Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T15:11:23.488Z Has data issue: false hasContentIssue false
  • English
  • Français

Changes in Emotion Processing following Brief Augmented Psychodynamic Interpersonal Therapy for Functional Neurological Symptoms

Published online by Cambridge University Press:  25 January 2018

Isobel Anne Williams ,
Stephanie Howlett ,
Liat Levita  and
Markus Reuber
Isobel Anne Williams*
Affiliation:
Academic Neurology Unit, The University of Sheffield
Stephanie Howlett
Affiliation:
Department of Neurology, The Royal Hallamshire Hospital
Liat Levita
Affiliation:
Department of Psychology, The University of Sheffield
Markus Reuber
Affiliation:
Academic Neurology Unit, The University of Sheffield
*
Correspondence concerning this article should be addressed to Isobel Anne Williams, Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF. E-mail: isobel.williams@sheffield.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Functional neurological symptoms (FNS) are considered non-volitional and often very disabling, but are not explainable by neurological disease or structural abnormalities. Brief Augmented Psychodynamic Interpersonal Therapy (BAPIT) was adapted to treat the putative emotion processing deficits thought to be central to FNS aetiology and maintenance. BAPIT for FNS has previously been shown to improve levels of distress and functioning, but it is unknown whether improvements on such measures correlate with changes in emotion processing ‒ which this treatment focuses on. Aim: To determine (a) whether the recently developed Emotional Processing Scale-25 can be used to demonstrate BAPIT-associated changes in patients with FNS, and (b) whether changes in the EPS-25 are associated with changes in previously validated outcome measures. Method: 44 patients with FNS completed questionnaires including the EPS-25 and measures of clinical symptomology (health-related quality of life (SF-36), somatic symptoms (PHQ-15), psychological distress (CORE-10) and illness understanding (BIPQ)) pre- and post-therapy. Results: At group level, emotion processing improved following therapy (p = .049). Some measures of clinical symptomology also improved, namely health-related quality of life (p = .02) and illness understanding (p = .01). Improvements in the EPS-25 correlated with improvements in mental health-related quality of life and psychological distress. Conclusions: Emotion processing and some measures of clinical symptomology improved in patients with FNS following BAPIT. The EPS-25 demonstrated changes that correlated with previously validated outcome measures. The EPS-25 is a suitable measure of psychotherapy-associated change in the FNS patient population.

