Background

There is great scientific and clinical interest in the effective integration of psychological treatments into comprehensive epilepsy care to optimize treatment outcomes and psychosocial functioning in people with epilepsy. Stepped care is a promising approach to accommodate personalized psychotherapeutic care in academic and regular outpatient settings. It aims at providing patients with the most adequate treatment duration, number of sessions, and treatment method while systematically monitoring their treatment processes.

Methods

This is an uncontrolled feasibility study of process-oriented and personalized psychotherapeutic care for epilepsy in a naturalistic setting. The objective of this study was to evaluate individual changes of health-related quality of life (QOLIE-31) and psychiatric comorbidity (BDI-II, BSI) in participants by applying the concept of the reliable change index (RCI) to outcomes that were obtained at baseline and six months after the beginning of the intervention. Additionally, we assessed the relationship between outcome scores, the number of attended sessions, and history of childhood trauma by linear regression models.

Results

Twenty patients [15 women/5 men, median age 48 years (range: 23–73 years)] were recruited. The median number of scheduled sessions was 11 (range: 6–22); there were no drop-outs. After psychotherapy quality of life (QOLIE-31), global distress (BSI) and depression (BDI-II) scores improved significantly (p-values: QOLIE-31: 0.03; BSI: 0.01; BDI-II: 0.01). The largest improvements were achieved for the emotional well-being subscale of the QOLIE-31 (47%, p-value: 0.02), the global severity index of the BSI (83%), and depression severity (BDI-II) (60%). Linear regression models did not reveal any significant association between interim changes, number of attended treatment sessions, and history of childhood trauma.

Conclusion

The results suggest that process-oriented and personalized psychotherapeutic has low attrition and results in improved quality of life and reduced psychiatric symptoms in people with epilepsy. Our findings indicate that responsiveness to psychotherapy is not dependent on the number of attended treatment sessions. Participants with childhood trauma did not need more treatment sessions to achieve an improvement. More research is needed to understand and address mechanisms and precursors of responsiveness to psychotherapy.

中文翻译：

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面向过程和个性化的癫痫心理治疗护理：可行性研究的中期结果

背景

将心理治疗有效地整合到全面的癫痫护理中以优化癫痫患者的治疗结果和心理社会功能，这在科学和临床上具有重大意义。阶梯式护理是一种在学术和常规门诊环境中适应个性化心理治疗护理的有前途的方法。它旨在为患者提供最合适的治疗时间、疗程和治疗方法，同时系统地监控他们的治疗过程。

方法

这是在自然环境中针对癫痫的过程导向和个性化心理治疗护理的不受控制的可行性研究。本研究的目的是通过将可靠变化指数 (RCI) 的概念应用于以下结果，评估参与者的健康相关生活质量 (QOLIE-31) 和精神共病 (BDI-II, BSI) 的个体变化。在基线和干预开始后六个月获得。此外，我们通过线性回归模型评估了结果分数、参加会议的数量和童年创伤史之间的关系。

结果

招募了 20 名患者 [15 名女性/5 名男性，中位年龄 48 岁（范围：23-73 岁）]。预定会话的中位数为 11（范围：6-22）；没有辍学。心理治疗后的生活质量 (QOLIE-31)、整体困扰 (BSI) 和抑郁 (BDI-II) 得分显着改善（p 值：QOLIE-31：0.03；BSI：0.01；BDI-II：0.01）。QOLIE-31 的情绪健康分量表（47%，p值：0.02）、BSI 的全球严重程度指数（83%）和抑郁严重程度（BDI-II）（60 %）。线性回归模型没有揭示中期变化、参加治疗的次数和童年创伤史之间的任何显着关联。

结论

结果表明，面向过程和个性化的心理治疗具有低损耗，可提高癫痫患者的生活质量并减少精神症状。我们的研究结果表明，对心理治疗的反应不依赖于参加治疗的次数。患有童年创伤的参与者不需要更多的治疗时间来实现改善。需要更多的研究来理解和解决心理治疗反应的机制和先兆。