Universiteit Leiden

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Research project

Epilepsy and anxiety: targeting a vicious cycle

How effective and efficient are cognitive behavioural therapy and eye movement desensitization and reprocessing in the treatment of epilepsy-related anxiety?

Karin van der Hiele

Stichting Epilepsie Instellingen Nederland (SEIN)
University of Amsterdam, Academic Centre for Dentistry Amsterdam, Department of Social Dentistry and Behavioral Sciences

Anxiety disorders occur in about 14-25% of people with epilepsy and have an adverse impact on health-related quality life (Johnson, Jones, Seidenberg, & Hermann, 2004). You can imagine that the unpredictable and uncontrollable nature of epilepsy may result in anxiety. Posttraumatic stress disorder (PTSD) is quite common and has been observed in 37% of adults with epileptic seizures that are hard to control with medication (Rosenberg, Rosenberg, Williamson, & Wolford, 2000).

There is some evidence for a bidirectional relationship between anxiety and epilepsy. Emotional states, such as stress, fear, anxiety and agitation are often mentioned as seizure triggers by people with epilepsy (Michaelis, Schonfeld, & Elsas, 2012). In addition, uncertainty about when the next seizure will occur may lead to heightened anxiety. This forms the basis of a vicious cycle in which seizures lead to heightened anxiety and vice versa. Psychological interventions may be beneficial to break this vicious cycle.

Both cognitive behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR) therapy are first-line treatments for PTSD. A recent review of 24 randomized controlled trials of psychological treatments in epilepsy, reported moderate-quality evidence that psychological and self-management interventions improve quality of life and emotional well-being and reduce fatigue in adults with epilepsy (Michaelis et al., 2017). Most of these treatments are focused on seizure reduction, whereas the mediating effects of anxiety and stress reduction are often not studied (Novakova, Harris, Ponnusamy, & Reuber, 2013). EMDR therapy has been found to significantly reduce the symptoms of PTSD, depression, anxiety, and subjective distress in PTSD patients and paediatric epilepsy (Chen et al., 2014; Dautovic, de Roos, van Rood, Dommerholt, & Rodenburg, 2016). To our knowledge, there are no randomized controlled studies comparing the efficacy and efficiency of CBT and EMDR therapy in treating anxiety in adults with epilepsy.

The current study aims to compare the efficacy and efficiency of CBT, EMDR therapy and a wait-list condition in treating posttraumatic stress and/ or anxiety symptoms related to epilepsy, up to 6 months after treatment. We expect that CBT and EMDR therapy will significantly reduce anxiety and physiological stress in epilepsy and that this will indirectly reduce the number of seizures and improve quality of life.

Literature references

Beyenburg, S., Mitchell, A.J., Schmidt, D., Elger, C.E., & Reuber, M. (2005). Anxiety in patients with epilepsy: systematic review and suggestions for clinical management. Epilepsy Behav, 7(2), 161-171. doi:10.1016/j.yebeh.2005.05.014

Chen, Y.R., Hung, K.W., Tsai, J.C., Chu, H., Chung, M.H., Chen, S.R., . . . Chou, K.R. (2014). Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: a meta-analysis of randomized controlled trials. PLoS One, 9(8), e103676. doi:10.1371/journal.pone.0103676

Dautovic, E., De Roos, C., Van Rood, Y., Dommerholt, A., & Rodenburg, R. (2016). Pediatric seizure-related posttraumatic stress and anxiety symptoms treated with EMDR: a case series. Eur J Psychotraumatol, 7, 30123. doi:10.3402/ejpt.v7.30123

Johnson, E.K., Jones, J.E., Seidenberg, M., & Hermann, B.P. (2004). The relative impact of anxiety, depression, and clinical seizure features on health-related quality of life in epilepsy. Epilepsia, 45(5), 544-550. doi:10.1111/j.0013-9580.2004.47003.x

Michaelis, R., Schonfeld, W., & Elsas, S.M. (2012). Trigger self-control and seizure arrest in the Andrews/Reiter behavioral approach to epilepsy: a retrospective analysis of seizure frequency. Epilepsy Behav, 23(3), 266-271. doi:10.1016/j.yebeh.2011.11.023

Michaelis, R., Tang, V., Wagner, J.L., Modi, A.C., LaFrance, W.C., Jr., Goldstein, L.H., . . . Reuber, M. (2017). Psychological treatments for people with epilepsy. Cochrane Database Syst Rev, 10, CD012081. doi:10.1002/14651858.CD012081.pub2

Novakova, B., Harris, P.R., Ponnusamy, A., & Reuber, M. (2013). The role of stress as a trigger for epileptic seizures: A narrative review of evidence from human and animal studies. Epilepsia, 54(11), 1866-1876. doi:10.1111/epi.12377

Rosenberg, H.J., Rosenberg, S.D., Williamson, P.D., & Wolford, G. L., 2nd. (2000). A comparative study of trauma and posttraumatic stress disorder prevalence in epilepsy patients and psychogenic nonepileptic seizure patients. Epilepsia, 41(4), 447-452.

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