Intensive Short Dynamic Psychotherapy for Dissociative Seizures
Research type
Research Study
Full title
Intensive Short Dynamic Psychotherapy (ISTDP) for Dissociative (non-epileptic) Seizures: A Pilot Study
IRAS ID
290144
Contact name
Javier Malda Castillo
Contact email
Sponsor organisation
MerseyCare NHS Foundation Trust
Duration of Study in the UK
0 years, 6 months, 9 days
Research summary
Research Summary
Dissociative seizures refer to a complex clinical presentation that is
often difficult to diagnose and treat. This group of Service Users (SU) often
struggle with mood, anxiety or other significant mental health difficulties. Although
they are relatively prevalent (2 to 33% per 100,000 people) they often get stuck in
limbo between mental health and physical health services.
Patients presenting with this difficulty make use of several healthcare resources.
These include pharmacotherapy, ambulances, A&E attendances, care homes,
hospital admissions, neurology and epilepsy clinic appointments as well as
primary and secondary mental health care involvement. This situation leads to
increased burden in services and high economic costs.
The evidence about what treatments are most effective for these SUs is
contested. Some studies show that psychological treatment can help.
Nevertheless, research in the area of psychological treatment for dissociative
(non-epileptic) seizures is very limited.
Intensive Short-Term Dynamic Psychotherapy (ISTDP) is one of the treatments
that has shown promising benefits for this population, both in symptom reduction and
healthcare costs. This therapy is unfortunately not currently available within the
NHS in Merseyside. Furthermore, Merseycare NHS Foundation Trust does not currently have a specialist pathway/service for people with Functional Neurological Disorder (FND) presentations.
The initial phase of ISTDP, which is called 'trial therapy' lasts
three hours and is both a psychological assessment as well as an intervention in
itself. It is focused on helping patients identify, label and experience emotions.
The aim of this pilot study is to test whether participants receiving 3 sessions of
ISTDP trial therapy experience a reduction in their mental distress levels and
decrease the need of mental and physical health services use.
The ultimate goal of this study is to collect preliminary evidence to inform a larger NIHR funded trial to test the
efficacy of a future ISTDP intervention for this population through a pragmatic randomised controlled trial. Furthermore, results of this study could also inform the development of 'Functional Neurological Disorder' service provision.Summary of Results
Research questions1. Primary Research Questions:
1.1 Do patients with dissociative seizures who undertake a brief course of Intensive Short Dynamic Psychotherapy (ISTDP) experience a reduction of healthcare resource usage?
1.2 Do patients with dissociative seizures experience clinically significant differences in their mental distress symptoms before and after undertaking a brief course of Intensive Short Dynamic Psychotherapy (ISTDP)?
2. Secondary Question/Objective:
2.1 Does the trial therapy of Intensive Short Dynamic Psychotherapy (ISTDP) have a good adherence rate for patients with dissociative seizures?
2.2 Is the trial therapy of Intensive Short Dynamic Psychotherapy
(ISTDP) safe for patients with dissociative seizures?• Study methods
- Week 0: telephone screening by research team (simple standard
questions to check participants meet inclusion criteria)
- Week 1: First research meeting
- Weeks 2, 3 & 4: ISTDP therapy.
- Week 5: Final Research Meeting and Debrief.
-Week 6: 1 month after ending therapy completion of self-report questionnairesTelephone screening: The researcher contacted the participant to
discuss the study in more detail, answer any questions and determine
whether they met eligibility for taking part in the study. If participants
consented to take part in the study, a first research meeting was
scheduled either face to face or online (depending on COVID/mobility
restrictions). During this first research meeting, participants signed
participant informed consent form (which will have been
posted/emailed/distributed to them so they have enough time to read
and make a decision) as well as completed self-report questionnairesTherapy: Following completion of this research meeting, participants were provided with three dates & times for their therapy appointments.
These therapy appointments occurred either face to face or online
(Depending on COVID/mobility restrictions). The first two therapy
appointments were 90 minutes each (following ISTDP manual) and the last therapy appointment was 60 minutes.Week 5: All participants were invited to a further research meeting
with a researcher where they were asked to complete a final set of
questionnaires. This meeting also included responding to three open qualitative questions.Follow-up: A month after completing the treatment participants were asked to complete the self-report questionnaires again.
• Analysis
SPSS Statistical Software was employed.
• Descriptive statistics to understand the sample complexity and sociodemographic profile.
• Mean Comparisons of baseline symptoms before therapy with post therapy and 1 month-follow up. T-tests for pre vs post comparisons and repeated measures ANOVA for Pre, post, and follow-up comparison.
• Findings
• CORE-34 and Brief Symptom Inventory self-report measures of psychiatric symptoms reduced after the intervention. The reduction was of moderate size and statistically significant.
• These differences were still statistically significant at follow-up for BSI but not for CORE-34
• The healthcare usage was significantly reduced when comparing 12 months healthcare usage prior to intervention with 12 months post intervention. This included a reduction on Acute Prescribed Medications; Crisis Calls as well as A&E attendances.
• The adherence to treatment was very high with 95% session attendance and 17/17 participants who started the treatment completing it.
• The treatment was deemed safe as no serious adverse events occurred during the study (defined as occurring up to 4 weeks after the last therapy session) and the adverse events questionnaire did not yield serious deterioration because of the treatment.
REC name
East of England - Cambridge East Research Ethics Committee
REC reference
20/EE/0291
Date of REC Opinion
20 Jan 2021
REC opinion
Further Information Favourable Opinion