{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T22:02:12Z","timestamp":1767650532343,"version":"build-2065373602"},"reference-count":34,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T00:00:00Z","timestamp":1678406400000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore whether the association between change in headache management self\u2010efficacy and posttraumatic headache\u2013related disability is partially mediated by a\u00a0change in anxiety symptom severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Many cognitive\u2013behavioral therapy treatments for headache emphasize stress management, which includes anxiety management strategies;\u00a0however, little is currently known about mechanisms of change in posttraumatic headache\u2013related disability. Increasing our understanding of mechanisms could lead to improvements in treatments for these debilitating headaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study is a secondary analysis of veterans (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a0193) recruited to participate in a randomized clinical trial of cognitive\u2013behavioral therapy, cognitive processing therapy, or treatment as usual for persistent posttraumatic headache. The direct relationship between headache management self\u2010efficacy and headache\u2010related disability, along with partial mediation through change in anxiety symptoms was tested.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mediated latent change direct, mediated, and total pathways were statistically significant. The path analysis supported a significant direct pathway between headache management self\u2010efficacy and headache\u2010related disability (\n                      <jats:italic>b<\/jats:italic>\n                      \u00a0=\u00a0\u22120.45,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; 95% confidence interval [CI: \u22120.58, \u22120.33]). The total effect of change of headache management self\u2010efficacy scores on change in Headache Impact Test\u20106 scores was significant with a moderate\u2010to\u2010strong effect (\n                      <jats:italic>b<\/jats:italic>\n                      \u00a0=\u00a0\u22120.57,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001; 95% CI [\u22120.73, \u22120.41]). There was also an indirect effect through anxiety symptom severity change (\n                      <jats:italic>b<\/jats:italic>\n                      \u00a0=\u00a0\u22120.12,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.003; 95% CI [\u22120.20, \u22120.04]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this study, most of the improvements in headache\u2010related disability were related to increased headache management self\u2010efficacy with mediation occurring through change in anxiety. This indicates that headache management self\u2010efficacy is a likely mechanism of change of posttraumatic headache\u2013related disability with decreases in anxiety explaining part of the improvement in headache\u2010related disability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.14480","type":"journal-article","created":{"date-parts":[[2023,3,11]],"date-time":"2023-03-11T02:29:06Z","timestamp":1678501746000},"page":"410-417","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Mechanisms of change in posttraumatic headache\u2013related disability: A mediation model"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0040-7196","authenticated-orcid":false,"given":"Paul S.","family":"Nabity","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of Texas Health Science at San Antonio  San Antonio Texas 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