Acceptance and Commitment Therapy and yoga for drug-refractory epilepsy: A randomized controlled trial
Introduction
Research suggesting that behavioral treatments can influence the seizure process is substantial [1], [2]. However, there are few signs that these low-cost, noninvasive interventions are integrated into everyday treatment of epilepsy. Antiepileptic drugs (AEDs) are normally the only treatment offered to those who have epilepsy despite the fact that they do not function effectively for everyone, entail adverse side effects and are not economically available to the majority of people [3], [4]. Seizures are only a small part of the overall problems associated with epilepsy. Persons who have seizures more frequently have psychiatric disorders like depression, anxiety, and low quality of life as compared with those with other chronic illnesses [5]. The stigmatization problems associated with epilepsy are well documented [6]. These conclusions suggest that persons with epilepsy and related problems need to be treated with a broad behavioral approach [7]. The project described here evaluates the effect of two active treatments, both of which address the larger context of epilepsy and quality of life—Acceptance and Commitment Therapy and yoga—in patients with drug-refractory seizures.
An epileptic seizure is, according to the behavior model, defined as a complex involving a biological predisposition to “seize” and internal and external contextual factors that increase or decrease the probability of seizure occurrence [8]. The epileptic seizure is seen as a chain of behavior, and analysis of that chain includes elicitation, inhibition, and the seizure function [9]. A tailormade program is developed based on the behavior analysis and includes preventive strategies, seizure management, and interventions dealing with the functions of seizure behavior [8]. The aim of applied behavior analysis is to predict and affect behavior. The goal of the intervention is to decrease seizure activity and increase quality of life.
Applied behavior analysis and learning theory have, in recent years, taken important steps in the development of a theoretical and clinical understanding of human functioning [10]. One recently developed model in behavior therapy is Acceptance and Committment Therapy (ACT). ACT is based on behavior psychology and grounded in a new theory of language and cognition called Relational Frame Theory (RFT) [11]. The effect of ACT has been evaluated in chronic illnesses such as epilepsy [1], diabetes [12], and pain [13] and the results are promising. ACT has also been evaluated in psychiatric disorders like depression, anxiety, stigmatization problems, and social phobia with good effects [10]. The aim of ACT is to create psychological flexibility and stimulate activity in directions that persons consider meaningful and vital, so-called valued directions. Psychological flexibility around difficult emotions and thoughts that function as a barrier to valued actions is created using acceptance and mindfulness processes. Acceptance refers to an active willingness to experience emotions, bodily sensations, and thoughts without trying to control or manipulate them [14]. Mindfulness is a process through which emotions, thoughts, and sensations are experienced here and now in a conscious flow [15]. The psychological flexibility developed through acceptance and mindfulness helps patients to act instead of react to bodily sensations [14]. ACT for epilepsy is built on basic behavior processes and focuses on both quality of life and the seizure pattern. The aim of an ACT treatment for epilepsy is to increase psychological flexibility around the chain of seizure development, decrease the epilepsy-related experiential avoidance, broaden the behavior repertoire, and motivate activity in the chosen valued direction. Reducing experiential avoidance with behavior methods may decrease the triggering function of experiences related to epilepsy [1].
Similarly to biofeedback training and relaxation, yoga may have an effect on the probability of seizure occurrence because of the effect it has on brain wave activity and arousal level [16], [17]. Research shows that sudden changes in cortical activity and arousal level affect the probability of seizure occurrence [18], [19]. Studies on biofeedback demonstrate that persons in a laboratory using video/EEG can be trained to generate brain waves that affect the probability of seizure occurrence [20]. Furthermore, Brown and Gerbarg [21] suggest that yoga training stimulates the vagus nerve, and stimulation of the vagus nerve has been shown to decrease seizure frequency by 28–38% [22], [23]. Yoga has been demonstrated to increase quality of life and decrease psychiatric problems for those who have epilepsy [16]. The aim of the yoga training described in this study was to prevent and decrease seizure behavior and increase quality of life.
Between 25 and 40% of those with epilepsy treated with pharmacotherapy have uncontrolled seizures, experience adverse side effects from medication, suffer from stigmatization, and have a higher degree of psychiatric disorders as compared with those with other chronic illnesses. For those who have epilepsy and related problems it is important to develop, evaluate, and implement a complementary treatment model in the everyday treatment of epilepsy [7], [24]. The Cochrane Library has expressed the need for well-designed, controlled outcome studies evaluating the effect of behavioral treatment of epilepsy [2]. The aim of this study was to evaluate and compare the effects of two active treatments for epilepsy: ACT and yoga.
Section snippets
Design
In this randomized, controlled, two-group study with repeated measures, participants were assigned to either ACT or yoga treatment using a computerized randomization table [25]. The design involved four sessions: one individual session, two group sessions, and one individual session. Booster sessions occurred at 6 and 12 months. The individual sessions and booster sessions were each 1.5 hours long and the group sessions were 3 hours, for a total therapy time of 12 hours, for each participant.
Subjects
Results
Effects of the two treatment conditions with respect to each of the dependent variables before and after treatment are described and compared.
Discussion
The results of the current study demonstrated that short-term ACT and yoga treatments for epilepsy decreased seizure index and quality of life. The ACT treatment led to a significantly larger decrease in seizure index as compared with the yoga treatment. The results from the quality-of-life measure indicated that quality of life increased significantly for participants in both groups over the 1-year follow-up period by one of two instruments. The present study contributes to the research base
References (38)
Stigma, epilepsy, and quality of life
Epilepsy Behav
(2002)Yoga for control of epilepsy
Seizure
(2001)- et al.
Acceptance and Commitment Therapy: model, processes, and outcomes
Behav Res Ther
(2006) - et al.
Psychosocial intervention in pediatric epilepsy: a critique of the literature
Epilepsy Behav
(2006) - et al.
Evaluation of Acceptance and Commitment Therapy for drug refractory epilepsy: a randomized controlled trial in South Africa: a pilot study
Epilepsia
(2006) - et al.
Psychological treatments for epilepsy
Cochrane Database Syst Rev
(2001) - et al.
Early identification of refractory epilepsy
N Engl J Med
(2000) - et al.
A comparison of surgical and medical costs for refractory epilepsy
Epilepsia
(2000) - et al.
Epilepsy in children
(2004) From precipitation to inhibition of seizures: rationale of a therapeutic paradigm
Epilepsia
(2005)
Behavior Analysis of epilepsy: conditioning mechanisms, behavior technology and the contribution of ACT
Behav Analyst Today
From precipitation to inhibition of seizures: rationale of a therapeutic paradigm
Epilepsia
Acceptance and Commitment Therapy, Relational Frame Theory, and the third wave of behavior therapy
Behav Ther
Improving diabetes self management through acceptance, mindfulness, and values: a randomized controlled trial
J Consult Clin Psychol
Acceptance and Commitment Therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: a preliminary randomized trial
Behav Ther
Acceptance and Commitment Therapy: an experiential approach to behavior change
Kapalabhati yogic cleansing exercise: II. EEG topography analysis
Homeostasis Health Dis
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2022, Epilepsy and BehaviorCitation Excerpt :In addition, statistically significant changes between groups and time (group × time interaction) were observed in seven studies [19–22,24,26,27]. However, in four studies significant improvements between pre- and post-results were observed in the control groups in seizures and symptoms [24], neurocognitive [20] and psycho-affective outcomes [22] and QoL [25]. Ten studies analysed the impact of exercise on seizure frequency [19,22,24,25,27–32].