ACT Treatment of Epilepsy : Time for a behavioral model?

Detta är en avhandling från Uppsala : Acta Universitatis Upsaliensis

Sammanfattning: 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.

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