Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Department of Psychology, Utah State University, Logan, Utah, USA.
Behav Cogn Psychother. 2024 Jul;52(4):356-375. doi: 10.1017/S1352465823000565. Epub 2023 Nov 29.
Research has demonstrated that implementation of Nocebo Hypothesis Cognitive Behavioural Therapy (NH-CBT) achieved full symptom remission in 93% of people with Functional Neurological Symptoms Disorder (FNSD), most of them exhibiting motor symptoms. The basis for NH-CBT is consistent with a predictive coding aetiological model of FNSD. This idea is transparently shared with people with FNSD in the form of telling them that their symptoms are caused by a nocebo effect, usually followed by some physical activity that aims to change the person's belief about their body.
To demonstrate that a version of NH-CBT can also be effective in eliminating or reducing non-epileptic seizures (assumed to be a sub-type of FNSD).
A consecutive case series design was employed. Participants were treated with NH-CBT over a 12-week period. The primary outcome measure was seizure frequency. Numerous secondary measures were employed, as well as a brief qualitative interview to explore participants' subjective experience of treatment.
Seven out of the 10 participants became seizure free at least 2 weeks before their post-treatment assessment, and all stayed seizure-free for at least 5 months. Six of those seven remained seizure free at 6-month follow-up. There were large positive effect sizes for the majority of secondary measures assessed.
This case series provides evidence of feasibility and likely utility of NH-CBT in reducing the frequency of non-epileptic seizures.
研究表明，实施反安慰剂假设认知行为疗法（NH-CBT）可使 93%的功能性神经症状障碍（FNSD）患者完全缓解症状，其中大多数患者表现出运动症状。NH-CBT 的基础与 FNSD 的预测编码病因模型一致。这一观点以告知患者其症状是由反安慰剂效应引起的形式，透明地与 FNSD 患者分享，通常随后进行一些旨在改变患者对自身身体看法的身体活动。
证明 NH-CBT 的一个版本也可以有效地消除或减少非癫痫性发作（假定为 FNSD 的一个亚型）。
采用连续病例系列设计。参与者在 12 周的时间内接受 NH-CBT 治疗。主要结局测量指标是癫痫发作频率。采用了许多次要测量指标，以及简短的定性访谈，以探讨参与者对治疗的主观体验。
10 名参与者中有 7 名在治疗后评估前至少 2 周无癫痫发作，且所有参与者至少 5 个月无癫痫发作。在这 7 名参与者中，有 6 名在 6 个月随访时仍无癫痫发作。评估的大多数次要指标的效应量均为正值。
本病例系列研究提供了 NH-CBT 降低非癫痫性发作频率的可行性和可能效用的证据。
