Mindfulness-based therapy for psychogenic nonepileptic seizures

Baslet, Gaston; Ehlert, Alexa; Oser, Megan; Dworetzky, Barbara A.

doi:10.1016/j.yebeh.2019.106534

Cited by 43 publications

(41 citation statements)

References 29 publications

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“…We identified 19 relevant studies, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] the characteristics and full author list of which are outlined in table 1. Elsewhere these studies are referred to by the first author's surname followed by the year of publication.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of psychotherapy for adults with functional neurological disorder

Gutkin¹,

McLean²,

Brown

et al. 2020

J Neurol Neurosurg Psychiatry

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Functional neurological disorder (FND) is a common and disabling disorder that is often considered difficult to treat, particularly in adults. Psychological therapies are often recommended for FND. Outcome research on psychological therapies for FND has grown in recent years but has not been systematically evaluated since 2005. This study aims to build on that by systematically reviewing the evidence-base for individual outpatient cognitive behavioural and psychodynamic psychotherapies for FND. Medical databases were systematically searched for prospective studies of individual outpatient psychotherapy for FND with at least five adult participants. Studies were assessed for methodological quality using a standardised assessment tool. Results were synthesised, and effect sizes calculated for illustrative purposes. The search strategy identified 131 relevant studies, of which 19 were eligible for inclusion: 12 examining cognitive behavioural therapy (CBT) and 7 investigating psychodynamic therapy (PDT). Eleven were pre–post studies and eight were randomised controlled trials. Most studies recruited a single symptom-based subtype rather than all presentations of FND. Effect sizes, where calculable, showed generally medium-sized benefits for physical symptoms, mental health, well-being, function and resource use for both CBT and PDT. Outcomes were broadly comparable across the two therapy types, although a lack of high-quality controlled trials of PDT is a significant limitation, as is the lack of long-term follow-up data in the majority of identified CBT trials. In conclusion, both CBT and PDT appear to potentially offer some benefit for FND, although better quality studies are needed.

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Section: Resultsmentioning

confidence: 99%

Systematic review of psychotherapy for adults with functional neurological disorder

Gutkin¹,

McLean²,

Brown

et al. 2020

J Neurol Neurosurg Psychiatry

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“… 55% reported seizure reduction Myers et al (2017) USA 88 Before-after, non-controlled study n=16 Prolonged exposure psychotherapy. 12–15 90 min weekly sessions 81% reported seizure freedom Mindfulness Baslet et al (2020) USA 93 Prospective uncontrolled trial n=26 Individual mindfulness-based psychotherapy (12X1/week or fortnightly) 50% reported seizure freedom. 23% reported sustained cessation of PNES Interpersonal therapy Mayor et al (2010) UK 92 Before-after, non-controlled study n=108 Psychodynamic IPT (19x50 min/week or fortnight) 25% reported seizure freedom Psychoeducation Mayor et al (2013) UK 96 Multicentre before-after, noncontrolled study n=13 Manualized psychoeducation (4x 60 min/week) 31% reported seizure freedom.…”

Section: Methodsmentioning

confidence: 99%

“…When evaluating the efficacy of this model on 108 patients, the authors found that between 12 and 60 months after the end of therapy, 25% of the patients were seizure-free and 40% presented a 50% reduction; furthermore, the use of health services had decreased significantly. 93 …”

Section: Methodsmentioning

confidence: 99%

Updated Review on the Diagnosis and Primary Management of Psychogenic Nonepileptic Seizure Disorders

Lanzillotti

Sarudiansky

Lombardi

et al. 2021

NDT

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Psychogenic nonepileptic seizures (PNES) are paroxystic and episodic events associated with motor, sensory, mental or autonomic manifestations, which resemble epileptic seizures (ES), but are not caused by epileptogenic activity. PNES affect between 20% and 30% of patients attending at epilepsy centers and constitute a serious mental health problem. PNES are often underdiagnosed, undertreated and mistaken with epilepsy. PNES are diagnosed after medical causes (epilepsy, syncope, stroke, etc.) have been ruled out, and psychological mechanisms are involved in their genesis and perpetuation. For psychiatry, there is not a single definition for PNES; the DSM-IV and ICD-10/11 describe the conversion and dissociative disorders, and the DSM-5 describes the functional neurological disorders. However, patients with PNES also have a high frequency of other comorbidities like depression, particularly trauma and post-traumatic stress disorder. It has been postulated that PNES are essentially dissociations that operate as a defensive psychological mechanism that use the mind as a defense to deal with traumas. With the advent of VEEG in the 90s, the recognition of PNES has significantly increased, and several psychological treatments have been developed. In this manuscript, we carried out a state-of-the-art review, with the aim to provide a critical approach to the extensive literature about PNES, focusing on diagnostic aspects, the primary management, and the available treatments that have been shown to be effective for the improvement of PNES.

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“…Interventions aimed at identification and management of dissociative experiences could be valuable in this group, particularly involving controlled exposure to dissociation-inducing stimuli, in combination with grounding and body-or emotion-focused techniques. Examples of existing treatments that may include some of these features are eye movement desensitisation and reprocessing (Cope et al, 2019) and mindfulness-based therapies (Baslet et al, 2020).…”

Section: Potential Clinical Implicationsmentioning

confidence: 99%

Dissociation and interoception in functional neurological disorder

Pick

Rojas-Aguiluz

Butler

et al. 2020

Cognitive Neuropsychiatry

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Introduction: We aimed to examine susceptibility to dissociation and the impact of dissociation on interoceptive processing in individuals with functional neurological disorder (FND). We hypothesised that dissociative states would be elevated and interoceptive accuracy and awareness impaired at baseline in people with FND, and that such differences would be exacerbated following acute dissociation. Methods: Nineteen adults with FND were compared to 20 healthy controls. A modified heartbeat tracking task measured interoceptive accuracy and awareness (confidence) before and after a validated dissociation induction procedure. An exteroceptive processing control task was included. Mann-Whitney tests and r-values (effect size) were computed for between-group comparisons. Results: The FND group displayed elevated dissociation at baseline (p = 0.001, r = 0.528) compared to controls which increased following dissociation-induction (p < 0.001, r = 0.663). Interoceptive accuracy did not differ between groups at baseline (p = 0.967, r = 0.009); however, the FND group had lower accuracy scores postinduction (p = 0.021, r = 0.379). A negative correlation (trend) between change scores for dissociation and interoceptive accuracy was noted (r s = −0.411, p = 0.057). Confidence ratings on interoceptive and exteroceptive processing tasks were lower in the FND group (p-values < 0.05 or <0.01, r-values 0.331-0.489). Conclusions: Individuals with FND experienced greater susceptibility to dissociation, metacognitive deficits and impaired interoceptive accuracy than controls after acute dissociation.

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Mindfulness-based therapy for psychogenic nonepileptic seizures

Cited by 43 publications

References 29 publications

Systematic review of psychotherapy for adults with functional neurological disorder

Systematic review of psychotherapy for adults with functional neurological disorder

Updated Review on the Diagnosis and Primary Management of Psychogenic Nonepileptic Seizure Disorders

Dissociation and interoception in functional neurological disorder

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