Examining implicit cognition in people with seizures

Background: An estimated 15-30% of individuals referred to epilepsy clinics are diagnosed with non-epileptic attack disorder (NEAD). NEAD is a well-known clinical problem which poses diagnostic and therapeutic challenges to neurological and psychological professionals (Gates & Erdahl, 1993). There are multiple theories on the mechanisms that underlie non-epileptic seizures; however there is limited empirical support for these. The development of implicit cognition has attracted much attention in the last few decades but has yet to be developed in the context of seizure research. This thesis aimed to offer a novel perspective on the psychological mechanisms underlying NEAD by examining implicit and explicit self-esteem and anxiety in people with seizures. It also explored the relationship of these constructs with experiential avoidance and seizure frequency. Methodology: 86 participants were recruited and completed a series of self-report questionnaires. The Rosenberg self-esteem questionnaire was used to measure explicit self-esteem. Spielberger’s State-Trait Anxiety Inventory was used to assess explicit anxiety. The Patient Health Questionnaire-15 was utilised to estimate somatic symptoms. The Multi-dimensional Experiential Avoidance Questionnaire was used to examine differences in avoidance. Finally they were administered two versions of the Implicit Relational Assessment Procedure (IRAPAnxiety; IRAP-Self-esteem) to examine implicit self-esteem and anxiety. Results: Analysis of Variance (ANOVAs) found no significant differences in implicit self-esteem and anxiety between the NEAD, epilepsy or non-clinical control groups. However, the NEAD group reported a significantly lower explicit self-esteem, higher avoidance and more somatic symptoms than their epilepsy counterparts. Although the NEAD and epilepsy groups reported high levels of anxiety, only the 3 NEAD group differed significantly from controls. The NEAD group had significantly larger implicit-explicit discrepancies for both anxiety and self-esteem, with explicit and discrepant scores correlating with self-reported avoidance and seizure frequency. A logistical regression model using explicit self-esteem, experiential avoidance and somatisation correctly classified 84.9% of individuals with seizures. However, the implicit measures did not add anything to the model. Conclusions: There are several interpretations for the implicit-explicit discrepancies observed. One suggestion is the high implicit low explicit profile reflects ‘damaged’ self-esteem, which can be understood more fully in context of events preceding seizure onset as well as the corollaries of diagnosis. Other authors have suggested that this profile reflects an unstable self-image, understood from early parenting and attachment perspectives. Given the correlation with discrepant scores it is possible that avoidance and seizures serve to reduce dissonance between implicit and explicit cognition. These findings support various psychological models of NEAD and offer a rationale for a range of psychological treatments that target avoidant behaviour patterns as well as deliberate evaluations that are within a person’s awareness

Examining implicit cognition in people with seizures

Background: An estimated 15-30% of individuals referred to epilepsy clinics are diagnosed with non-epileptic attack disorder (NEAD). NEAD is a well-known clinical problem which poses diagnostic and therapeutic challenges to neurological and psychological professionals (Gates & Erdahl, 1993). There are multiple theories on the mechanisms that underlie non-epileptic seizures; however there is limited empirical support for these. The development of implicit cognition has attracted much attention in the last few decades but has yet to be developed in the context of seizure research. This thesis aimed to offer a novel perspective on the psychological mechanisms underlying NEAD by examining implicit and explicit self-esteem and anxiety in people with seizures. It also explored the relationship of these constructs with experiential avoidance and seizure frequency. Methodology: 86 participants were recruited and completed a series of self-report questionnaires. The Rosenberg self-esteem questionnaire was used to measure explicit self-esteem. Spielberger’s State-Trait Anxiety Inventory was used to assess explicit anxiety. The Patient Health Questionnaire-15 was utilised to estimate somatic symptoms. The Multi-dimensional Experiential Avoidance Questionnaire was used to examine differences in avoidance. Finally they were administered two versions of the Implicit Relational Assessment Procedure (IRAPAnxiety; IRAP-Self-esteem) to examine implicit self-esteem and anxiety. Results: Analysis of Variance (ANOVAs) found no significant differences in implicit self-esteem and anxiety between the NEAD, epilepsy or non-clinical control groups. However, the NEAD group reported a significantly lower explicit self-esteem, higher avoidance and more somatic symptoms than their epilepsy counterparts. Although the NEAD and epilepsy groups reported high levels of anxiety, only the 3 NEAD group differed significantly from controls. The NEAD group had significantly larger implicit-explicit discrepancies for both anxiety and self-esteem, with explicit and discrepant scores correlating with self-reported avoidance and seizure frequency. A logistical regression model using explicit self-esteem, experiential avoidance and somatisation correctly classified 84.9% of individuals with seizures. However, the implicit measures did not add anything to the model. Conclusions: There are several interpretations for the implicit-explicit discrepancies observed. One suggestion is the high implicit low explicit profile reflects ‘damaged’ self-esteem, which can be understood more fully in context of events preceding seizure onset as well as the corollaries of diagnosis. Other authors have suggested that this profile reflects an unstable self-image, understood from early parenting and attachment perspectives. Given the correlation with discrepant scores it is possible that avoidance and seizures serve to reduce dissonance between implicit and explicit cognition. These findings support various psychological models of NEAD and offer a rationale for a range of psychological treatments that target avoidant behaviour patterns as well as deliberate evaluations that are within a person’s awareness

