Psychobehavioral therapy for epilepsy

doi:10.1016/j.yebeh.2013.12.004

Epilepsy & Behavior

Volume 32, March 2014, Pages 147-155

https://doi.org/10.1016/j.yebeh.2013.12.004 Get rights and content

Highlights

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Psychobehavioral therapy has been applied as alternative therapy for epilepsy.
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Most therapies aim at enhancing psychological well-being and seizure control.
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We reviewed the application, possible mechanisms, and effectiveness of these therapies.
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Implications for future trial designs were proposed.

Abstract

Growing evidence suggests a bidirectional interaction between epileptic seizures and psychological states, fuelling the interest in the development and application of psychobehavioral therapy for people with epilepsy (PWE). The objective of this article is to review the various psychobehavioral therapies in regard to their application, hypothesized mechanisms, and effectiveness. Most psychobehavioral therapy aims at improving psychological well-being and seizure control. Behavioral approaches, cognitive–behavioral therapy (CBT), and mind–body interventions are the most widely applied approaches for PWE. Cognitive–behavioral therapy, mind–body approaches, and multimodel educative interventions have consistently demonstrated positive effects on enhancing well-being. Nevertheless, the effects on seizure control remain inconsistent, partly attributable to small clinical trials and inadequate control groups. Assessor-blinded randomized controlled trials with sufficient power and carefully defined therapeutic components corresponding with objective and subjective outcome measures are recommended for future trial designs.

Introduction

Accumulating evidence from animal models and clinical studies suggests a bidirectional relation between seizures and psychological states [1], [2], [3]. This understanding has been coupled with increasing research effort in incorporating psychobehavioral therapy in epilepsy care to improve psychological well-being and seizure control. This article aims to review the application and efficacy of psychobehavioral therapy for people with epilepsy (PWE) and to draw conclusions regarding the implications for future trial designs and clinical practice. The hypothesized mechanisms of these therapies are also discussed, which complement existing reviews [4], [5]. For the purpose of this review, psychobehavioral interventions are defined as those based on theory of psychotherapy. Alternative remedies for epilepsy such as spirituality, energy healing, and aromatherapy, although they appear to be psychological in nature, will not be considered.¹

Section snippets

What psychobehavioral therapies are/may be useful in epilepsy?

Therapeutic elements in psychobehavioral therapies that are most extensively applied include behavioral approaches, cognitive–behavioral therapy, and mind–body approaches. The majority of therapies are based on a primary therapeutic approach with a correspondent conceptualization of the psychological mechanism that underlies seizure activity [6], [7], [8]. However, some interventions employed a composition of therapeutic elements from different approaches, which are delivered as multimodel

What are the hypothesized mechanisms of action of psychobehavioral therapy for epilepsy?

The application of psychobehavioral therapy to epilepsy as a chronic neurological disease does not necessarily aim at resolving psychopathology as in the traditional psychiatric setting. Instead, therapies aim at assisting individuals to increase their ability of coping with their disorder on a psychological level with possible underlying neurobiological alterations that might contribute to improved seizure control and psychological well-being.

Despite their diverse approaches, all

Is psychobehavioral therapy effective in epilepsy?

Although many individual trials have reported beneficial effects of psychobehavioral therapy in terms of psychological well-being and seizure control, robust evidence is scarce. This section assesses the published evidence from prospective trials in regard to its effectiveness. Table 1 presents a summary of evidence from randomized controlled trials (RCTs).

Deficiencies in study design

One of the most common shortcomings of these studies relates to the lack of control groups [4], [83]. There was precedence for “significant” findings in uncontrolled studies to fail reproducibility when the intervention was subjected to a controlled trial as reported by Mittan in a comprehensive review [5]. Most RCTs were, however, compromised by the inadequate statistical power, which critically affected the validity of the results.

Many psychotherapy protocols consist of a mixture of

Acknowledgments

We thank Dr. Gerd Heinen for allowing us to prepare adaptions of figures from his recently published doctoral thesis “Selbst-Handeln bei Epilepsie, Eine subjektwissenschaftliche Grundlegung einer psychosomatischen Epileptologie”, Pabst Science Publishers, Lengerich (2013). We thank Samson Kirschning for carrying out the graphic art work.

