Dr. Elizabeth Seng

Dr. Elizabeth Seng, associate professor at and research associate professor in the Department of Neurology at , will use a grant from the National Institutes for Health/Nation Center for Complementary and Integrative Health, to study the use of mindfulness therapy to mitigate migraine. (See other articles about Dr. Seng’s research here, here and .) News had a chance to catch up with Dr. Seng and discuss the significance of this line of research.

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Congratulations on receiving a grant of $1.8 million over four years from the National Institutes for Health/National Center for Complementary and Integrative Health. You and your colleague, Dr. Amanda Shallcross from New York University, will be studying the “Feasibility and Acceptability of Telephone-delivered MBCT for Migraine and Depression.”

Can you explain briefly what MBCT is and how it applies to the management of migraine and depression?

MBCT stands for Mindfulness-Based Cognitive Therapy. Mindfulness is the non-judgmental awareness of the present moment. It is a very different way of existing than our typical auto-pilot way of thinking, where we spend a lot of time worrying about the past and future. MBCT cultivates mindfulness in several ways: through formal meditation practice, through thought exercises and by “guided inquiry,” during which a trained facilitator guides a group of people through understanding how to use mindfulness in their daily lives. Migraine is a common disabling disease that accounts for an astonishing amount of reduced occupational and social functioning worldwide, particularly among women in the middle of their lives. Depressive symptoms are common among people with migraine and can interfere with treatment seeking and engagement in valued activities. Being a patient with migraine is really hard. Migraine treatment is complicated and expensive, and often requires countless doctor visits and multiple combinations of treatment options. Depressive symptoms just get in the way of the extraordinary amount of tenacity and resilience it takes to manage migraine. The hope is that MBCT will provide people with migraine and depressive symptoms tools to reduce how much migraine is interfering with daily life and to minimize how much depressive symptoms get in the way of seeking treatment and engaging in valued life activities.  

What makes you think that MCBT delivered by telephone can be an effective therapy?

One word: access. In our previous mindfulness studies, we have used multiple modalities to offer treatment. Although in-person meetings are wonderful, they are often very difficult for patients to work into their lives. As one of our astute patients noted in a qualitative exit interview: “I shouldn't be so stressed out trying to get to stress management treatment!” In addition, we often lost interested patients of lower socioeconomic status because they were already working so hard to juggle all of the pieces of their lives—multiple jobs, challenging commutes, childcare and elder care obligations— and they had no way to get to our treatment sessions. Both telephone- and video-based delivery modalities overcome some of these barriers and will hopefully increase access to care across socioeconomic status.  

You’ve also worked with Dr. Christopher Metts of the Medical University of South Carolina on a phone-based app to help manage their migraine. How does that work tie in with your work with Dr. Metts?

This study is well aligned with the work I conduct with Dr. Metts; we have been developing remote behavioral treatment delivery for migraine, and this study certainly moves toward that goal. Although this study treatment will be delivered to groups via either telephone or video technology, this study will use the mobile app developed with Dr. Metts as the headache diary. Migraine studies really rely on high-quality daily diary data, which is how we determine important clinical outcomes in migraine. This app provides a foundation for understanding how the treatment could influence migraine symptoms.  

What effect, if any, do you think the ongoing COVID-19 pandemic will have on your study?

Our team has been interested in remote-care delivery before it became so common during the pandemic. Dr. Shallcross and I have conducted multiple studies using telephone, video and mobile health delivery modalities for psychological interventions. Migraine and depressive symptoms didn’t go away because we are living through a pandemic, and it is important for the health care system to evaluate treatments that can be delivered remotely. We believe this study is an important step forward in understanding how to deliver feasible and acceptable remote behavioral treatments for migraine and depressive symptoms.  

If the study shows that telephone-based MCBT works, how could this finding be turned into an effective treatment?

This particular study is evaluating the feasibility and acceptability of telephone- and video-based MBCT for migraine and depressive symptoms; if found feasible and acceptable, the next study will evaluate clinical outcomes. This line of research makes me so excited because it is so easy to translate to the bedside. MBCT training programs already exist across the country, and a wide array of individuals such as psychologists, counselors, social workers and nurses can be trained as facilitators. Our team has translated MBCT for migraine and depressive symptoms, and part of this grant is to develop the training materials needed to ensure that MBCT facilitators can deliver the treatment faithfully. Finally, because these are remote-delivered options, a smaller number of highly trained facilitators would be able to access a wide geographic range of patients with migraine and depressive symptoms.