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Thursday, July 17, 2014

Can Cognitive Behavioral Therapy Reduce Non-Epileptic Psychogenic Seizures?
by Tom Valeo

With and without the use of a selective serotonin reuptake inhibitor (SSRI), a form of cognitive behavioral therapy reduced psychogenic non-epileptic seizures (PNES), according to the results of a pilot randomized clinical trial reported in the July 2 online edition of JAMA Psychiatry.

In the trial, 38 patients were divided into four groups. One received only sertraline (Zoloft), a common SSRI. Another received only cognitive behavior therapy-informed psychotherapy (CBT-ip), which was devised for this study. A third group received a combination of sertraline and CBT-ip, and a fourth received treatment as usual, which usually involved tapering antiepileptic medication and referral to a psychiatrist or psychologist.

CBT-ip alone produced a 51.4 percent reduction in seizures (p=.01) — the primary outcome measure — as well as improvement in quality of life, social interactions, and comorbidities such as depression and anxiety (p<.001).  CBT-ip combined with sertraline produced the largest reduction in seizures — 59.3 percent (p=.08) — as well as improvements in secondary outcome measures, including global functioning (p=.007). Neither sertraline alone nor treatment as usual produced a significant reduction in seizures.

The participants received 12 one-hour sessions of CBT-ip from therapists who followed a treatment workbook designed to promote more effective behaviors.

“Before the therapy the participants would communicate only in a passive or an aggressive manner,” said the study’s lead author W. Curt LaFrance, Jr., MD, MPH, FAAN, director of neuropsychiatry and behavioral neurology at Rhode Island Hospital, and an assistant professor of psychiatry and neurology at Brown University’s Alpert Medical School in Providence, RI. “They learned to practice assertive communication, which improves their relationships with others. Some learned to identify the aura that precedes a seizure so they could take action to avoid it. Some kept a thought record so they could look at their thoughts and moods from a different perspective.”

The CBT-ip also was used to teach mindfulness techniques to patients with a history of trauma and abuse. The patients in this group showed significant reductions in their seizures and improvement in other symptoms, as well as in quality of life.

“It’s more than just supportive talk therapy,” said Dr. LaFrance. “I think the power of this version of psychotherapy is that it gets down to the core beliefs, and helps people go from feeling like a victim to feeling empowered, and they take control of their seizures. It's really exciting to see this transformation occur in patients.”

The treatment workbook used in the study, Taking Control of Your Seizures: A Workbook, will be published by Oxford University Press later this year, he added.

Read more about Dr. LaFrance’s research on PNES and cognitive behavioral therapy in the Aug. 7 issue of Neurology Today. For our previous coverage of CBT for the treatment of neurological disorders, browse our archives: