Cognitive Therapy and Research, Vol. 11, No. 6, 1987, pp. 635-652 Cognitive Changes Accompanying Headache Treatment: The Use of a Thought-Sampling Procedure I Christopher R. Newton 2 and Howard E. Barbaree" Queen's University Thirty-six community residents with mixed headache symptomatology were assigned either to a group receiving cognitive-behavioral treatment or to a waiting list control. Treatment focused explicitly upon training subjects to manage headache attacks more effectively. During a baseline assessment and following completion of treatment, all participants self-monitored cognitive activity during headache and kept a written record of headache symptoms. Cognitions were obtained by means of a thought-sampling procedure in which subjects provided a series of cognitive reports during each headache episode. Headache cognitions were scored on five cognitive measures developed in a preliminary study. In comparison with controls, treated subjects appraised headache attacks in a more positive manner and reported more frequent oc- currence of coping thoughts of a problem-solving nature. Changes in cogni- tive appraisal were also correlated with reductions in headache intensity following treatment. In addition, prior to treatment, reported levels of pain intensity appeared to be related to cognitive activity during headache. The findings provide support for a multidimensional model of pain and suggest that treatment effectiveness may be mediated by changes in particular cog- nitive reactions to headache. KEY WORDS: headache; thought-sampling; cognitions; chronic pain; behavioral medicine. ~This paper is based upon portions of a doctoral dissertation submitted by the first author, under supervision of the second author, to Queen's University, 1985. The research was sup- ported in part by funding provided by the Medical Research Council of Canada. Appreciation is expressed to Marlies Sudermann, Carol Harris, and Zindel Siegal for their assistance. 2Address all correspondence to Christopher Newton, Department of Psychology, St. Thomas Psychiatric Hospital, P.O. Box 2004, St. Thomas, Ontario, Canada N5P 3V9. 635 0147-5916/87/1200-0635505.00/0 © 1987 Plenum Publishing Corporation