Activismo o garantismo en el proceso contencioso administrativo colombiano

Resumen En el derecho procesal se discute sobre el rol que debe desempeñar el juez dentro del juicio. Por una parte, un juez activo; por otra, un juez garantista que deja el protagonismo a las partes, considerando que de esa forma se materializa la igualdad y la imparcialidad. Por esta razón, se formuló como problema de investigación: ¿Cuál es el sistema procesal y el concepto de finalidad del proceso que define el rol del juez en el proceso contencioso administrativo colombiano? Se propone analizar, desde el interior de las instituciones procesales, las cargas y deberes del juez y de las partes, partiendo de la hipótesis de que no existen linderos que permitan definir con precisión la naturaleza del sistema procesal y el concepto de finalidad de proceso al que debe acudir el juez para el ejercicio de su función. Para ello se adelantó un estudio exploratorio-analítico de las normas aplicables. El resultado de tal análisis es que el rol del juez en el proceso contencioso administrativo no lo define ni el sistema procesal ni los conceptos de la finalidad del proceso, sino que se debe a la naturaleza jurídica de la pretensión o medio del control

Differences in illness perceptions between patients with non-epileptic seizures and functional limb weakness

Objectives Illness perceptions play an important role in the onset and maintenance of symptoms in functional neurological symptom disorder (conversion disorder). There has, however, been little work examining differences between subtypes of this disorder. We therefore aimed to compare illness perceptions of patients with non-epileptic seizures (NES) and those with functional weakness (FW) with matching neurological disease controls to examine their specificity. Methods The Illness Perception Questionnaire Revised (IPQ-R) was completed by patients with functional limb weakness, non-epileptic seizures and patients with neurological disease causing limb weakness and epilepsy in two separate case control studies. Results Patients with FW (n=107), NES (= 40), Epilepsy (n=34) and neurological disease causing limb weakness (NDLW) (n=46) were included in the analysis. Both FW and NES patients reported a low level of personal control, understanding of their symptoms and a tendency to reject a psychological causation of their symptoms. However NES patients rejected psychological causes less strongly than FW patients (P<.01). Patients with NES were also more likely to consider their treatment to be more effective (P<.01). None of these differences appeared in a similar comparison between patients with epilepsy and patients with NDLW. Conclusion Although patients with NES tended, as a group, to reject psychological factors as relevant to their symptoms, they did so less strongly than patients with functional limb weakness in these cohorts. This has implications for both the way in which these symptoms are grouped together but also the way in which treatment is approached. Keywords Psychogenic non-epileptic seizures; Functional weakness; Conversion disorder; Epilepsy; Illness perception; Neurolog

A multicenter evaluation of a brief manualized psychoeducation intervention for psychogenic nonepileptic seizures delivered by health professionals with limited experience in psychological treatment

