scores than the NTC at immediate post-treatment. At 1-month follow-up, the SET group reported more headache diary use than the IOT and NCT groups, whereas both the SET and IOT groups reported more frequent performance of the relaxation and stretching behaviors than the NTC group. Despite a smaller sample size, the SET treatment produced a slight increase in headache management self-efficacy immediately after treatment, as well as increased performance of three of the four headache management behaviors at 1-month follow-up. A reduction in self-efficacy following the immediate posttreatment period suggests that multiple treatment exposure may be necessary to effect long-lasting change with respect to self-efficacy, behavioral performance and ultimately changes in headache activity. Although limited in their ability to provide feedback and reinforcement, the potential benefits for patients and health care professionals warrant continued development and study of behavior theory-driven self-help treatment for headache. Future studies should include a larger sample that consists of motivated patients with less severe headache problems who may be more apt to benefit from such theory-driven strategies.




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