Could Prolonged Exposure (PE) therapy be useful in treating psychogenic non-epileptic seizures?

scared girlUp to 90% of patients with psychogenic non-epileptic seizures (PNES) report histories of significant trauma (often childhood sexual and physical abuse).  If we compare with control groups and the general US population, we find that in fact, patients with psychogenic non epileptic seizures have suffered more abuse than these other groups.   As for post-traumatic stress disorder (PTSD), studies have reported percentages of patients with both PNES and PTSD that range anywhere from 22-100%.

Our group recently wrote up results based on a study of 61 of our patients with PNES.  This is now in press (preliminary title:Psychological trauma in patients with psychogenic non-epileptic seizures: Trauma characteristics and those who develop PTSD) and may be coming out this year in Epilepsy and Behavior.

We looked carefully at our patients’ histories, including trauma details and gave out self–report forms including an inventory of personality functioning and another one that measures a variety of trauma symptoms.  We found a history of trauma in almost 3/4s of the group and a substantial number of these received a diagnosis of post-traumatic stress disorder (PTSD).  This is an exciting finding for those of us who treat PNES because there are a few well researched therapies for PTSD that could prove useful.

Probably the most empirically validated treatment for PTSD is prolonged exposure (PE) therapy which is a type of treatment that has been researched extensively and has been found to be a highly effective treatment for PTSD. PE is a combination of behavioral and cognitive treatment that targets the most resistant symptoms of PTSD.  The PE theory is simple to understand (although the treatment itself requires a trained professional): extreme trauma teaches the survivor that in order to remain safe many dangers in life need to be avoided.  Avoidance becomes a big part of the survivor’s life (e.g. avoiding men who look like the person who committed the crime, being home alone like when the attack occurred, not wearing a certain type of dress, etc.).  The list of things that are avoided to ensure safety can be endless and may grow in time.  Avoidance behaviors and beliefs about the dangers of the world keep the trauma strong and unchanged.  The logical answer to counteract this is to stop avoiding and start facing that which is feared.  Note: this is not something that should be done on your own or outside of the structure and safety provided by a trained therapist.  Also note: prolonged exposure (PE) is not an easy treatment and requires that you walk into it motivated to get better and ready to do a lot of work in session and a lot of homework.

The next step would now be to offer PE to patients with PNES and PTSD and see the effects of this.

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