Cognitive-behavioral therapy for psychogenic nonepileptic seizures

Goldstein, Laura H.; Chalder, Trudie; Chigwedere, Craig; Khondoker, Mizanur; Moriarty, John; Toone, Brian; Mellers, John D. C.

doi:10.1212/wnl.0b013e3181e39658

Cited by 396 publications

(336 citation statements)

References 96 publications

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“…Cognitive behavioral therapy (CBT) and psychodynamic therapy are the leading published psychological interventions effective for PNESs [82][83][84][85][86].Our findings support the idea that increasing tolerance of unpleasant emotions and reducing maladaptive avoidant behavior patterns might represent mechanisms of change in these approaches. Therapies which directly target experiential avoidance, such as accep-tance and commitment therapy (ACT), or DBT (which also addresses cognitive dissonance, as noted above [80]), may be useful in augment-ing treatment for patients with PNESs [87].…”

Section: Discussionsupporting

confidence: 70%

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

Dimaro

Dawson

Roberts

et al. 2014

Epilepsy & Behavior

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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.

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Section: Discussionsupporting

confidence: 70%

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

Dimaro

Dawson

Roberts

et al. 2014

Epilepsy & Behavior

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“…The scale assesses impairment in five areas of work and social activities, including work, home management, social leisure activities, private leisure activities, and family and relationships, with higher values indicating greater impairment. The WSAS has been established as a valid, reliable and sensitive measure in a number of different disorders, including depression, anxiety, OCD, phobic disorders, or insomnia and it has proven a sensitive measure in a number of studies of patients with psychogenic non-epileptic seizures [25][26][27][28][29].…”

Section: Work and Social Adjustment Scale (Wsas)mentioning

confidence: 99%

A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy

Dewhurst

Nováková

Reuber

2015

Epilepsy & Behavior

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Objective: The aim of this service evaluation was to explore the effectiveness of a psychotherapeutic treatment for patients with epilepsy based on the Acceptance and Commitment Therapy (ACT) approach and to assess whether this treatment is likely to be cost-effective. Method:We conducted an uncontrolled prospective study of consecutive patients with refractory epilepsy referred for outpatient psychological treatment to a single psychotherapist because of emotional difficulties related to their seizure disorder. Participants were referred by consultant neurologists, neuropsychologists or epilepsy nurses and completed a set of validated self-report questionnaires (Short Form -12 Version 2, Generalised Anxiety Disorder -7, Neurological Disorders Depression Inventory for Epilepsy, Work and Social Adjustment Scale, and Rosenberg Self-Esteem Scale) at referral, the end of therapy and six months post therapy. Patients received a maximum of 20 sessions of one-to-one psychological treatment supported by a workbook. Cost-effectiveness was estimated based on the calculation of quality-adjusted life year (QALY) gains associated with the intervention.Results: Sixty patients completed the pre-and post-psychotherapy questionnaires, 41 also provided six-month follow-up data. Patients received six to 20 sessions of psychotherapy (mean = 11.5, S.D. = 9.6). Psychotherapy was associated with significant medium to large positive effects on depression, anxiety, quality of life, self-esteem, work and social adjustment (Ps < .001), which were sustained six months after therapy. The mean cost of the psychotherapy was £445.6 and, assuming that benefits were maintained for at least six months after the end of therapy, the cost per QALY was estimated to be £11,140 ( 9, $18,016; the cost per QALY would be half this amount if the benefits lasted one year). Conclusion:The findings of this pilot study indicate that the described psychotherapeutic intervention may be a cost-effective treatment for patients with epilepsy. The results suggest that randomised controlled trial of the psychotherapy programme is justified.

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“…Recent reports reveal the effectiveness of Cognitive Behavioral Therapy (CBT) to reduce seizure frequency [10]. In addition, Brief Psychodynamic Therapy (BPT) has been also successfully used in the treatment of PNES patients [10]. Thus, in the present study, we compared the effects of two psychotherapeutically approaches, CBT and BPT on seizure frequency and on self-perceived quality of life in patients diagnosed with PNES.…”

Section: Introductionmentioning

confidence: 97%

“…Mounting evidence support the notion that PNES is a psychiatric disorder requiring mental health professionals to deliver a proper management [4]. Recent reports reveal the effectiveness of Cognitive Behavioral Therapy (CBT) to reduce seizure frequency [10]. In addition, Brief Psychodynamic Therapy (BPT) has been also successfully used in the treatment of PNES patients [10].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Therapy Psychodynamic and Cognitive Behavioral Therapy on Quality of Life in Patients with PNES

Ni¹,

Arana-Lechuga²,

Esqueda-León³

et al. 2017

J Psychol Psychother

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Objective: In the search for effective therapeutically tools for Psychogenic Non-epileptic Seizures (PNES), in the present study we analyzed the effect of two different psychotherapeutic approaches, Brief Psychodynamic Therapy (BPT) and Cognitive Behavioral Therapy (CBT) on the frequency of PNES as well as on quality of life in these patients.Methods: 23 patients displaying PNES were randomly assigned to a group receiving BPT for 6 months, a group receiving CBT for 6 months and a control group no receiving psychotherapy. Presence of PNES was confirmed by electroencephalography (EEG). To assess self-perception quality of life, the QOLIE-31 questionnaire was applied before and every three months including a six months' follow-up after treatment ended.Results: PNES frequency decreased significantly after the first three months of both therapies compared to control group. No differences were observed when the two therapies were compared. The significant decrease of PNES frequency remains until six months after the end of psychotherapy. Concerning self-perceived quality of life, QOLIE-31 results indicate a significant improvement since the first three months. At the beginning all the patients report a poor quality of life. After three months of psychotherapy most of them improve to a normal quality of life. After 6 months of therapy patients showed values reflecting an excellent quality of life, remaining at these levels six months after therapies ended. Conclusion:The present results support the notion that both psychotherapeutic approaches are reliably procedures for decrease PNES frequency and improve quality of life in these patients.

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Cognitive-behavioral therapy for psychogenic nonepileptic seizures

Abstract: This study provides Class III evidence that CBT in addition to SMC, as compared to SMC alone, significantly reduces seizure frequency in patients with PNES (change in median monthly seizure frequency: baseline to 6 months follow-up, CBT group, 12 to 1.5; SMC alone group, 8 to 5).

Cited by 396 publications

References 96 publications

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

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

A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy

The Effect of Therapy Psychodynamic and Cognitive Behavioral Therapy on Quality of Life in Patients with PNES

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