Rationale The aim of this study was to add to our understanding of the impact of psychoeducation on patients' acceptance of the diagnosis of psychogenic nonepileptic seizures (PNESs), the frequency of their seizures, and their quality of life. The study also aimed to evaluate the effectiveness of brief manualized psychoeducation interventions for PNESs, delivered by a more diverse range of clinicians and in a wider range of treatment settings. Method The final sample consisted of 25 patients diagnosed with PNESs by a neurologist specializing in the treatment of seizure disorder and referred to the psychotherapy service. The study included patients from four centers, using a manualized psychoeducation intervention delivered over 4 sessions by specialist epilepsy nurses and assistant psychologists. All patients completed self-measure questionnaires for Seizure Frequency, Impaired Functioning (WSAS), Psychological Distress (CORE-OM), Illness Perception (BIPQ), Health-Related Quality of Life: general (ED-QOL) and epilepsy-specific (NewQOL-6D), Symptom Attribution, and patient's perception of usefulness and relevance of the intervention. All measures were collected at baseline and after the completion of the fourth session. Results All measures improved from baseline to postintervention, but this improvement was only significant for CORE-OM (p < .05) and BIPQ (p < .01). Out of the 25 patients who completed the intervention information, 6 out of 25 (24%) had been seizure-free for the past month, and an additional 6 out of 25 (24%) had achieved seizure frequency reduction. Consequently, upon completion of the intervention, 12 out of 25 patients (48%) were either seizure-free or experienced fewer seizures compared with the start of the intervention. Conclusion The evidence suggests that brief manualized psychoeducation intervention can reduce PNES frequency, improve the psychological distress, and have an effect on patients' illness perceptions that should help them engage with a more extended psychotherapy program if that was necessary. The intervention was carried out successfully by staff with relatively little training in delivering psychological interventions. Further controlled studies are required to provide proof of efficacy

Emotion processing and psychogenic non-epileptic seizures: A cross-sectional comparison of patients and healthy controls

Purpose This exploratory study aimed to examine emotion-processing styles in patients with psychogenic non-epileptic seizures (PNES), compared to healthy individuals, and to explore associations of emotion processing with other psychological measures and seizure frequency, using the new Emotional Processing Scale (EPS-25), which had not previously been used in this patient group. Methods Fifty consecutive patients with PNES referred for psychotherapy completed a set of self-report questionnaires, including the Emotional Processing Scale (EPS-25), Clinical Outcome in Routine Evaluation (CORE-10), Short Form-36 (SF-36), Patient Health Questionnaire (PHQ-15), and Brief Illness Perception Questionnaire (BIPQ). Responses on the EPS-25 were compared to data from 224 healthy controls. Results Patients with PNES had greater emotion processing deficits across all dimensions of the EPS-25 than healthy individuals (suppression/unprocessed emotion/unregulated emotion/avoidance/impoverished emotional experience). Impaired emotion processing was highly correlated with psychological distress, more frequent and severe somatic symptoms, and a more threatening understanding of the symptoms. Emotion processing problems were also associated with reduced health-related quality of life on the mental health (but not the physical health) component of the SF-36. The unregulated emotions sub-scale of the EPS was associated with lower seizure frequency. Conclusion The results showed clear impairments of emotion processing in patients with PNES compared to healthy individuals, which were associated with greater psychological distress and reduced mental health functioning. These findings seem to support the face validity of the EPS-25 as a measure for PNES patients and its potential as a tool to assess the effectiveness of psychological interventions

La prueba: teoría y práctica

Especialistas de talla mundial discurren en torno al núcleo básico de la administración de la justicia: la prueba, un tema fundamental que —precisamente por su carácter basilar— tiende a ser pasado por alto o a revisarse de manera superficial. En esta obra colectiva, se estudian —desde una perspectiva tanto conceptual como práctica— problemas fundamentales en torno a la prueba, desde diferentes puntos de vista que se soportan en diversas áreas del conocimiento como la filosofía, la epistemología, la psicología, entre otras. Modestia aparte, no es fortuito que en el prólogo del libro Bujosa Vadell declare que “está llamado a ser obra de cabecera para los juristas que, desde la academia y desde el foro, se preocupan por una conducción adecuada de la actividad probatoria”. Así pues, académicos, juristas, abogados litigantes y jueces tienen a su disposición la décima segunda entrega del Grupo de Investigaciones en Derecho Procesal, de la Universidad de Medellín, reconocido mundialmente por su compromiso y dedicación a la hora de coordinar esta ya tradicional serie de libros de investigación en derecho procesal.https://catalogo.udem.edu.co/la-prueba-teoria-y-practica--derecho-procesal-civil.html#.XbdVx-gzbc

