title: A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy.
abstract: OBJECTIVE
  The aims of this service evaluation were to explore the effectiveness of a psychotherapeutic treatment for patients with epilepsy based on the acceptance and commitment therapy (ACT) approach and to assess whether this treatment is likely to be cost-effective.
  
  
  METHODS
  We conducted an uncontrolled prospective study of consecutive patients with refractory epilepsy referred for outpatient psychological treatment to a single psychotherapist because of emotional difficulties related to their seizure disorder. Participants were referred by consultant neurologists, neuropsychologists, or epilepsy nurses, completed a set of validated self-report questionnaires (Short Form - 12 version 2, Generalized Anxiety Disorder - 7, Neurological Disorders Depression Inventory for Epilepsy, Work and Social Adjustment Scale, and Rosenberg Self-Esteem Scale), and reported their seizure frequency at referral, the end of therapy, and six months posttherapy. Patients received a maximum of 20 sessions of one-to-one psychological treatment supported by a workbook. Cost-effectiveness was estimated based on the calculation of quality-adjusted life year (QALY) gains associated with the intervention.
  
  
  RESULTS
  Sixty patients completed the prepsychotherapy and postpsychotherapy questionnaires, among whom 41 also provided six-month follow-up data. Patients received six to 20 sessions of psychotherapy (mean=11.5, S.D.=9.6). Psychotherapy was associated with significant medium to large positive effects on depression, anxiety, quality of life, self-esteem, and work and social adjustment (ps<.001), which were sustained six months after therapy. The mean cost of the psychotherapy was £445.6, and, assuming that benefits were maintained for at least six months after the end of therapy, the cost per QALY was estimated to be £11,140 (€14,119, $18,016; the cost per QALY would be half this amount if the benefits lasted one year).
  
  
  CONCLUSIONS
  The findings of this pilot study indicate that the described psychotherapeutic intervention may be a cost-effective treatment for patients with epilepsy. The results suggest that a randomized controlled trial of the psychotherapy program is justified.
authors: Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK. Electronic address: edel.dewhurst@sth.nhs.uk.
authors: Edel
authors: E
authors: Dewhurst
authors: Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Electronic address: bnovakova1@sheffield.ac.uk.
authors: Barbora
authors: B
authors: Novakova
authors: Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK; Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Electronic address: markus.reuber@sth.nhs.uk.
authors: Markus
authors: M
authors: Reuber
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000191:economics / Q000379:methods*; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000628:therapy; D003362:Cost-Benefit Analysis; D003863:Depression / Q000628:therapy; D000069279:Drug Resistant Epilepsy / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D055815:Young Adult
keywords: Anxiety; Depression; Psychotherapy; Quality of life; Refractory epilepsy; Self-esteem