Background/Aims: Early work suggests that migraine may be triggered by a diet-induced reactive hypoglycemia. The aim here is to report on the efficacy of dietary therapy in the management and treatment of headache symptoms in a chronic migraine (without aura) patient. Methods: A 51-year-old man previously diagnosed with chronic migraine (without aura) presented for treatment. The patient, upon request by his treating medical practitioner, had maintained a comprehensive headache diary, which included details of headache frequency and severity, time of headache onset, and headache-related medication usage for a period of six months. Several interviews were conducted to determine medical and complimentary health treatment history prior to the introduction of dietary therapy. As part of the dietary regimen the patient was required to: (1) completely eliminate alcohol, monosodium glutamate, artificial sweeteners, sugar, and food containing sucrose natural or otherwise from the diet; (2) modify the consumption of fruit, dairy, and fat; (3) eat at least six small meals per day; (4) ensure the interval between meals did not exceed 3 hours; (5) consume complex carbohydrate and a small glass of water at every meal and upon waking in the middle of the night; and (6) avoid all medication deemed to be unsuitable for hypoglycemic patients. The patient was also required to maintain his headache diary at all times. The results showed that the implementation of the dietary regimen successfully reduced the need for headache-related pain medication by at least 70% when compared to pre-treatment levels. Alternatively, subsequent deviation from the prescribed dietary regimen immediately resulted in a 2.5 fold increase in headache related pain medication usage. Conclusions: Dietary therapy may be effective in reducing headache frequency and should be explored when deciding on the best treatment and management strategy for migraine patients.

Background: Psychosocial distress can contribute to avoidance, refusal, or discontinuation of cancer treatment, which could impact recovery and survival. Aims: The aim of the present study was to evaluate the effectiveness of a community based psychosocial program on alleviating mood disturbance in breast cancer survivors at different stages of their breast cancer journey. Method: A total of 37 women participated in an 8-week psychosocial program at their local community centre. The weekly 3-hour program was delivered in a small group format. Program components included health education, behavioural training, cognitive behavioural therapy, art therapy and stress-management. Questionnaires aimed at assessing psychiatric morbidity and mood adjustment were administered at the beginning of the program (Pre) and at the completion of the program (Post). Results: Group data revealed a significant reduction in psychiatric morbidity and improved psychological adjustment. When participants were divided into degree of psychiatric morbidity (mild, moderate, severe, very severe) a significant reduction in the reporting of anxiety symptoms in the mild, moderate, severe and very severe groups was reported; depression symptoms in the severe and very severe groups were noted, and anger, confusion and somatic symptoms in the mild group were noted. The level of activity was also significantly improved in the very severe group. Conclusions: A structured community based psychosocial program is beneficial to women struggling to come to terms with the emotional consequences of breast cancer at all stages of recovery.

In this study, an aspect of psychodrama, a little-known, action-oriented form of group psychotherapy, will be examined. Psychodrama was founded by the psychiatrist Dr Jacob Moreno in the 1920s, and was regarded as a major alternative to Freudian psychoanalysis in the United States of America during the 1930s and 1940s. Today, although practised worldwide, psychodrama has been overshadowed by less action-oriented and more talking-oriented, non-psychoanalytic psychotherapies, and therefore lacks visibility. Further, due to a lack of outcome research published in scholarly journals, it is not being included among evidencedbased psychotherapies.

Reviews of outcome studies published between 1970 and 2016 have shown that psychodrama researchers regard the single psychodrama enactment as the basic therapeutic unit, while other group psychotherapies regard the whole multi-session group process as such. Although some psychodrama researchers acknowledge the possible influence of group process on psychodrama outcomes, none have studied this influence. The reviewers saw this as a gap in the research. They also noted that no researcher has mentioned client psychosocial themes that arise during single enactments or during multi-session psychodrama groups.

This study examined the development of client psychosocial themes in a multisession psychodrama group, and used Young’s early maladaptive schema (EMS) framework to assess these themes. A collective case study approach was used with both within-case and across-case data being analysed. As no other universally accepted theme theoretical framework exists, schemas—which comprise cognitive, affective and somatic elements—were used to assess psychosocial themes. Young’s EMS framework was chosen because it offered an accepted, standardised system of naming and defining schemas, and his EMS questionnaires have been shown to be valid and reliable.

Ethics approval was obtained to video-record a multi-session psychodrama group that ran for nine three-hour sessions over three consecutive days. There were nine participants. The psychodramatist and group leader was a registered psychotherapist accredited with the Australian and Aotearoa New Zealand Psychodrama Association (AANZPA). The researcher was not present in the group.

The group leader, who was recruited through an email sent from the AANZPA research committee to its members, recruited participants from among his clients and psychodramatist trainees. All participants consented to being video-recorded for research purposes. The contents of each video-recorded session were catalogued in detail. Researcher-developed schema rating sheets based on Young’s EMS were used to assess and record each client’s schemas arising in psychodrama enactments. Two raters completed the assessment separately and achieved significant inter-rater agreement.

A qualitative descriptive approach was used to analyse the within-case and across-case data. Due to the paucity of multiple enactments for most participants, it was not possible to examine within-case schema development. However, it was possible to examine across-case data for the nine sessions as a whole.

The data was also examined as possible support for Moreno’s assertion that there is a deficit of spontaneity among people in the civilised world. He saw spontaneity as a pre-requisite to finding new solutions to old, dysfunctional, psychosocial problems and adequate solutions to new ones, in a creative way. The occurrence of the emotional inhibition schema in 92% of enactments supported his assertion.

The data was also examined to assess whether the psychodramatic techniques of doubling, mirroring and role-reversal effectively reduced emotional inhibition and increased spontaneity. Most enactments demonstrated this through a reduction of dysfunctional interpersonal behaviours and increase in new functional ones. Transcripts of three enactments are provided to support this. This change did not occur as strongly as a result of member-to-member group interaction outside the enactments. The next most frequently occurring schemas came from the disconnection and rejection domain, which had implications for the participants’ ability to establish and maintain intimate relationships.

This study is significant for future research into the connection between the therapeutic effects of psychodrama and group process, and moves psychodrama closer to becoming accepted as evidence-based. It will also add to the knowledge and skill base of psychodrama practitioners.