Derecho procesal del siglo XXI. Visión innovadora

Dieciocho ensayos escritos por destacados académicos de América Latina y Europa, que se dan cita en esta obra para responder al desafío de pensar el Derecho procesal del siglo XXI desde una visión innovadora. Los ejes de los debates académicos responden a las siguientes preguntas de investigación: ¿cómo prevenir la corrupción en el proceso judicial?, ¿cómo puede contribuir el Derecho procesal a garantizar los derechos humanos?, ¿cuáles son los aportes de la psicología en el estudio del Derecho probatorio?, ¿qué interacciones existen entre las tradiciones jurídicas del civil law y el common law?, ¿cómo contribuyen las reformas procedimentales en los ámbitos civil, penal, laboral y administrativo al fortalecimiento de la Administración de Justicia? Se trata pues, de la undécima entrega del Grupo de Investigación en Derecho Procesal (Universidad de Medellín), ampliamente reconocido por el juicioso trabajo que realizan sus investigadores a la hora de coordinar esta ya tradicional serie de libros de investigación en Derecho procesal. Como lo menciona Eduardo Oteiza, en el prólogo de esta obra, “basta con recordar el éxito de las anteriores diez ediciones para despertar la curiosidad por enriquecerse con cada una de las colaboraciones, sin perder de vista que se trata de un nuevo hito de uno de los proyectos más importantes de investigación en Derecho procesal de América Latina”

Self-compassion and adjustment in epilepsy and psychogenic nonepileptic seizures

Purpose Self-compassion has been associated with a set of adaptive coping strategies, which in turn explain better adjustment in individuals with chronic illnesses such as inflammatory bowel disease and arthritis. The aim of this study was to investigate whether self-compassion is associated with adjustment in people with epilepsy (PWE) and people with psychogenic nonepileptic seizures (PWPNES). Adjustment was measured via coping efficacy, quality of life (QoL), anxiety, and depression. Method A cross-sectional questionnaire design was employed. People with epilepsy (N = 74), PWPNES (N = 46), and controls (N = 89), recruited from outpatient seizure clinics and online, completed questionnaires about their self-compassion, coping efficacy, QoL, anxiety, and depression levels. Results Overall, self-compassion was associated with adjustment in PWE and PWPNES. Self-compassion was negatively related to anxiety and depression in PWE, PWPNES, and controls and positively related to coping efficacy in PWE and PWPNES. Self-compassion was also positively related to QoL in PWE and controls; however, this relationship was not significant in PWPNES. Conclusion Self-compassion is associated with better adjustment in PWE and PWPNES. Implications of these findings for psychotherapeutic interventions for individuals with seizure disorders and future research are discussed

Implicit and explicit self-esteem discrepancies in people with psychogenic nonepileptic seizures

Abstract PURPOSE: Self-esteem (SE), or one's sense of competence and worth, is reduced in many mental and physical disorders. Low SE is associated with perceived stigma and disability and poor treatment outcomes. The present study examined implicit and explicit SE (automatic and deliberate views about the self) in people with epilepsy and people with psychogenic nonepileptic seizures (PNESs). Discrepancies between implicit SE and explicit SE have been found to correlate with psychological distress in disorders often associated with PNESs but are relatively unexplored in PNESs. We hypothesized that, compared with epilepsy, PNESs would be associated with lower self-reported SE and greater discrepancies between implicit SE and explicit SE. METHODS: Thirty adults with PNESs, 25 adults with epilepsy, and 31 controls without a history of seizures were asked to complete the Rosenberg Self-esteem Scale as a measure of explicit SE and an Implicit Relational Assessment Procedure as a measure of implicit SE. The State-Trait Anxiety Inventory and Patient Health Questionnaire-15 (a somatic symptom inventory) were also administered. RESULTS: We found significant group differences in explicit (p<0.001) but not implicit SE. Patients with PNESs reported lower SE than the other groups. No group differences were found in implicit SE. Implicit-explicit SE discrepancies were larger in the group with PNESs than in the other groups (p<0.001). Higher frequency of PNESs (but not epileptic seizures) was associated with lower explicit SE (rs=-.83, p<0.01) and greater SE discrepancies (i.e., lower explicit relative to implicit SE; rs=.65, p<0.01). These relationships remained significant when controlling for anxiety and somatization. CONCLUSION: Patients with PNESs had lower explicit SE than those with epilepsy or healthy controls. In keeping with our expectations, there were greater discrepancies between implicit SE and explicit SE among patients with PNESs than in the other groups. Our results, including the strong relationship between PNES frequency, anxiety, and explicit-implicit SE discrepancies, support the interpretation that PNESs serve to reduce cognitive dissonance, perhaps protecting patients' implicit SE