Background Dissociative seizures are paroxysmal events resembling epilepsy or syncope with characteristic features that allow them to be distinguished from other medical conditions. We aimed to compare the effectiveness of cognitive behavioural therapy (CBT) plus standardised medical care with standardised medical care alone for the reduction of dissociative seizure frequency. MethodsIn this pragmatic, parallel-arm, multicentre randomised controlled trial, we initially recruited participants at 27 neurology or epilepsy services in England, Scotland, and Wales. Adults (≥18 years) who had dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous 12 months were subsequently randomly assigned (1:1) from 17 liaison or neuropsychiatry services following psychiatric assessment, to receive standardised medical care or CBT plus standardised medical care, using a web-based system. Randomisation was stratified by neuropsychiatry or liaison psychiatry recruitment site. The trial manager, chief investigator, all treating clinicians, and patients were aware of treatment allocation, but outcome data collectors and trial statisticians were unaware of treatment allocation. Patients were followed up 6 months and 12 months after randomisation. The primary outcome was monthly dissociative seizure frequency (ie, frequency in the previous 4 weeks) assessed at 12 months. Secondary outcomes assessed at 12 months were: seizure severity (intensity) and bothersomeness; longest period of seizure freedom in the previous 6 months; complete seizure freedom in the previous 3 months; a greater than 50% reduction in seizure frequency relative to baseline; changes in dissociative seizures (rated by others); health-related quality of life; psychosocial functioning; psychiatric symptoms, psychological distress, and somatic symptom burden; and clinical impression of improvement and satisfaction. p values and statistical significance for outcomes were reported without correction for multiple comparisons as per our protocol. Primary and secondary outcomes were assessed in the intention-to-treat population with multiple imputation for missing observations. This trial is registered with the International Standard Randomised Controlled Trial registry, ISRCTN05681227, and ClinicalTrials.gov, NCT02325544.

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This study is the second in a series of investigations designed to determine Rorschach criteria for predicting continuation in psychotherapy. The hypothesis for the study was suggested by the results of an initial study of group psychotherapy patients [3]. These results had indicated that a group of neurotic patients who continued in group psychotherapy had, on the average, higher FC minus CF, R, and D% Rorschach scores than a matched group of patients who discontinued group psychotherapy without the consent of the psychotherapist. A weighted combination of the three Rorschach scores derived by a discriminant function analysis permitted an accurate allocation of each patient to a "continuing" and "noncontinuing" group in 69 per cent of the cases. A chi-square test indicated that this percentage of successful allocation was significant beyond the 1 per cent level.The aim of the present study was to determine at an empirical level whether the three Rorschach variables which were useful in determining continuation in group psychotherapy could predict the same behavior in individual psychotherapy. Subjects and ProcedureThe Rorschach records of twenty-six "con-Reviewed in the Veterans Administration and published with the approval of the Chief Medical Director. The statements and conclusions published by the authors are the results of their own study and do not necessarily reflect the opinion or policy of the Veterans Administration.

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