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Effectiveness of psychological interventions for people with poorly controlled epilepsy

People with epilepsy are at increased risk of anxiety and depression, of experiencing low self esteem, and of suffering from the stigma attached to having epilepsy. A recent, large community study (based on responses by 696 adults)1 showed the importance of frequency of current seizures in determining anxiety, depression, and perceived life fulfilment. Factors other than frequency of seizures may influence ability to cope psychologically.2 In addition, psychological factors have become increasingly recognised as playing a part in the occurrence of seizures.3Psychological interventions might consider, therefore, both the psychological disturbances that accompany poorly controlled seizures, and the occurrence of the seizures themselves.

The present review sets out to consider the status of psychological interventions, both for dealing with psychological disturbances associated with epilepsy, and for the reduction of occurrence of seizures. MedLine and PsychLit searches were undertaken to identify recent literature (1990–6) using the terms epilepsy and self control, group therapy, psychotherapy, psychological treatment, psychological problems, cognitive therapy, behaviour therapy, psychosocial, anxiety, depression, stigma, relaxation, biofeedback. This was supplemented by a manual search and the use of some existing reviews.3-8 On the basis of this review, indications for further research and for the practical application of such work with patients will be discussed.

Little rigorous research has been undertaken to investigate methods of alleviating psychological disturbance in patients with epilepsy.

Psychodynamic psychotherapy has been discussed from purely theoretical aspects, with some case vignettes9-13 which were not systematically controlled. Psychotherapy has, for example, been used to alleviate strong emotional feelings and stigma associated with having epilepsy, and to assist patients in dealing with psychosocial stresses associated with seizure precipitance, emotional conflicts in patients’ lives, anxiety, depression, and low self esteem (for example, Mathers9 and Miller12) Single case reports of patients (often children) treated …