Counseling for People With Nonepileptic Seizures

If you’re familiar with psychogenic nonepileptic seizures, or PNES, you may be aware that proper treatment is crucial for obtaining relief. Unlike epileptic seizures, which result from brief irregularities in the brain’s normal electrical activity, PNES do not respond to seizure medication. Because PNES are caused by emotional distress or a psychiatric condition, they require a different treatment approach known as cognitive behavioral therapy, or CBT.

CBT is based on the concept that beliefs and thoughts have a direct effect on mood and behavior. It helps individuals become aware of any irrational and destructive thoughts, and replace them with balanced and realistic ones. What sets CBT apart from other types of counseling is that the patient is an active participant in the treatment. After a CBT session, the patient is expected to complete some homework and practice assignments in order to master the coping techniques introduced during the session.

[See: Was That a Seizure?]

CBT can be tailored for treatment of PNES in children, but for specific treatment of PNES in adults, there is a specialized form called neurobehavioral therapy, or NBT. The 12-week comprehensive NBT program for PNES incorporates a treatment workbook that patients can work on at home as part of the counseling. The patient and a trained counselor meet weekly for about an hour, either virtually or in a clinic, to discuss each chapter from the treatment workbook.

Topics include education about seizures and medications for seizures and depression, self-awareness techniques to identify seizure triggers and pre-seizure auras, communication and relaxation techniques, emotion awareness techniques such as journaling and thought records, resolving current and past stress and trauma, and ways to enhance physical health. The counselor guides individuals to navigate the treatment and achieve mastery of the skills by use of in-session role-playing and feedback.

Counselors identify four treatment targets for neurobehavioral therapy in people experiencing PNES:

— Addressing the emotions and thoughts that trigger PNES or emerge after PNES onset and exacerbate the condition.

— Relieving the underlying emotional distress related to depression and anxiety, post-traumatic stress disorder, or other psychological conditions.

— Recognizing and modifying any negative beliefs and thoughts about one’s health and the PNES diagnosis that may be leading to reduced self-esteem, isolation, and decreased quality of life.

— Helping individuals improve any strained relationships in their lives that are causing the distress and PNES.

[Read: When Your Child Has Out-of-Control Epilepsy.]

In a 2014 study of adults with PNES, the frequency of seizures was reduced by 51.4% after a course of neurobehavioral therapy alone, and by 59.3% after treatment with NBT plus the antidepressant drug sertraline. In contrast, there was no significant reduction in PNES for patients who received sertraline alone without NBT, or neither of the two. Patients in the NBT-plus-sertraline group also experienced significant improvement in depression, anxiety, quality of life and overall functioning, and these positive changes may have helped reduce the PNES by improving patients’ ability to engage in treatment.

A pitfall of the NBT program is that it’s a time-limited intervention conducted in 12 sessions. For some people experiencing PNES who also have other psychiatric conditions, this timeline may be insufficient. If the PNES do not respond with the usual course, additional counseling may be necessary, sometimes for a prolonged period. Additionally, sometimes the NBT program must be modified to accommodate persons with learning difficulties or limited English language skills.

[See: Relieving the Stigma of Epilepsy.]

William James, known as the father of American psychology, once said, “The greatest discovery of my generation is that a human being can alter his life by altering the attitudes of his mind.” As complex and challenging as PNES may be, the journey to recovery lies in patients’ recognition of their ability to modify their thoughts and learn healthier ways of responding to their emotions in order to eliminate their symptoms.

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