Cognitive-emotion processing in psychogenic nonepileptic seizures (original) (raw)
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Regulation of emotions in psychogenic nonepileptic seizures
Epilepsy & Behavior, 2014
Background: Despite the long history of psychogenic nonepileptic seizures (PNES), relatively little is known about the mechanisms that cause and maintain this condition. Emerging research evidence suggests that patients with PNES might have difficulties in regulating their emotions. However, much remains to be learned about the nature of these difficulties and the emotional responses of individuals with PNES. This study aimed to gain a detailed understanding of emotion regulation processes in patients with PNES by examining differences between patients with PNES and a healthy control group with regard to intensity of emotional reactions, understanding of one's emotional experience, beliefs about emotions, and managing emotions by controlling emotional expression. Method: A cross-sectional design was used to compare the group with PNES (n = 56) and the healthy control group (n = 88) on a range of self-report measures. Results: Participants with a diagnosis of PNES reported significantly poorer understanding of their emotions, more negative beliefs about emotions, and a greater tendency to control emotional expression compared to the control group. While intensity of emotions did not discriminate between the groups, poor understanding and negative beliefs about emotions were found to be significant predictors of PNES, even after controlling for age, education level, and emotional distress. Furthermore, the presence of some emotion regulation difficulties was associated with self-reported seizure severity. Conclusions: The results of this study are largely consistent with previous literature and provide evidence for difficulties in emotion regulation in patients with PNES. However, this research goes further in bringing together different aspects of emotion regulation, including beliefs about emotions, which have not been examined before. As far as it is known, this is the first study to suggest that levels of alexithymia in a population with PNES are positively associated with self-reported seizure severity. The findings suggest a need for tailored psychological therapies addressing specific emotion regulation difficulties in individuals with PNES.
Seizure, 2020
The term PNES refers to a conversion disorder that mimics epileptic seizures but has a psychological etiology. Recent studies report that in patients with PNES, there is reduced understanding of emotions, impulse control difficulties, and limited access to emotional regulation strategies. The aim of this study was to compare patients diagnosed with PNES with healthy volunteers on the presence of maladaptive emotional regulation. Method: Patients (N = 64 F:M 52:12; mean age 35.5 years; duration ≥ 2 years) were assessed while inpatients at the Epilepsy Center, Na Homolce Hospital, Prague. PNES diagnosis was based on normal EEG findings, habitual seizure capture, suggestive seizure provocation, neuropsychological assessment and patients´history. The clinical sample was compared with healthy volunteers (N = 64 F:M 52:12; mean age 35.8 years). The presence of maladaptive emotional regulation was assessed through the Czech research version of the ASQ and DERS. Results: Compared with a healthy sample, patients with PNES had greater emotion regulation impairments across nearly all dimensions of the DERS-Nonacceptance = 17.0 (M = 14.5), p = 0.006, Goals = 16.0 (M = 11.5), p < 0.001, Impulse control = 13.8 (M = 11.5), p = 0.005, Awareness = 16.4 (M = 15.3), p = 0.183, Strategies = 17.9 (M = 13.0), p < 0.001, Clarity = 11.8 (M = 9.5), p < 0.001 and the total score of the DERS = 92.9 (M = 75.3), p < 0.001. Similar results were found in ASQ questionnaire scales-Concealing = 24.5 (M = 21.0), p = 0.002, and Adjusting = 20.9 (M = 22.8), p = 0.076 but not on the Tolerating Scale = 14.5 (M = 14.7), p = 0.873. Conclusion: Our results highlight that maladaptive emotional regulation is a key psychological mechanism in PNES. Emotional dysregulation may represent an important target when designing psychoeducational and psychotherapeutic approaches for patients with PNES.
Epilepsia, 2009
Purpose: Psychogenic nonepileptic seizures (PNES) have long been considered as paroxysmal dissociative symptoms characterized by an alteration of attentional functions caused by severe stress or trauma. Although interpersonal trauma is common in PNES, the proposed relation between trauma and attentional functions remains under explored. We examined the attentional processing of social threat in PNES in relation to interpersonal trauma and acute psychological stress.Methods: A masked emotional Stroop test, comparing color-naming latencies for backwardly masked angry, neutral, and happy faces, was administered to 19 unmedicated patients with PNES and 20 matched healthy controls, at baseline and in a stress condition. Stress was induced by means of the Trier Social Stress Test and physiologic stress parameters, such as heart rate variability (HRV) and cortisol, were measured throughout the experiment.Results: No group differences related to the acute stress induction were found. Compared to controls, however, patients displayed a positive attentional bias for masked angry faces at baseline, which was correlated to self-reported sexual trauma. Moreover, patients showed lower HRV at baseline and during recovery.Discussion: These findings are suggestive of a state of hypervigilance in patients with PNES. The relation with self-reported trauma, moreover, offers the first evidence linking psychological risk factors to altered information processing in PNES.
