SEIN, Epilepsy Institute in the Netherlands, Heemstede, The Netherlands.
Seizure. 2011 Oct;20(8):628-34. doi: 10.1016/j.seizure.2011.06.006. Epub 2011 Jul 12.
Psychogenic Non Epileptic Seizures (PNES) have been theorized to reflect a learned pattern of avoidant behavior to deal with stressors. Although such observation may be relevant for our understanding of the etiology of PNES, evidence for this theory is largely build on self-report investigations and no studies have systematically tested actual avoidance behavior in patients with PNES. In this study, we tested automatic threat avoidance tendencies in relation to stress and cortisol levels in patients with PNES and healthy controls (HCs).
The approach and avoidance (AA) task was administered to 12 patients with PNES and 20 matched HCs at baseline and following stress-induction using the Cold Pressor Test (CPT). The AA task requires participants to evaluate the emotional valence of pictures of angry and happy faces by making arm movements (arm flexion or extension) that are either affect-congruent (avoid-angry; approach-happy) or affect-incongruent (approach-angry; avoid-happy) with their intuitive action tendencies. Saliva cortisol was measured throughout the experiment.
Patients, but not HCs, showed increased approach-avoidance congruency-effects for angry faces on the AA task at baseline, with relatively slower approach of angry faces, which was overall associated with basal pre-task cortisol. This congruency-effect disappeared after the CPT.
The present findings provide an objective confirmation of previous suggestions from self-report studies indicating that PNES patients show relatively increased avoidance tendencies to social threat cues. The registering of threat avoidance behavior may prove to be a clinically valuable contribution to evaluate psychological treatment effectiveness and perhaps even PNES prognosis.
心因性非癫痫性发作（PNES）被认为反映了一种习得的回避行为模式，以应对压力源。尽管这种观察可能与我们对 PNES 病因的理解有关，但该理论的证据主要基于自我报告调查，尚无研究系统测试过 PNES 患者的实际回避行为。在这项研究中，我们测试了与应激和皮质醇水平相关的 PNES 患者和健康对照（HCs）的自动威胁回避倾向。
在基线时和使用冷加压试验（CPT）进行应激诱导后，向 12 名 PNES 患者和 20 名匹配的 HCs 施行了接近-回避（AA）任务。AA 任务要求参与者通过手臂运动（手臂弯曲或伸展）来评估愤怒和快乐的面孔图片的情绪效价，这些动作要么与他们的直觉动作倾向一致（回避-愤怒；接近-快乐），要么与他们的直觉动作倾向不一致（接近-愤怒；回避-快乐）。在整个实验过程中测量唾液皮质醇。
与 HCs 相比，患者在基线时的 AA 任务中对愤怒面孔表现出增加的接近-回避一致性效应，表现为对愤怒面孔的相对较慢的接近，这总体上与基础前任务皮质醇相关。这种一致性效应在 CPT 后消失。
本研究结果客观地证实了先前自我报告研究的提示，表明 PNES 患者对社会威胁线索表现出相对增加的回避倾向。威胁回避行为的记录可能被证明是一种有价值的临床贡献，可以评估心理治疗的有效性，甚至可能是 PNES 的预后。
