The scholars used a series of questionnaires and computer tests to determine if a patient regularly avoids situations which might bring on anxiety. The tests correctly predicted whether a patient had epilepsy or PNESs in 83% of study participants. Such seizures appear on the surface to be similar to epileptic fits, which are caused by abnormal brain activity.
Lead researcher Dr. Lian Dimaro completed the study as part of her doctorate in Clinical Psychology on the Trent Doctorate in Clinical Psychology program, which is jointly run by the University of Lincoln and University of Nottingham.
“PNES can be a very disabling condition, and it is important that we understand the triggers so that we provide the correct care and treatment,” said Dimaro, who is now a Clinical Psychologist based at Nottinghamshire Healthcare NHS Trust.
“This study was one of the first to bring modern psychological tools of investigation to this problem. The findings support the idea that increasing a person’s tolerance of unpleasant emotions and reducing avoidant behavior may help with treatment, suggesting that patients could benefit from a range of therapies including acceptance and commitment therapy to help reduce the frequency of seizures, although more research is needed in this area.”
Participants completed questionnaires to determine the level to which they suffered from anxiety, their awareness of their experiences, and if they would avoid situations which would make them feel anxious.
They then completed a computer task which required rapid responses to true or false statements. This test was designed to gather data on immediate, or implicit, beliefs about anxiety. Participants also answered questions about common physical complaints that may have no medical explanation, also called somatic symptoms. These can include things like gastrointestinal problems, tiredness and back pain.
The results showed that those with PNES reported significantly more somatic symptoms than others in the study, as well as avoidance of situations which might make them anxious. The group with PNES also scored significantly higher on a measure of how aware they were of their anxiety compared with the control group.
The test subjects comprised of 30 adults with PNES, 25 with epilepsy, and a further 31 adults with no reported history of seizures who served as a nonclinical control group.
The results suggest that including tests to determine levels of anxiety and avoidance behaviour may enable health professionals to make earlier diagnosis, and develop more effective intervention plans.
Dr David Dawson, Research Clinical Psychologist from the University of Lincoln, said: “Epileptic seizures are caused by abnormal electrical activity in the brain, while most PNESs are thought to be a consequence of complex psychological processes that manifest in physical attacks.
“It is believed that people suffering with PNES may have difficulty actively engaging with anxiety – a coping style known as experiential avoidance. We wanted to examine whether it was possible to make a clear link between seizure frequency and how people experience and manage anxiety. Our study is another step in understanding PNES, which could ultimately lead to better treatment and therefore patient outcomes in the future.”
Citation: Anxiety and avoidance in psychogenic nonepileptic seizures: The role of implicit and explicit anxiety. Lian V. Dimaro, David L. Dawson, Nicole A. Roberts, Ian Brown, Nima G.Moghaddam, Markus Reuber. DOI: 10.1016/j.yebeh.2014.02.016
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