Psychological inflexibility and non-epileptic attack disorder

Overview: This thesis explored concepts important to the construct of psychological inflexibility within non-epileptic attack disorder (NEAD). NEAD is the presentation of seizure like attacks, which cannot be explained medically, and are thereby thought to be psychological in nature. Psychological inflexibility is defined as the view that one is unable to change their internal or external behaviour to be in accordance with their own desires and values. This exploration was done over the course of three separate papers: a systematic literature review, an empirical paper, and a critical appraisal of the thesis. Systematic Literature Review: The systematic literature review explored avoidance within NEAD, through narrative synthesis and quantitative meta-analyses. The review identified that individuals with NEAD utilise avoidance more than individuals with epilepsy or healthy controls. Avoidance appears to be an important component of NEAD. Empirical Paper: The empirical paper included 285 individuals with NEAD and utilised an online, one group observational design. Variables relevant to psychological inflexibility: cognitive fusion, experiential avoidance and mindfulness were explored in regards to relationships with three outcome variables in NEAD: somatisation, impact of NEAD upon life, and non-epileptic attack (NEA) frequency. It was found that all of the psychological inflexibility variables were correlated with somatisation and impact upon life. Only mindfulness was found to be correlated, with NEA frequency. Mindfulness was the only psychological variable which uniquely and independently predicted somatisation in NEAD. Somatisation in turn contributes significantly to the impact upon life and NEA frequency. Critical Appraisal: Further background on the theory which was considered in the conceptualisation of this thesis are provided and future directions of research are discussed

Avoidance in nonepileptic attack disorder:A systematic review and meta-analyses

Background Avoidance is the active process of trying to escape from or not experience situations, places, thoughts, or feelings. This can be done through behavioral or cognitive strategies, or more broadly, a combination of both, utilized in an attempt to disengage from private experiences referred to as experiential avoidance (EA). Avoidance is considered important in the development and maintenance of nonepileptic attack disorder (NEAD). This review aimed to understand avoidance in NEAD and evaluate its role as a contributory factor. Methods Fourteen articles were identified by searching Cumulative Index to Nursing and Allied Health (CINAHL), MEDLINE Complete, PsycINFO, and EMBASE and were combined in a narrative synthesis. Six of these articles were included in a meta-analysis comparing levels of EA for individuals with NEAD and healthy controls (HC), and four were included in a meta-analysis comparing EA in NEAD to epilepsy comparisons (EC). Conclusions Experiential avoidance appears to be a strategy that is used by a high proportion of the population with NEAD. The group with NEAD utilized significantly more avoidance compared with both the HC and EC. However, further research is needed to understand the extent and types of avoidance that are relevant

Psychological Inflexibility and Somatisation in Non-Epileptic Attack Disorder

Background There is no clear understanding of what causes and maintains nonepileptic attack (NEA) disorder (NEAD), or which psychological therapies may be helpful. The relationships between variables of psychological inflexibility: experiential avoidance (EA), cognitive fusion (CF), mindfulness, and key outcome variables in NEAD: somatization, impact upon life, and NEA frequency were investigated. Method Two hundred eighty-five individuals with NEAD completed validated measures online. Linear regression was used to explore which variables predicted somatization and impact upon life. Ordinal regression was used to explore variables of interest in regard to NEA frequency. Results Mindfulness, EA, CF, somatization, and impact upon life were all significantly correlated. Mindfulness uniquely predicted somatization when considered in a model with EA and CF. Higher levels of somatization increased the odds of experiencing more NEAs. Individuals who perceived NEAD as having a more significant impact upon their lives had more NEAs, more somatic complaints, and more EA. Conclusions Higher levels of CF and EA appear to be related to lower levels of mindfulness. Lower levels of mindfulness predicted greater levels of somatization, and somatization predicted NEA frequency. Interventions that tackle avoidance and increase mindfulness, such as, acceptance and commitment therapy, may be beneficial for individuals with NEAD. Future directions for research are suggested as the results indicate more research is needed