Seizure, 2018
There is increasing evidence that patients with PNES can form subgroups distinguished by emotion dysregulation and comorbid psychological symptoms. The purpose of this study was to determine if patients with comorbid PTSD differ from other patients with PNES in terms of alexithymia and stress coping strategies. Methods: 156 adult patients with video-EEG confirmed PNES were assessed with the Trauma Symptom Inventory-2 (TSI-2) and diagnostic clinical interview, Toronto Alexithymia Scale (TAS-20), and the Coping Inventory for Stressful Situations (CISS). There were 3 groups: 48 patients with PTSD, 62 patients who had experienced trauma and did not have PTSD, and 46 patients who denied experiencing trauma. Results: One-way ANCOVA revealed a significant difference between groups on reported levels of alexithymia [F(2, 154) = 18.21, p < .001] and use of emotion-focused coping [F(2, 156) = 11.12, p < .001]. Tukey HSD post-hoc comparisons indicated that the PNES/PTSD group had significantly higher mean alexithymia scores (M = 59.54, SD = 12.89) than both the no trauma (M = 49.51, SD = 14.92) and the trauma with no PTSD groups (M = 49.98, SD = 13.27), which did not differ from each other. The PNES/PTSD group was also significantly more likely (M = 62.44, SD = 11.56) than the no trauma (M = 52.87, SD = 13.57) and the trauma with no PTSD groups (M = 52.06, SD = 12.63) to utilize emotion-focused coping strategies. No significant differences were found between groups on use of task-or avoidance-focused coping. Conclusion: The study revealed elevated alexithymia and use of potentially more maladaptive emotionfocused coping strategies among patients with PNES and comorbid PTSD. These findings highlight discrete areas to target in treatment depending on comorbid symptomatology, and suggests that PNES, which is often regarded as a homogeneous entity, appears to encompass distinct subgroups.
Epilepsy & Behavior, 2014
Objectives: The objective of this study was to examine cognitive and clinical differences among three groups of patients diagnosed with psychogenic nonepileptic seizures (PNESs): those with posttraumatic stress disorder (PTSD), those with a history of trauma but no PTSD, and those without a history of trauma. Methods: Seventeen patients who were confirmed to have PTSD based on the Trauma Symptom Inventory-2 (TSI-2) and clinical interview were compared with 29 patients without PTSD who had experienced trauma and 17 patients who denied experiencing trauma. We analyzed demographic data, psychiatric information, trauma characteristics, and neuropsychological variables in these groups. Results: Our study revealed that patients with PNESs with comorbid PTSD performed significantly worse on episodic verbal memory (narrative memory); had greater self-reported Total, Verbal, and Visual Memory impairments; and had higher substance abuse history and use of psychopharmacological agents compared with patients without PTSD regardless of a history of trauma. Conclusion: The present study showed that patients with PNESs diagnosed with PTSD exhibited memory functions that were significantly different from those in patients with PNESs who do not carry a diagnosis of PTSD (regardless of history of trauma). Furthermore, these specific cognitive findings in narrative memory are consistent with those reported in patients with PTSD alone. The present findings contribute to further identifying discrete intragroup differences within PNESs. Identifying a specific psychopathological subgroup such as PTSD will allow clinicians to accurately select treatment.
