title: Cognitive behaviour therapy with adults with intractable epilepsy and psychiatric co-morbidity: preliminary observations on changes in psychological state and seizure frequency.
abstract: Cognitive behaviour therapy (CBT) was undertaken with six adults with chronic, poorly controlled seizures and co-existing psychiatric and/or psychosocial difficulties. During 12 sessions of CBT from an experienced CBT Nurse Specialist, treatment focused concurrently on epilepsy-related problems, associated psychopathology and on the development of psychological strategies to reduce seizure occurrence. At the end of treatment participants rated their initial epilepsy-related problem as having less impact on their daily lives and at one-month follow-up reported less deleterious impact on everyday life in terms of their psychological difficulties. In addition participants demonstrated significant improvements in terms of their self-rated work and social adjustment, and in their decreased use of escape-avoidance coping strategies. These positive findings occurred despite the absence of a significant decrease in seizure frequency. Issues raised by the complexity and severity, both of these patients' psychological/psychosocial difficulties and their epilepsy, are discussed in relation to the optimal length of treatment that may be required when adopting a CBT model in this patient group.
authors.affiliation: Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. l.goldstein@iop.kcl.ac.uk
authors.forename: L H
authors.initials: LH
authors.lastname: Goldstein
authors.forename: M
authors.initials: M
authors.lastname: McAlpine
authors.forename: A
authors.initials: A
authors.lastname: Deale
authors.forename: B K
authors.initials: BK
authors.lastname: Toone
authors.forename: J D C
authors.initials: JD
authors.lastname: Mellers
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004827:Epilepsy / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012917:Social Adjustment