Keywords

functional neurological symptomsemotion processingpsychopathologyquality of life
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 3 , May 2018 , pp. 350 - 366
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edition). Arlington, VA: American Psychiatric Association.Google Scholar
Aybek, S., Nicholson, T. R., O'Daly, O., Zelaya, F., Kanaan, R. A. and David, A. S. (2015). Emotion-motion interactions in conversion disorder: an FMRI study. PLoS One, 10, e0123273. doi:10.1371/journal.pone.0123273. eCollection 2015.Google Scholar
Bagby, R. M. (1994). The twenty-item Toronto Alexithymia scale-I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 23–32. doi: 10.1016/0022-3999(94)90005-1CrossRefGoogle ScholarPubMed
Baker, R., Owens, M., Thomas, S., Whittlesea, A., Abbey, G., Gower, P. et al. (2012). Does CBT facilitate emotional processing? Behavioural and Cognitive Psychotherapy, 40, 19–37. doi: 10.1017/s1352465810000895CrossRefGoogle ScholarPubMed
Baker, R., Thomas, P., Thomas, S., Santonastaso, M. and Corrigan, E. (2015). The Emotional Processing Scale. Oxford, UK: Hogrefe.Google Scholar
Baker, R., Thomas, S., Thomas, P. W., Gower, P., Santonastaso, M. and Whittlesea, A. (2009). The Emotional Processing Scale: scale refinement and abridgement (EPS-25). Journal of Psychosomatic Research, 68, 83–88. doi: 10.1016/j.jpsychores.2009.07.007Google Scholar
Baker, R., Thomas, S., Thomas, P. W. and Owens, M. (2007). Development of an emotional processing scale. Journal of Psychosomatic Research, 62, 167–178. doi: 10.1016/j.jpsychores.2006.09.005CrossRefGoogle ScholarPubMed
Bakvis, P., Roelofs, K., Kuyk, J., Edelbroek, P. M., Swinkels, W. A. and Spinhoven, P. (2009). Trauma, stress, and preconscious threat processing in patients with psychogenic nonepileptic seizures. Epilepsia, 50, 1001–1011. doi: 10.1111/j.1528-1167.2008.01862CrossRefGoogle ScholarPubMed
Beck, A. T., Erbaugh, J., Ward, C. H., Mock, J. and Mendelsohn, M. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561.Google Scholar
Broadbent, E., Petrie, K. J., Main, J. and Weinman, J. (2006). The Brief Illness Perception Questionnaire. Journal of Psychosomatic Research, 60, 631–637. doi: 10.1016/j.jpsychores.2005.10.020CrossRefGoogle ScholarPubMed
Carson, A. J., Brown, R., David, A. S., Duncan, R., Edwards, M. J., Goldstein, L. H. et al. (2012). Functional (conversion) neurological symptoms: research since the millennium. Journal of Neurology, Neurosurgery, and Psychiatry, 83, 842–850. doi: 10.1136/jnnp-2011-301860Google Scholar
Carson, A. J., Stone, J., Hibberd, C., Murray, G., Duncan, R., Coleman, R. et al. (2011). Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by organic disease’. Journal of Neurology, Neurosurgery, and Psychiatry, 82 (7), 810–813. doi: 10.1136/jnnp.2010.220640Google Scholar
Compare, A., Del Forno, D., Callus, E., Giallauria, F., Vitelli, A., Buccelli, C. and Vigorito, C. (2012). Post-traumatic stress disorder, emotional processing and inappropriate implantable cardioverter-defibrillator shocks: clinical consideration by a single case report. Monaldi Archives for Chest Disease, 78, 160–166.Google ScholarPubMed
Connell, J. and Barkham, M. (2007). CORE-10 User Manual, version 1.1: CORE System Trust and CORE Information Management Systems.Google Scholar
Demartini, B., Petrochilos, P., Ricciardi, L., Price, G., Edwards, M. J. and Joyce, E. (2014). The role of alexithymia in the development of functional motor symptoms (conversion disorder). Journal of Neurology, Neurosurgery, and Psychiatry, 85, 1132–1137. doi: 10.1136/jnnp-2013-307203CrossRefGoogle ScholarPubMed
Edlund, M. J., Wang, P. S., Berglund, P. A., Katz, S. J., Lin, E. and Kessler, R. C. (2002). Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. American Journal of Psychiatry, 159, 845–851. doi: 10.1176/appi.ajp.159.5.845Google Scholar
Esteves, J. E., Wheatley, L., Mayall, C. and Abbey, H. (2013). Emotional processing and its relationship to chronic low back pain: results from a case-control study. Manual Therapy, 18, 541–546. doi: 10.1016/j.math.2013.05.008Google Scholar
Field, A. P. (2013). Discovering Statistics using IBM SPSS: and sex and drugs and rock and roll (4th edition). London: SAGE.Google Scholar
Gratz, K. L. and Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. doi: 10.1023/b:joba.0000007455.08539.94Google Scholar
Hobson, R. F. (1985). Forms of Feeling, The Heart of Psychotherapy. Tavistock Publications Ltd.Google Scholar
