Cognitive behavioural therapy as a potential treatment for vasovagal/neurocardiogenic syncope—a pilot study

Abstract

Vasovagal syncope (VVS) is an exaggerated tendency to the common faint that affects any age group. Conventional treatment is non-specific and involves strategies to increase blood pressure. Patients with VVS are often unable to work or complete education due to actual, or fear of, syncopal symptoms. Here we present a series of nine patients with VVS whose symptoms had proved resistant to conventional treatments where intervention with cognitive behavioural therapy (CBT) led to significant reductions in reported syncopal episodes and consultations at our unit. All subjects post-intervention were able to return to work or schooling. CBT is an effective treatment in those with difficult to manage VVS. Randomized controlled trials are needed.

Association between psychological complaints and recurrence of vasovagal syncope

“…Since we found that this treatment is less likely to be effective in patients who are more severely affected by general psychological complaints, psychiatric evaluation might be considered in patients not responding to this treatment and in whom higher levels of general psychological complaints are suspected as a possible reinforcing factor or a consequence of their episodes. In these patients, psychological treatment besides more physical oriented treatment might be beneficial [21].…”

Does any therapy really work for neurocardiogenic syncope?

“…Syncope sufferers have many therapeutic targets: perceived likelihood of fainting, negative consequences, and lack of control; unfounded activity restriction, avoidance and protective behavior; vigilance of somatic signs linked with fainting and amplification by fear arousal. In a small retrospective observational series of 9 patients, syncopal episodes and medical consultations significantly reduced following psychology intervention aiming to restructure maladaptive beliefs and somatic attention [29]. These preliminary findings merit further exploration in larger cohorts, but in some respects lack champions of the technique in the syncope realm.…”

A Case of Orthostatic Tachycardia Syndrome Presenting with Panic Attack during Tilt Table Testing

“…The possible occurrence of frequent episodes of syncope in the future may require specific therapies to prevent these episodes [4], including cognitive behavioral therapy [15]. The limitation of this study is the lack of data on the evaluation of cerebral blood flow in the reported patient.…”