Cognitive behavioural therapy for psychogenic non-epileptic seizures in the context of mild intellectual disability: a case study

Abstract

Purpose There is a growing evidence base for cognitive behavioural therapy (CBT) as a treatment for psychogenic non-epileptic seizures (PNES) in the general population. Despite the relatively high proportion of individuals with PNES who have an intellectual disability (ID) there is a paucity of literature on the use of CBT for PNES in this population. The purpose of this paper is to describe the use of an adapted CBT approach to treat PNES in a woman with mild ID. Design/methodology/approach The intervention used a CBT approach that included both the client and her mother, her primary care giver, throughout the therapy sessions. It involved 13 1-hour sessions over 20 weeks. Findings Over the course of the intervention the client experienced a reduction in seizure activity. Both the client and her mother reported increases in her perceived ability to cope with the seizures. Originality/value This report describes an adapted CBT-based intervention for individuals with PNES in the context of ID. It is the first report to include the involvement of a care-giver in adapting this approach for individuals with ID.

Cognitive behavioural therapy for psychogenic nonepileptic seizures (PNES) in an adult with a learning disability: A case study

“…The results of this study are broadly consistent with the results of a large randomised‐controlled study with people without learning disabilities (Goldstein et al, 2020) and case studies of people with learning disabilities (Atnas & Lippold, 2013; Diamond & Delaney, 2020). Previous research suggests that CBT is associated with improvements in various areas of psychological functioning in people with PNES (Goldstein et al, 2020), and with PNES reduction, but not complete remission of PNES (Atnas & Lippold, 2013; Diamond & Delaney, 2020). Based on the findings of the current study, we can tentatively conclude that CBT with adaptations for people with learning disabilities might have the potential to reduce PNES frequency and improve clinically relevant aspects of functioning in individuals with PNES.…”

“…The results of this study are broadly consistent with the results of a large randomised‐controlled study with people without learning disabilities (Goldstein et al, 2020) and case studies of people with learning disabilities (Atnas & Lippold, 2013; Diamond & Delaney, 2020). Previous research suggests that CBT is associated with improvements in various areas of psychological functioning in people with PNES (Goldstein et al, 2020), and with PNES reduction, but not complete remission of PNES (Atnas & Lippold, 2013; Diamond & Delaney, 2020).…”

“…Eleven sessions were delivered face to face, and four sessions were delivered remotely due to coronavirus disease 2019 (COVID‐19). As there is no established treatment protocol for PNES for adults with learning disabilities, our treatment process was informed by previously published case studies (Atnas & Lippold, 2013; Diamond & Delaney, 2020) and studies of people without learning disabilities (Goldstein et al, 2020). Based on Susan's formulation, session content was also informed by treatment protocols for panic disorder and health anxiety (Clark, 1986; Salkovskis & Warwick, 1986).…”

“…A recent randomised controlled trial failed to demonstrate that CBT based on this model leads to a significant reduction of seizure frequency compared to standardised medical treatment in people with PNES (Goldstein et al, 2020); however, individuals in the CBT group reported significantly better psychological functioning, subjective clinical improvement and treatment satisfaction compared to the treatment as usual group, indicating that CBT could be beneficial for these individuals. However, this trial excluded people with learning disabilities and therefore the evidence base for CBT for PNES in people with learning disabilities is limited to case reports (Atnas & Lippold, 2013; Diamond & Delaney, 2020).…”

“…However, this trial excluded people with learning disabilities and therefore the evidence base for CBT for PNES in people with learning disabilities is limited to case reports (Atnas & Lippold, 2013;Diamond & Delaney, 2020).…”