Howlett, S., Grunewald, R. A., Khan, A. and Reuber, M. (2007). Engagement in psychological treatment for functional neurological symptoms ‒ barriers and solutions. Psychotherapy (Chic), 44 (3), 354–360. doi: 10.1037/0033-3204.44.3.354CrossRefGoogle ScholarPubMed
Howlett, S. and Reuber, M. (2009). An augmented model of brief psychodynamic interpersonal therapy for patients with nonepileptic seizures. Psychotherapy (Chic), 46, 125–138. doi: 10.1037/a0015138Google Scholar
IBM Corporation (2013). IBM SPSS Statistics for Windows (version 22.0). Armonk, NY: IBM Corporation.Google Scholar
Jacobson, N. S., Roberts, L. J., Berns, S. B. and McGlinchey, J. B. (1999). Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. Journal of Consulting and Clinical Psychology, 67, 300–307.CrossRefGoogle ScholarPubMed
Kret, M. E. and Ploeger, A. (2015). Emotion processing deficits: a liability spectrum providing insight into comorbidity of mental disorders. Neuroscience and Biobehavioral Reviews, 52, 153–171. doi: 10.1016/j.neubiorev.2015.02.011Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2002). The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64, 258–266.CrossRefGoogle ScholarPubMed
Mayor, R., Howlett, S., Grunewald, R. and Reuber, M. (2010). Long- term outcome of brief augmented psychodynamic interpersonal therapy for psychogenic nonepileptic seizures: seizure control and health care utilization. Epilepsia, 51, 1169–1176. doi: 10.1111/j.1528-1167.2010.02656.xCrossRefGoogle ScholarPubMed
Novakova, B., Howlett, S., Baker, R. and Reuber, M. (2015). Emotion processing and psychogenic non-epileptic seizures: a cross-sectional comparison of patients and healthy controls. Seizure, 29, 4–10. doi: 10.1016/j.seizure.2015.03.007Google Scholar
Rachman, S. (1980). Emotional processing. Behaviour Research and Therapy, 18, 51–60.CrossRefGoogle ScholarPubMed
Reuber, M., Burness, C., Howlett, S., Brazier, J. and Grunewald, R. (2007a). Tailored psychotherapy for patients with functional neurological symptoms: a pilot study. Journal of Psychosomatic Research, 63, 625–632. doi: 10.1016/j.jpsychores.2007.06.013Google Scholar
Reuber, M., Howlett, S., Khan, A. and Grunewald, R. A. (2007b). Non-epileptic seizures and other functional neurological symptoms: predisposing, precipitating, and perpetuating factors. Psychosomatics, 48, 230–238. doi: 10.1176/appi.psy.48.3.230Google Scholar
Ricciardi, L., Demartini, B., Crucianelli, L., Krahe, C., Edwards, M. J. and Fotopoulou, A. (2015). Interoceptive awareness in patients with functional neurological symptoms. Biological Psychology. doi: 10.1016/j.biopsycho.2015.10.009Google Scholar
Roberts, N. A. and Reuber, M. (2014). Alterations of consciousness in psychogenic nonepileptic seizures: emotion, emotion regulation and dissociation. Epilepsy and Behavior, 30, 43–49. doi: 10.1016/j.yebeh.2013.09.035CrossRefGoogle ScholarPubMed
Rothschild, B. (2000). The Body Remembers ‒ The Psychophysiology of Trauma and Trauma Treatment. New York: W.W. Norton.Google Scholar
Sattel, H., Lahmann, C., Gundel, H., Guthrie, E., Kruse, J., Noll-Hussong, M. et al. (2012). Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: randomised controlled trial. British Journal of Psychiatry, 200, 60–67. doi: 10.1192/bjp.bp.111.093526Google Scholar
Sharpe, M., Stone, J., Hibberd, C., Warlow, C., Duncan, R., Coleman, R. et al. (2010). Neurology out-patients with symptoms unexplained by disease: illness beliefs and financial benefits predict 1-year outcome. Psychological Medicine, 40 (4), 689–698. doi: 10.1017/s0033291709990717Google Scholar
Stone, J. (2013). Functional neurological symptoms. Clinical Medicine, 13, 80–83.Google Scholar
Urbanek, M., Harvey, M., McGowan, J. and Agrawal, N. (2014). Regulation of emotions in psychogenic nonepileptic seizures. Epilepsy and Behavior, 37, 110–115. doi: 10.1016/j.yebeh.2014.06.004CrossRefGoogle ScholarPubMed
Ware, J. E., Kosinski, M. and Gandek, B. (2000). SF-36 Health Survey: Manual and Interpretation Guide. Lincoln, RI: Quality Metric Incorporated.Google Scholar
World Health Organization (2016). ICD-10 version: 2016. Available at: http://apps.who.int/classifications/icd10/browse/2016/en#Google Scholar
Supplementary material: File

Williams et al. supplementary material

Table S1

Download Williams et al. supplementary material(File)
File 13.6 KB
Supplementary material: File

Williams et al. supplementary material

Table S2

Download Williams et al. supplementary material(File)
File 13.9 KB
Submit a response

Comments

No Comments have been published for this article.