title: Anxiety and avoidance in psychogenic nonepileptic seizures: the role of implicit and explicit anxiety.
abstract: This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p<.001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r=.63, p<.01) and frequency of seizures (r=.67, p<.01); implicit anxiety correlated with frequency of seizures only (r=.56, p<.01). Our findings demonstrate the role of implicit anxiety in PNESs and provide additional support for the contribution of explicit anxiety and experiential avoidance to this disorder.
authors.affiliation: Nottinghamshire Healthcare NHS Trust, Rampton Hospital, Retford, Nottinghamshire DN22 0PD, UK. Electronic address: lian.dimaro@gmail.com.
authors.forename: Lian V
authors.initials: LV
authors.lastname: Dimaro
authors.affiliation: Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK. Electronic address: ddawson@lincoln.ac.uk.
authors.forename: David L
authors.initials: DL
authors.lastname: Dawson
authors.affiliation: School of Social and Behavioural Sciences, Arizona State University, 4701 W, Thunderbird Road, MC 3051, Glendale, AZ 85306, USA. Electronic address: Nicole.A.Roberts@asu.edu.
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Roberts
authors.affiliation: Clinical Psychology Unit, Department of Psychology, University of Sheffield, Western Bank, Sheffield S10 2TN, UK. Electronic address: ian.brown@sheffield.ac.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Brown
authors.affiliation: Trent Doctorate in Clinical Psychology, Health, Life and Social Sciences, University of Lincoln, Brayford Pool, Lincoln, Lincolnshire LN6 7TS, UK. Electronic address: nmoghaddam@lincoln.ac.uk.
authors.forename: Nima G
authors.initials: NG
authors.lastname: Moghaddam
authors.affiliation: Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Electronic address: markus.reuber@sth.nhs.uk.
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D004827:Epilepsy / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011602:Psychophysiologic Disorders / Q000523:psychology*; D012640:Seizures / Q000523:psychology*; D013001:Somatoform Disorders / Q000523:psychology*; D055815:Young Adult
keywords: Anxiety; Avoidance; Implicit; Implicit Relational Assessment Procedure; Nonepileptic; Seizures