Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: A randomized controlled trial

Lundgren, Tobias; Dahl, JoAnne; Yardi, Nandan; Melin, Lennart

doi:10.1016/j.yebeh.2008.02.009

Cited by 258 publications

(165 citation statements)

References 22 publications

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“…Closer examination of the changes in seizure frequency showed that although 37.2% of patients reported a more than 50% reduction in seizure frequency, there were more patients (39.5%) who experienced a smaller than 50% improvement or no change at all. This finding is in contrast with the findings of the studies by Lundgren et al [43,44] who reported a significant decrease in seizure frequency as a result of ACT psychotherapeutic treatment. However, the overall evidence for effectiveness of psychological interventions for reducing seizures is mixed [11], and it is important to emphasise that the focus of the therapeutic approach used in our study was on the psychosocial issues associated with epilepsy rather than reduction of seizure frequency per se.…”

Section: Discussioncontrasting

confidence: 99%

“…This finding is concordant with existing evidence from a small number of controlled studies of cognitive behavioural therapy and ACT for epilepsy. Martinovic et al reported both significant reduction of depressive symptoms and improved quality of life in adolescent patients receiving a CBT intervention, compared to a control group [41], a CBT intervention was also effective in improving quality of life in a small RCT from Hong Kong [42], and two small-scale RCTs by Lundgren et al showed significant improvements in quality of life following a short-term ACT treatment [43,44].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

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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“…This has primarily been used in clinical settings to aid in values clarification and committed action. A second measure is the Bull's-Eye, which assesses values attainment, discrepancy between stated values and behavior, perceived barriers to valued living, and behavioral persistence (Lundgren, Dahl, Melin, & Strosahl, 2008) and has been shown to function well as an outcome measure and a process measure and as a tool for educating clients about values in a clinical context (Lundgren, Dahl, & Hayes, 2008;Lundgren, Dahl, Kies, & Melin, 2006;Lundgren, Dahl, Yardi, & Melin, 2008). The Personal Values Questionnaire (Blackledge & Ciarrochi, 2006) is an ACT-consistent modification of Sheldon et al's (2002) Measures of values-consistent behavior have thus far been assessed by self-report in the clinical domain, through the use of values homework sheets, the consistency portion of the Valued Living Questionnaire, or the Bulls-Eye diary.…”

Section: Empirical Support For the Process Of Values In Actmentioning

confidence: 99%

In search of meaning: Values in modern clinical behavior analysis

et al. 2009

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Skinner described behavior analysis as the field of values and purpose. However, he defined these concepts in terms of a history of reinforcement and failed to specify whether and how human and nonhuman values might differ. Human values have been seen as theoretically central within a number of nonbehavioral traditions in psychology, including humanism and positive psychology. However, these approaches have failed to provide explanations of the behaviorenvironment relations involved in valuing that might allow prediction and influence with respect to this phenomenon. Modern clinical behavior analysis in the form of acceptance and commitment therapy (ACT), however, succeeds in providing a functional definition of human values that meets this latter criterion. ACT is rooted in behavior analysis and relational frame theory (RFT) and defines values in terms of verbally established motivation. ACT empirical research into values has begun to blossom in recent years, and ACT-RFT researchers are currently investigating the concept at the most basic empirical level as well as in the applied clinical arena, heralding new interest in and insight into values within clinical behavioral psychology.

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“…For instance, clinical trials are ongoing for several brain disorders, such as autism and Huntington's disease. In the epilepsy realm, recent studies have highlighted the benefits of cognitive behavioral therapy and mindfulness in epilepsy (9), promoting these nonpharmacological interventions as potential avenues for adjunctive treatment. In addition, these interventions may also benefit psychiatric comorbidities of epilepsy.…”

Section: Disease-modification In Epilepsy By Nonpharmacological Methodsmentioning

confidence: 99%

Disease-Modification in Epilepsy by Nonpharmacological Methods

Jones¹

2018

Epilepsy Curr

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CommentaryIn laboratory studies, environmental enrichment (EE) refers to altered housing conditions designed to enhance sensory, motor, social, and cognitive stimulation, not to mention improved animal welfare. This may include larger housing containers, enhanced novelty and complexity of toys, exercise equipment, and increased number of occupants, relative to control conditions. EE has repeatedly been demonstrated improved outcomes across many different animal models of neurological disease (1), delaying disease onset and limiting symptom severity in both genetic and acquired diseases. These improvements are likely driven by experience-dependent synaptic plasticity of neuronal circuits, which can counteract the progression of disease, although specific mechanisms are elusive and possibly disease-specific. Epilepsy is no exception, and there exists strong rationale to anticipate beneficial effects of EE (2): Early work showed that rats raised in EE conditions are protected against excitotoxic seizures and seizure-related cell death (3), and exhibit delayed epileptogenesis in the amygdala kindling model (4, 5). The recent article by Vrinda and colleagues extends this work by introducing EE to epileptic rats, and report a range of epilepsy-, behavior-, and physiologyrelated improvements.One of the primary strengths of the article by Vrinda et al. relates to the study design. In the vast majority of research looking for anti-epileptogenic or disease-modifying therapies, interventions are almost exclusively given in the immediate hours after the precipitating insult, such as status epilepticus. But without biomarkers to identify patients likely to develop epilepsy, this is not a clinically appropriate timepoint since patients only present when they are diagnosed with epilepsy, sometimes years or decades following the causal insult. A more practical and translatable approach is to randomize treatment to patients already experiencing seizures-an approach adopted by Vrinda and colleagues. Epilepsy was triggered by pilocarpine-induced status epilepticus; after 6 weeks' monitoring for spontaneous seizures, animals entered into their respective housing programs: The EE groups were introduced into enriched cages for 6 h/day for 2 weeks, while the control rats Enriched Environment Attenuates Behavioral Seizures and Depression in Chronic Temporal Lobe Epilepsy.Vrinda M, Sasidharan A, Aparna S, Srikumar BN, Kutty BM, Rao BSS. Epilepsia 2017;58: [1148][1149][1150][1151][1152][1153][1154][1155][1156][1157][1158] Temporal lobe epilepsy (TLE) is commonly associated with depression, anxiety, and cognitive impairment. Despite significant progress in our understanding of the pathophysiology of TLE, it remains the most common form of refractory epilepsy. Enriched environment (EE) has a beneficial effect in many neuropsychiatric disorders. However, the effect of EE on cognitive changes in chronic TLE has not been evaluated. Accordingly, the present study evaluated the effects of EE on chronic epilepsy-induced alterations in cognitive ...

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Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: A randomized controlled trial

Cited by 258 publications

References 22 publications

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

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

In search of meaning: Values in modern clinical behavior analysis

Disease-Modification in Epilepsy by Nonpharmacological Methods

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