Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety

Abstract

This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p b .001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r = .63, p b .01) and frequency of seizures (r = .67, p b .01); implicit anxiety correlated with frequency of seizures only (r =.56,p b .01). Our findings demonstrate the role of implicit anxiety in PNESs and provide addi-tional support for the contribution of explicit anxiety and experiential avoidance to this disorder.

Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures

“…The present findings resemble those of a previously reported study [30], which examined the same groups of patients with seizures and healthy controls in terms of implicit versus explicit anxiety. In that study, we found greater explicit-implicit discrepancies for patients with PNESs and a significant relationship between these discrepancy scores and PNES frequency.…”

“…However, our findings are consistent with previous reports indicating that discrepancies between implicit SE and explicit SE are detrimental [53], perhaps supporting a cognitive dissonance account of PNESs. Such discrepancies are also associated with greater experiential avoidance (which we previously documented in this patient group [30]) and consistent with reports that many patients with PNESs lack emotional and psychological awareness [1]. Furthermore, the relatively high implicit, low explicit SE profile mirrors that observed in people with a diagnosis of borderline personality disorder and depression with suicidal ideation [22] and [23] and may be reflective of a fragmented self that is commonly associated with dissociative disorders.…”

“…Accounting for the inverse relationship between anxiety and self-esteem, a similar pattern was observed in the present findings. As discussed elsewhere with respect to anxiety [30], the profile of relatively more normal implicit and low explicit SE may reflect what Wilson and colleagues describe as a 'damaged' self. Such a profile may identify people whose SE has diminished later in life [50].…”

“…For instance, Jordan and colleagues showed that individuals with high explicit but low implicit SE were more defensive and rationalized their decisions more than those with consistent implicit-explicit SE [29]. As implicit-explicit discrepancies may be associated with anxiety, the present study builds on our previous findings examining the relationship between discrepancies in anxiety and PNES frequency [30].…”

“…As part of a larger study [30], 30 adults with PNESs and 25 adults with epilepsy (13 structural/metabolic epilepsy, five genetic generalized epilepsy, and seven unclassifiable epilepsy) were recruited from outpatient seizure clinics at the Sheffield Teaching Hospital NHS Foundation Trust between February and September 2012. All diagnoses were made by neurologists specializing in the treatment of seizures, and only those whose diagnoses were supported by a previous video-EEG recording of a typical seizure were included.…”