Long‐term outcome of brief augmented psychodynamic interpersonal therapy for psychogenic nonepileptic seizures: Seizure control and health care utilization

Abstract

Summary Purpose: Most neurologists endorse psychotherapy as the treatment of choice for psychogenic nonepileptic seizures (PNES), but its effectiveness remains unproven, and there are no previous reports of long‐term outcome after psychotherapy. This study aimed to establish the outcome of brief augmented psychodynamic interpersonal therapy (PIT) for 47 patients with PNES in terms of seizures and health care utilization 31–65 months (median 50 months) after diagnosis. Methods: Participants completed questionnaires before starting therapy (Clinical Outcomes in Routine Evaluation Outcome Measure [CORE‐OM]; Patient Health Questionnaire [PHQ15]; Short‐Form Health Survey [SF‐36]). Forty‐seven of 66 consecutive patients (71%) also completed a follow‐up questionnaire about current seizure frequency, employment status, and health care utilization 42 months after the end of therapy (range 12–61 months). Factors associated with seizure outcome and predictors of seizure cessation were evaluated. Results: At follow‐up, 25.5% of patients had become seizure‐free; a further 40.4% achieved a seizure reduction of >50%. Logistic regression showed “economic activity” status to be the only significant baseline predictor of seizure cessation (p < 0.021). Health care utilization declined significantly from baseline to follow‐up (p < 0.039), suggesting minimum expected annual health care expenditure savings of £245 ($408). Discussion: These results indicate that this intervention is associated with a significant improvement in seizure frequency and health care utilization, suggesting that a randomized controlled study of the intervention is justified.

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

“…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].…”

Psychogenic non-epileptic seizures and psychoanalytical treatment: results

“…Despite this, the results obtained with the psychoanalytic method in relation to decrease and cessation of seizures were higher than those presented in the scientific literature, 21,34 given that these studies only presented a decline in the frequency of seizures and not cessation of symptoms.…”

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

“…More specifically then, our findings support the idea that in the context of a self-accepting dialogue, modifying negative and discrepant selfevaluations and, therefore, reducing cognitive dissonance or stabilizing one's self-image might represent mechanisms of change in these approaches. While CBT and psychodynamic therapy are the leading published psychological interventions effective for PNESs [54] and [55], there are a range of therapies which could address these aspects (e.g., compassion-focused therapy or acceptance and commitment therapy), which are evidence-based for a number of comorbidities associated with PNESs, and which may be equally as effective for this population. However, these ideas require further research.…”