Three sessions of intensive short-term dynamic psychotherapy (ISTDP) for patients with dissociative seizures: a pilot study

Abstract

Intensive Short Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of several Functional Neurological Disorders (FND) including dissociative seizures. However, its implementation in secondary mental health and specialist services within the English National Health Service (NHS) is scarce. The aim of this pilot study was to explore the estimates of the therapeutic effects of a 3-session course of this treatment as well as establish safety and acceptability for a complex patient group. Method: The study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Participants completed self-report outcome measures at the start, at the end and 1-month following the completion of therapy. Three open ended questions examined their therapy experiences qualitatively and these were analysed through thematic analysis. Results: All participants who started the treatment (N=17) completed the intervention and attendance rates were very high (95%). No serious adverse effects were observed, and the CORE-OM and BSI showed improvements both at the end of the treatment and at follow-up. Healthcare utilisation was also reduced including acute medications, A&E attendances, and crisis line usage. Conclusions: The results provide preliminary support for the safe use of ISTDP in this complex group of participants but further evidence from controlled and randomized studies is warranted.

Intensive short-term dynamic psychotherapy for irritable bowel syndrome: a randomized controlled trial examining improvements in emotion regulation, defense mechanisms, quality of life, and IBS symptoms

“…Overall, research indicates that ED problems among patients with IBS could exacerbate the severity/frequency of the IBS symptoms (e.g., Kano et al, 2007 ; Phillips et al, 2013 ; Lee et al, 2017 ; Sibelli et al, 2018 ; Selvi and Bozo Özen, 2022 ). In this vein, our findings provide evidence that ISTDP is effective in significantly improving ER abilities in individuals with IBS which is in line with theory and prior research on the effectiveness of the ISTDP on ER (e.g., Frederickson et al, 2018 ; Town et al, 2019 ; Malda Castillo et al, 2022 ). ISTDP facilitates the development of a deeper understanding of emotional experiences, triggers, and patterns.…”

“…Additionally, ISTDP supports the processing and integration of unresolved emotional experiences and conflicts ( Cooper et al, 2017 ). This therapeutic process encourages individuals to explore and express their emotions in a safe and supportive environment, leading to a reduction in emotional distress and an enhancement in their capacity to regulate emotions (e.g., Town et al, 2019 ; Malda Castillo et al, 2022 ). In this vein, a study on the effectiveness of ISTDP for dissociative seizures showed that participants gained increased control over their seizures and experienced fewer and less frequent episodes, partially due to their improved recognition and ability to address triggers.…”

“…In this vein, a study on the effectiveness of ISTDP for dissociative seizures showed that participants gained increased control over their seizures and experienced fewer and less frequent episodes, partially due to their improved recognition and ability to address triggers. Participants also mentioned acquiring skills and techniques from ISTDP to manage their emotions and bodily sensations, reducing the likelihood of seizures ( Malda Castillo et al, 2022 ). Furthermore, our study revealed that ISTDP led to a significant increase in the utilization of mature defenses, while simultaneously resulting in a significant reduction in the employment of neurotic and immature defenses.…”

Dissociation and its biological and clinical associations in functional neurological disorder: systematic review and meta-analysis

“…For FND, this proximity invites questions about treatment options and whether some people with FND would benefit from treatments that target dissociative disorders and symptoms, including those currently being evaluated in FND such as eye movement desensitisation and reprocessing (EMDR) 128 – 131 and dynamic psychotherapies. 132 , 133 …”

“…For FND, this proximity invites questions about treatment options and whether some people with FND would benefit from treatments that target dissociative disorders and symptoms, including those currently being evaluated in FND such as eye movement desensitisation and reprocessing (EMDR) [128][129][130][131] and dynamic psychotherapies. 132,133 Dissociative symptoms are elevated in FND and vary by subgroup Dissociative symptoms, as measured through validated scales, ranged widely in the FND samples. However, most studies reported elevated dissociative symptom scores in FND samples that were above clinical cut-off scores and/or the scores reported for comparison groups.…”