Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

Migraine is a disabling neurological disorder with high prevalence, the clinical manifestations of which are highly dependent on stress. The overall theme of the present thesis was to address aspects of stress in migraine. A multimodal behavioral treatment (MBT) program was developed specifically designed for migraine and focusing on stress as a trigger and an intervention was performed using this Internet-administered program. Migraine symptoms were followed via an Internet administered diary and questionnaires were answered at regular intervals during the 11-month study period. The thesis is based on four papers: In Paper I, life events and current stress, personality traits, and gender were studied cross-sectionally in 106 women and 44 men with migraine, who suffered at least two attacks a month at inclusion. Paper II describes a randomized controlled trial of the MBT program performed on 58 women and 25 men recruited from participants of the study described in Paper I. In the MBT study participants were randomized into one control group and two MBT groups, one of which received hand massage as part of the treatment. In Paper III, complete migraine drug use and changes in use and in drug efficacy during the MBT program were studied. In Paper IV, the salivary cortisol levels of MBT participants were evaluated as a biological stress marker. The MBT program proved effective in decreasing migraine headache; it was feasible and there was low attrition. Moreover, MBT resulted in decreased migraine drug use and increased drug efficacy, but had no discernible effects on salivary cortisol profiles. No effect of hand massage on migraine headache frequency was seen. Personality trait profiling revealed high scores for the neuroticism factor. Stress susceptibility was the single most aberrant personality trait and correlated highly with the reported level of current stress and with experienced negative life events. Gender differences included higher scores for women on trait anxiety, negative life events, depressive mood, anxiety, tension type headache, use of triptans, and efficacy of analgesics, whereas men displayed higher use of analgesics. In conclusion, the efficacy and low attrition associated with the present MBT program appears promising and timely with regard to the development of better and more accessible migraine treatment. Stress susceptibility, gender, negative life events and psychosomatic comorbidity are important factors to consider in relation to the care of persons with migraine.

Intensive in-home services is a family-centered, strength-based intervention program offering comprehensive treatment that includes family therapy, mental health treatment and parenting skills for caregivers, development of positive social systems, and assistance with accessing community resources for long-term support (Youth Villages, 2013b). Framed on family system theory, Intensive-In Home Services (IIHS) was developed from Cognitive Behavioral Therapy, Functional Family Therapy, Social Development, and Crisis Intervention models as a means to modify behaviors that place youth at risk for out-of-home placement. The socio-historical development of these models is examined in the literature review. Intensive in-home services is a family-centered, strength-based intervention program offering comprehensive treatment that includes family therapy, mental health treatment and parenting skills for caregivers, development of positive social systems, and assistance with accessing community resources for long-term support (Youth Villages, 2013b). Framed on family system theory, Intensive-In Home Services (IIHS) was developed from Cognitive Behavioral Therapy, Functional Family Therapy, Social Development, and Crisis Intervention models as a means to modify behaviors that place youth at risk for out-of-home placement. The socio-historical development of these models is examined in the literature review. The purpose of this study was to evaluate predictors that may influence outcome measures of a youth’s inclination to remain in the home after having received IIHS treatment. The significant predictors were determined to be age, race, and total length of service received. The study sampled 3,131 youth ages birth through 17 who received IIHS services in Tennessee over a 10-year period and were discharged from July 2001 to July 2010. The study was limited to youth designated under Comprehensive Child and Family Treatment (CCFT), which is classified as part of TennCare coverage. The primary goal of CCFT is to empower families to monitor and manage mental health needs and high-risk youth behaviors in order to provide permanency and longterm stability in the natural home environment (UnitedHealthcare, 2012).

No description available.