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This essay reviews the clinical importance of seizure phenomenology, and the challenges clinicians face in eliciting accurate and clinically relevant descriptions of ictal experience. I conclude by discussing tools that clinicians may use to support the clinical application of seizure phenomenology, and exploring the subjectivity of epilepsy more broadly.
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Anxiety is one of the most relevant psychiatric comorbidities in people with epilepsy (PwE). The role of resilience (RES) in the development of anxiety is not well understood. We purposed to better characterize RES impact on anxiety severity in PwE.
One hundred and seventy-six PwE underwent online surveys including a collection of socio-demographic, seizure-related, and psychological variables. PwE were grouped according to the data collected; anxiety levels were compared through non-parametric statistics. Hierarchical regression analysis (HRA) and logistic regression were performed to characterize RES contribute in predicting the presence and the severity of anxiety. Mediation/moderation analysis was performed to evaluate causal effects among RES, depression, and anxiety.
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Eleven randomized controlled trials, involving 941 adults with chronic epilepsy, were included. All studies were of sound methodological quality. Third-wave therapies were typically delivered in a group format although varied in their face-to-face, telephone, and online learning options. Programs evaluating Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy, or elements of both, outperformed wait-listed controls or usual care, although individual variability in treatment response was evident (g_range = −0.11–2.28).
Acceptance techniques and mindfulness practice may bring mental health benefits for some people living with epilepsy, but do not have consistent results for everyone. Patient diversity and preferences need to be factored into effective third-wave approaches for this cohort.
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Meditation has been deemed a miracle cure for a wide range of neurological disorders. However, it is unclear whether meditation practice would be beneficial for patients suffering from epilepsy. Here we report on the comparison of the effects of focused-attention meditation and a control task on electroencephalographic (EEG) activity in a patient undergoing stereoencephalographic (SEEG) investigation for drug-resistant epilepsy. The patient routinely practiced focused-attention meditation and reported that she found it beneficial. During the SEEG investigation, intracerebral EEG data were recorded during meditation as well as during mind-wandering task. The EEG data were analyzed for type of electrical activity (labeled) by two expert epileptologists. We found that the proportion of EEG segments containing activity classified as interictal epileptiform discharges (IEDs; abnormal electrical activity that occurs between seizures) increased significantly during meditation practice. Although the finding was surprising, this increase in IEDs may not correlate with an increase in seizure frequency, and the patient might still benefit from practicing meditation. The finding does, however, warrant further studies on the influence of meditation on epileptic activity.
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Targeted ReviewPsychobehavioral therapy for epilepsy

Highlights

Abstract

Introduction

Section snippets

What psychobehavioral therapies are/may be useful in epilepsy?

What are the hypothesized mechanisms of action of psychobehavioral therapy for epilepsy?

Is psychobehavioral therapy effective in epilepsy?

Deficiencies in study design

Acknowledgments

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

J Behav Ther Exp Psychiatry

Behav Res Ther

Epilepsy Behav

Seizure

Epilepsy Behav

Epilepsy Behav

Behav Ther

Seizure

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Seizure

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Biol Psychiatry

Epilepsy Res

Prog Brain Res

Seizure

Behav Ther

Seizure

Seizure

Epilepsy Behav

Epilepsy Behav

Epilepsy Behav

Patient Educ Couns

Seizure

Epilepsy Behav

Epilepsy Behav

Psychoneuroendocrinology

Psychiatry Res Neuroimaging

Conscious Cogn

Epilepsy: bidirectional link between epilepsy and psychiatric disorders

Nat Rev Neurol

Psychological treatment for epilepsy

Cochrane Database Syst Rev

Evaluation of acceptance and commitment therapy for drug refractory epilepsy: a randomized controlled trial in South Africa—a pilot study

Epilepsia

Sepulveda Epilepsy Education: the efficacy of a psychoeducational treatment program in treating medical and psychosocial aspects of epilepsy

Epilepsia

The efficacy of an educational treatment program for patients with epilepsy (MOSES): results of a controlled, randomized study. Modular service package epilepsy

Epilepsia

Targeted Review
Psychobehavioral therapy for epilepsy