Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Psychol Med. 2024 Jun;54(8):1725-1734. doi: 10.1017/S0033291723003665. Epub 2024 Jan 10.
We compared dissociative seizure specific cognitive behavior therapy (DS-CBT) plus standardized medical care (SMC) to SMC alone in a randomized controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms.
We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland, and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: (a) beliefs about emotions, (b) a measure of avoidance behavior, (c) anxiety and (d) depression.
All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures (DS), WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behavior, anxiety, and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behavior.
Our findings largely confirmed the logic model underlying the development of CBT for patients with DS. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes.
我们在一项随机对照试验中比较了分离性癫痫特异性认知行为疗法（DS-CBT）加标准化医疗护理（SMC）与单纯 SMC。DS-CBT 在 12 个月随访时的几项次要试验结果指标上产生了更好的结果。本文的目的是评估可能的治疗机制。
我们对 CODES 试验进行了二级中介分析。从英格兰、苏格兰和威尔士的国家卫生服务的二级/三级护理中招募了 368 名参与者。评估了对应于重要试验结果和假定中介的 16 个中介假设。考虑的 12 个月试验结果是最后一个月的癫痫发作频率、工作和社会适应量表（WSAS）和 SF-12v2，这是一个提供身体（PCS）和心理成分综合（MCS）评分的生活质量测量。在六个月时选择进行分析的中介变量包括：（a）对情绪的信念，（b）回避行为的衡量标准，（c）焦虑和（d）抑郁。
除了对情绪的信念外，所有假定的中介变量都被发现通过 DS-CBT 得到了改善。我们发现 DS-CBT 通过改善回避行为、焦虑和抑郁等目标变量，对分离性癫痫（DS）、WSAS 和 SF-12v2 MCS 评分等结果变量具有 DS-CBT 效应中介的证据。唯一能调节 SF-12v2 PCS 评分中 DS-CBT 效应的变量是回避行为。
我们的发现在很大程度上证实了为 DS 患者开发 CBT 的逻辑模型。可以进一步开发干预措施来专门解决对情绪的信念，以评估它是否改善结果。
