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ACT Treatment of Epilepsy: Time for a behavioral model?
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The present dissertation contributes to the understanding of behavioral treatment of epilepsy and supports the integration of medical and behavioral science to develop a treatment model to help those who suffer from drug refractory epilepsy. There is a lack of well-designed randomized controlled trials evaluating behavioral therapy for epilepsy. Medical science has contributed significantly to the development of antiepileptic drugs for seizure control, yet despite these efforts approximately 1/3 of patients suffer from recurrent seizures. The comorbidity between epilepsy and psychiatric problems is significant and quality of life is lower for those who suffer from epilepsy compared to those who suffer from other chronic illnesses. The purpose of the present dissertation is to develop and evaluate a behavioral treatment model for those who suffer from recurrent epileptic seizures and associated problems. Acceptance and commitment therapy (ACT) is compared to supportive treatment and yoga. Outcome variables are seizure frequency, seizure index (frequency * duration) and quality of life. The dissertation consists of three studies; two studies with randomized controlled group designs to evaluate treatment effects and one mediational analysis study evaluating the effect of specific therapeutic processes. The mediational analysis examines specific ACT processes such as value attainment, epilepsy related psychological flexibility and persistency in overcoming barriers. The results of the two randomized controlled trials show a significant decrease in seizure frequency and seizure index in favor of the ACT group compared to the control groups and significant changes in life quality. The results of the mediational study indicate that the evaluated processes, alone or in combination, had a mediational role in three of the four outcome variables. In conclusion, the present dissertation supports the integration of behavior and medical science to help those who suffer from epilepsy and associated problems.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , 53 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 68
National Category
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-151778ISBN: 978-91-554-8084-4OAI: oai:DiVA.org:uu-151778DiVA: diva2:411343
Public defence
2011-05-31, Sal IX, Universitetshuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-05-10 Created: 2011-04-18 Last updated: 2011-07-01Bibliographically approved
List of papers
1. Evaluation of acceptance and commitment therapy for drug refractory epilepsy: A randomized controlled trial in South Africa - A pilot study
Open this publication in new window or tab >>Evaluation of acceptance and commitment therapy for drug refractory epilepsy: A randomized controlled trial in South Africa - A pilot study
2006 (English)In: Epilepsia, ISSN 0013-9580, E-ISSN 1528-1167, Vol. 47, no 12, 2173-2179 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: Psychological interventions in the treatment of epilepsy have been developed and evaluated for many years but the amount of research has hardly made an impact on how epilepsy is treated. The purpose of this study was to develop and evaluate a psychological treatment program consisting of Acceptance and Commitment Therapy together with some behavioral seizure control technology shown to be successful in earlier research.

Methods: The method consisted of a RCT group design with repeated measures (N= 27). All participants had an EEG verified epilepsy diagnosis with drug refractory seizures. Participants were randomized into one of two conditions, ACT or Supportive therapy (ST). Therapeutic effects were measured by examining changes in quality of life (SWLS and WHOQOL) and seizure index (frequency * duration). Both treatment conditions consisted of only 9 hours of professional therapy distributed in two individual and two group sessions during a four-week period.

Results: The results showed significant effects over all of the dependent variables for the ACT group as compared to the ST group at 6 and twelve-month follow ups.

Conclusions: The results from this study suggest that a short-term psychotherapy program combined with anticonvulsant drugs may help to prevent the long-term disability that occurs from drug refractory seizures.

Keyword
Epilepsy, Acceptance and Commitment Therapy, Seizure control techniques, South Africa
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-16417 (URN)10.1111/j.1528-1167.2006.00892.x (DOI)000242784000025 ()17201719 (PubMedID)
Available from: 2008-05-23 Created: 2008-05-23 Last updated: 2011-07-01Bibliographically approved
2. Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: A randomized controlled trial
Open this publication in new window or tab >>Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: A randomized controlled trial
2008 (English)In: Epilepsy & Behavior, ISSN 1525-5050, Vol. 13, no 1, 102-108 p.Article in journal (Refereed) Published
Abstract [en]

Objective. There is a need for controlled outcome studies on behavioral treatment of epilepsy. The purpose of this study was to evaluate Acceptance and Commitment Therapy (ACT) and yoga in the treatment of epilepsy. Methods. The design consisted of a randomized controlled trial with repeated measures (N = 18). All participants had an EEG-verified epilepsy diagnosis with drug-refractory seizures. Participants were randomized into one of two groups: ACT or yoga. Therapeutic effects were measured using seizure index (frequency x duration) and quality of life (Satisfaction with Life Scale, WHOQOL-BREF). The treatment protocols consisted of 12 hours of professional therapy distributed in two individual sessions, two group sessions during a 5-week period, and booster sessions at 6 and 12 months posttreatment. Seizure index was continuously assessed during the 3-month baseline and 12-month follow-up. Quality of life was measured after treatment and at the 6-month and 1-year follow-ups. Results. The results indicate that both ACT and yoga significantly reduce seizure index and increase quality of life over time. ACT reduced seizure index significantly more as compared with yoga. Participants in both the ACT and yoga groups improved their quality of life significantly as measured by one of two quality-of-life instruments. The ACT group increased their quality of life significantly as compared with the yoga group as measured by the WHOQOL-BREF, and the yoga group increased their quality of life significantly as compared with the ACT group as measured by the SWLS. Conclusions. The results of this study suggest that complementary treatments, such as ACT and yoga, decrease seizure index and increase quality of life.

Keyword
epilepsy, acceptance and commitment therapy, yoga, India
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-110021 (URN)10.1016/j.yebeh.2008.02.009 (DOI)000257009400018 ()
Available from: 2009-11-02 Created: 2009-11-02 Last updated: 2011-07-01Bibliographically approved
3. Evaluation of mediators of change in the treatment of epilepsy with Acceptance and Commitment Therapy
Open this publication in new window or tab >>Evaluation of mediators of change in the treatment of epilepsy with Acceptance and Commitment Therapy
2008 (English)In: Journal of behavioral medicine, ISSN 0160-7715, E-ISSN 1573-3521, Vol. 31, no 3, 225-235 p.Article in journal (Refereed) Published
Abstract [en]

The present study examined the mediators of change accounting for outcomes of a previously published study on Acceptance and Commitment Therapy for the self-management of epilepsy and its life restricting impact. Conducted with 27 poor South Africans, a nine-hour ACT protocol that included seizure management methods was shown to greatly reduce epileptic seizures and to increase quality of life over the next year as compared to an attention placebo control. A series of bootstrapped non-parametric multiple mediator tests showed that pre to follow-up changes in: seizures, quality of life, and well-being outcomes were mediated to a degree by ACT process measures of epilepsy-related acceptance or defusion, values attainment, persistence in the face of barriers, or their combination. The results of this study contribute to the understanding of the contextual conditioning mechanisms at work for those suffering from epilepsy and may show that helping people live vital lives may also help to reduce seizures.

Keyword
Acceptance and Commitment Therapy, mediational analysis, epilepsy, values, acceptance, defusion, psychological flexibility, South Africa
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-16419 (URN)10.1007/s10865-008-9151-x (DOI)000256090000005 ()18320301 (PubMedID)
Available from: 2008-05-22 Created: 2008-05-22 Last updated: 2011-07-01Bibliographically approved

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