title: Emotion processing and psychogenic non-epileptic seizures: A cross-sectional comparison of patients and healthy controls.
abstract: OBJECTIVE
  This exploratory study aimed to examine emotion-processing styles in patients with psychogenic non-epileptic seizures (PNES), compared to healthy individuals, and to explore associations of emotion processing with other psychological measures and seizure frequency, using the new Emotional Processing Scale (EPS-25), which had not previously been used in this patient group.
  
  
  METHODS
  Fifty consecutive patients with PNES referred for psychotherapy completed a set of self-report questionnaires, including the Emotional Processing Scale (EPS-25), Clinical Outcome in Routine Evaluation (CORE-10), Short Form-36 (SF-36), Patient Health Questionnaire (PHQ-15), and Brief Illness Perception Questionnaire (BIPQ). Responses on the EPS-25 were compared to data from 224 healthy controls.
  
  
  RESULTS
  Patients with PNES had greater emotion processing deficits across all dimensions of the EPS-25 than healthy individuals (suppression/unprocessed emotion/unregulated emotion/avoidance/impoverished emotional experience). Impaired emotion processing was highly correlated with psychological distress, more frequent and severe somatic symptoms, and a more threatening understanding of the symptoms. Emotion processing problems were also associated with reduced health-related quality of life on the mental health (but not the physical health) component of the SF-36. The unregulated emotions sub-scale of the EPS was associated with lower seizure frequency.
  
  
  CONCLUSIONS
  The results showed clear impairments of emotion processing in patients with PNES compared to healthy individuals, which were associated with greater psychological distress and reduced mental health functioning. These findings seem to support the face validity of the EPS-25 as a measure for PNES patients and its potential as a tool to assess the effectiveness of psychological interventions.
authors.affiliation: Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK. Electronic address: bnovakova1@sheffield.ac.uk.
authors.forename: Barbora
authors.initials: B
authors.lastname: Novakova
authors.affiliation: Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. Electronic address: stephanie.howlett@sth.nhs.uk.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Howlett
authors.affiliation: Bournemouth University Clinical Research Unit, Bournemouth University, Bournemouth, UK. Electronic address: rbaker@bournemouth.ac.uk.
authors.forename: Roger
authors.initials: R
authors.lastname: Baker
authors.affiliation: Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK; Department of Neurology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. Electronic address: markus.reuber@sth.nhs.uk.
authors.forename: Markus
authors.initials: M
authors.lastname: Reuber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011602:Psychophysiologic Disorders / Q000628:therapy; D011613:Psychotherapy; D012640:Seizures / Q000209:etiology / Q000523:psychology* / Q000628:therapy; D057566:Self Report; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Avoidance; Dissociative disorder; Emotion processing; Health-related quality of life; Non-epileptic seizures; Somatic symptoms