Epilepsy & Behavior, 2014
This study examined the task-switching ability and emotion regulation strategies in 72 patients with psychogenic nonepileptic seizures (PNES) and 72 healthy individuals, where participants categorized emotion and age dimensions among faces. Results demonstrated cognitive impairment in terms of the interrupted ability to switch between emotion and nonemotion face categorizations in patients with PNES. In contrast, healthy individuals exhibited efficient switching between these face categorizations. In patients with PNES, there was an asymmetric relationship between emotion and age tasks, while this asymmetry was absent in the healthy group. The results demonstrated that patients with PNES used expressive suppression to regulate their emotions more frequently than the control group. On the other hand, patients with PNES less frequently reappraised their cognitions than healthy individuals. Switching deficits in patients with PNES were positively correlated with expressive suppression but were negatively correlated with cognitive reappraisal. This is the first study demonstrating the presence of switching deficits in terms of inferior cognitive control of emotion in patients with PNES as compared to healthy individuals. The switching deficits are associated with emotion regulation strategies. These findings suggest that emotion regulation strategies are significant markers of switching deficits in patients with PNES.
Cognitive Distortions and Emotion Regulation Among Post Traumatic Stress Disorder Victims
Psychological Applications and Trends 2019, 2019
Many authors have studied the links between cognition and emotions, including the links between cognitive distortions and emotional cognitive regulation strategies. Nevertheless, the explorations of these two instances in a clinical population presenting a posttraumatic stress disorder have very little been explored. The literature on this subject suggests that a specific profile could emerge in these subjects compared to a different clinical population and / or non-clinical. 184 subjects divided into three groups (60 subjects exposed to a traumatic event with PTSD, 61 subjects exposed to a traumatic event without PTSD, 63 control subjects) passed the CERQ, PCL-5 and a cognitive distortions scale. The main results, which are preliminary results. highlight the presence of a profile distinguishing subjects with PTSD. They have difficulties in managing their emotions, as well as increased use of cognitive distortions, but they do not use them the most. The results lead us to question the cognitive functioning of people with PTSD but also the importance and consequences of therapeutic and drug monitoring of these patients.
Emotion regulation and neuropsychological status in functional neurological disorder variants
Few clinically meaningful treatment options exist for patients with functional neurological disorders (FND) due to limited understanding of within-group differences in cognitive and emotional factors that may differentially influence mental health outcomes. This study aimed to determine the relationship between emotion regulation strategies (suppression vs. reappraisal), psychological symptoms, and cognitive status in two FND variants: non-epileptic seizures (NES) and other functional (hyperkinetic) movement disorders (FMD). Thirty-two patients (NES = 16; FMD = 16) completed a neuropsychological battery including self-report questionnaires of emotion regulation and psychopathology. In the NES group, lower cognition was associated with more severe PTSD symptoms, greater suppression and lower positive emotions. In the FMD group, lower cognition was associated with more severe PTSD symptoms and greater reappraisal. When controlling for general cognition, individuals classified as “supp...
Epilepsy & Behavior, 2019
Psychogenic nonepileptic seizures (PNES) have the appearance of epileptic seizures, yet show no epileptiform discharges in the brain. The quality of life (QOL) in patients with PNES is reportedly low and trauma eems to be a relevant risk factor. The objective of this study was to examine the difference between measures of (epilepsy-specific) QOL (Quality of Life in Epilepsy Inventory; QOLIE-31p) and psychological dysfunction (trauma symptom inventory; TSI) between patients with diagnosed PNES with self-reported trauma and those without self-reported trauma. Methods: Patients whose PNES diagnoses were through video-electroencephalogram (EEG) monitoring at the Northeast Regional Epilepsy Group between 2008 and 2018 were included. Patients who reported to have a history of psychological trauma and those who did not were assigned to separate groups. Scores from the TSI and QOLIE-31p were compared by using multivariate analysis of covariance. Results: The total sample was comprised of 217 adult patients, 148 of which self-reported as having experienced psychological trauma in the past and 69 who did not report any psychological trauma. Traumatized patients significantly differed in terms of QOL and TSI from nontraumatized patients. Traumatized patients were demonstrated to have lower scores on the subdomain "energy" of the QOLIE-31p and the total QOLIE-31p score compared to the nontraumatized group. Similarly, the traumatized group had significantly higher scores on nearly all TSI subscales with the exception of suicidality, sexual disturbances, and somatization. Conclusion: This study demonstrated significant differences between patients with PNES who have been psychologically traumatized and those who have not. In particular, patients with a history of psychological trauma present greater psychopathology and would possibly benefit from rapid identification and referral to traumabased therapy. In turn, this may result in a reduction of disease burden, increase QOL, and a reduction in healthcare costs resulting from diagnostic delays and implementation of less targeted treatments.