Abstracts

Rationale: Psychogenic nonepileptic seizures (PNES) are the most common functional symptom presenting in neurologists’ offices. Psychological distress is common in patients with PNES and can profoundly impact a patient’s daily functioning. In the current study, we developed an intervention as part of a larger treatment program within the multi-disciplinary PNES Clinic at VA Boston Healthcare System. The 7-week outpatient intervention combines psychoeducation and skill-building modules that incorporate elements of raising psychological awareness to help patients identify PNES triggers and symptoms. Furthermore, patients learn to on understand the relationship between symptoms and use of effective coping strategies.

Methods: Six patients (4 males, 2 females) with confirmed PNES completed the group intervention. Participants were between the ages of 30 – 56 (M =47.83, SD =9.52). All participants had comorbid mental health diagnoses, including PTSD (83%), depression (67%), and anxiety (33%). Participants completed a pre- and post-assessment that included questionnaires about mood, perceived locus of control, and quality of life. Additionally, a pre- and post- qualitative assessment was administered to obtain information related to the effectiveness of the intervention based on knowledge of their PNES triggers and symptoms, perceived levels of psychological awareness, and use of coping strategies

Results: There was an increase in the number of identified triggers from pre- to post- (3 and 5, respectively), as well as number of PNES symptoms (5 and 7, respectively). Qualitative analyses suggested that the increase in number of PNES symptoms was associated with “mind processes” compared to “body processes” identified at post-assessment. Four themes emerged from qualitative responses about the effectiveness of the intervention: (1) intervention was specific and helpful, (2) increased knowledge of etiology of PNES, (3) increased awareness and understanding of PNES triggers and symptoms, and (4) intervention design (i.e., group format) increased feelings of hope and positive outlook after hearing others’ experiences with PNES., There were no significant changes between pre- and post-intervention on objective measures of depression (p = .36,ƞ²_p= 5.56), anxiety (p = .23,ƞ²_p=2.53), or PTSD (p = .81,ƞ²_p=15.58).

Conclusions: This 7-week intervention increased knowledge about PNES triggers and symptoms, as well as overall satisfaction (i.e., feeling connected to others with PNES, increased assertiveness). Findings did not support a decrease in anxiety, depression, or PTSD symptoms on self-report questionnaires following the intervention, though it is likely that the small sample size impacted these results. To the best of our knowledge, this intervention is novel because it incorporates components of psychoeducation, awareness-building, and skill-building. Despite the small sample size, findings from qualitative analyses are promising and suggest that elements of this intervention uniquely resonated with patients, including an increase in knowledge of PNES triggers and symptoms, increased awareness, and overall satisfaction with the intervention.  

Funding: Not applicable