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The Use of a Habit Reversal Treatment for Chronic Facial Pain in a Minimal Therapist Contact Format

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The Use of a Habit Reversal Treatment for Chronic Facial Pain in a Minimal Therapist Contact Format Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 1999 The Use of a Habit Reversal Treatment for chronic Facial Pain in a Minimal Therapist Contact Format Donald R. Townsend Virginia Commonwealth University Follow this and additional works at: https://scholarscompass.vcu.edu/etd Part of the Psychology Commons © The Author Downloaded from https://scholarscompass.vcu.edu/etd/1202 This Dissertation is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. The Use of a Habit Reversal Treatment for Chronic Facial Pain in a Minimal Therapist Contact Format A dissertation submitted for partial fulfillment of ihe requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. by Donald R. Townsend Bachelor of Arts, University of Minnesota, 199 1 Master of Arts, Mankato State University, 1994 Director: Sandra E. Gramling, Ph.D. Associate Professor, Department of Psychology Virginia Commonwealth University Richmond, Virginia December 1999 Table of Contents Page List of Abbreviations ................................ .. ............................................................... viii List of Figures .................................................................................................................. ix List of Tables ................................................................................................................... x Abstract ............................................................................................................................ xi Introduction ........................................................................................................................ 1 Temporomandibular Joint Dysfunction ................................................................. 2 Anatomy of TMD ..................................................................................... 2 Signs and Symptoms of TMD .................................................................... 3 Prevalence of TMD .................................................................................... 4 Psychological Characteristics of Individuals with TMD ........................... 5 Etiology .............................................................................................................................. 8 Stress and TMD Pain ....................................... .................................................... 11 Masseter Muscle Hyperactivity ......................................................................... 12 Stress Reactivity Studies ...................................................................... 12 Treatments Targeting Muscle Hyperactivity ........................................... 14 Maladaptive Oral Habits and Masseter Pain ........................................................ 15 Summary of Theoretical Evidence ....................................................................... 17 Treatment of TMD ........................................................................................................... 19 Treatments .................................................................................. 19 iii iv Psychological Treatments .................................................................................... 20 Progressive Relaxation Training .............................................................. 21 Negative Practice ................................................................................ 22 Biofeedback ........................................................................................... 22 Cognitive Modification ............................................................................ 25 Multi-component Treatments ................................................................... 26 Habit Reversal .......................................................................................... 28 Steps in Habit Reversal ................................................................ 28 Oral Habit Reversal ...................................................................... 29 Oral Habit Reversal in Group Treatment Designs ........................ 30 Minimal Contact Therapy ............................................................................................... 34 Definitions ......................................................................................................... 34 RationaIe for MCT ...................................,,..... ..................................................... 36 Uses of MCT in Clinical Psychology .................................................................. 39 Anxiety Disorders ................................................................................... 39 Oral Problem Behaviors ........................................................................... 42 Other Disorders ............................,,,......................................................... 44 Pain Disorders .......................................................................................... 44 Headaches .................................................................................... 44 Temporomandibular Disorders .................................................... 46 Method of Treatment Delivery ..................................................................................... 48 Statement of Problem and Hypotheses Hypotheses Primary Outcome Variables .................................................................... 53 Hypothesis # 1 .............................................................................. 53 Hypothesis #2 .............................................................................. 53 Hypothesis #3 ............................................................................... 54 Secondary Outcome Variables ................................................................. 54 Hypothesis #4 ...............................................................................54 Hypothesis #5 .......................................................................... 55 Method ............................................................................................................................. 56 Participants Acknowledgment The author wishes to express his thanks for the following. I want to thank God for giving me the ability, motivation, and dedication to accomplish such an arduous task, as well as providing me with constant strength during difficult times. I want to thank my wife, C yndy, for her support. If it had not been for graduate school and the grace of God, we would not be married today. Cyndy is the best thing that has ever happened to me. 1 also thank my advisor, Dr. Sandra E. Gramling, for being a role model, colleague, and good friend. She made my graduate school experience tolerable. I hope to maintain our personal and professional relationship for many years to come. Sample Characteristics ............................................................................. 56 Procedures ............................................................................................................ 57 Recruitment .............................................................................................. 57 Initial Screening ....................................................................................... 59 Initid Assessment .................................................................................... 60 Instruments ............................................................................................... 61 Weekly Facial Pain Diary ............................................................ 61 Oral Habits Questionnaire ............................................................ 61 Hassles Scale ................................................................................ 62 State-Trait Anxiety Inventory ...................................................... 63 Brief Symptom Inventory ............................................................ 63 West Haven-Yale Multidimensional Pain Inventory ................... 63 Treatment Expectations Questionnaire ........................................ 64 Facial Pain Treatment Rating Form ............................................. 65 Random Assignment ................................................................................ 66 Initial TherapisKlient Contact ................................................................ 66 Treatment Length .................................................................................... 68 Treatment Protocol ............................................................................... 69 Minimal Contact Therapy ............................................................ 72 Wait-list Control Condition .................................................... 76 Treatment Fidelity .............................................................................. 77 Therapist .................................................................................................. 78 Results .............................................................................................................................. 79 Treatment Expectations ....................................................................................... 80 Pre-treatment Comparisons .................................................................................
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