Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Dr. Malcolm Robertson

Second Advisor

Dr. R. Wayne Fuqua

Third Advisor

Dr. Chris Koronokos

Fourth Advisor

Dr. Thomas Van Den Abell


The purpose of the study was to compare the relative efficacy and cost-efficiency of two reduced-therapist-contact formats for delivery of a behavioral package to treat chronic headaches. The 8-week treatment was delivered in a group-administered format to one treatment group and in a self-administered format to a second. A waiting-list control group was also included. Treatment components included education about headaches and their precipitants, relaxation training, and cognitive-behavioral stress management techniques. The participants in the study suffered from migraine, mixed, or tension headaches. Eleven subjects were assigned to each of the 3 treatment conditions. At posttreatment subjects in the group-administered (GA) and self-administered (SA) treatments showed 56.3% and 54.5% reductions in headache activity, respectively. Subjects in the waiting-list control (WLC) showed a 7.2% reduction. Statistically, the treatment groups differed significantly from the WLC at posttreatment, but not from each other. At a 6 month follow-up the GA group maintained a 52.8% reduction, while the SA group maintained only a 32.6% decrease. These differences were not statistically significant within either group, nor did the 2 groups differ significantly from each other at follow-up. Both treatments were found to be highly cost-effective and did not differ significantly from each other in this respect. However, the attrition rate was 45% for the SA condition compared to 18% for the GA condition. While subjects can benefit from both treatment formats, logistical aspects of treatment delivery and possibly reduced attrition rates favor the group-administered treatment format within this study. Overall, the study provides further evidence that minimal-contact treatments hold considerable promise as effective and cost-efficient methods in the treatment of chronic headaches.

Access Setting

Dissertation-Open Access