TY - JOUR
T1 - Shame in the treatment of patients with psychogenic nonepileptic seizures
T2 - The elephant in the room
AU - Myers, Lorna
AU - Gray, Cordelia
AU - Roberts, Nicole
AU - Levita, Liat
AU - Reuber, Markus
N1 - Funding Information:
Markus Reuber: Payments from Elsevier as Editor-in-Chief of Seizure, educational grant from UCB Pharma. Markus Reuber and Lorna Myers: Income from book authorships (including books about PNES). None of these interests should have any bearing on the content of this article. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Publisher Copyright:
© 2021
PY - 2022/1
Y1 - 2022/1
N2 - Previous research has established a link between psychogenic nonepileptic seizures (also known as dissociative or functional seizures) and abnormal emotion processing. In a companion article to this multidisciplinary narrative review, we have argued that, in the context of a biopsychosocial understanding of the condition, the emotion of shame is particularly likely to contribute to the aetiology, manifestation, semiology and perpetuation of psychogenic non-epileptic seizures (PNES). Here we demonstrate how unrecognised and unaddressed shame may cause difficulties when clinicians explain the diagnosis, attempt to engage patients in psychological treatment, construct a diagnostic formulation and undertake psychotherapy. Case vignettes are used to bring theoretical considerations to life and to illustrate the complex interactions which may be observed between high shame proneness, chronic and dysregulated shame, stigma and PNES. The particular focus on shame does not mean that recent explanatory models of PNES are obsolete. Rather, we demonstrate how the inclusion of shame helps to embed the emotional, cognitive and behavioural aspects of the Integrative Cognitive Model (ICM) of PNES in a social / interpersonal context. While we describe how a number of different psychotherapeutic approaches can help to address shame-related processes we conclude that specific modalities are less important than the eventual enhancement of emotional literacy and tolerance through a healing relationship with the psychotherapist.
AB - Previous research has established a link between psychogenic nonepileptic seizures (also known as dissociative or functional seizures) and abnormal emotion processing. In a companion article to this multidisciplinary narrative review, we have argued that, in the context of a biopsychosocial understanding of the condition, the emotion of shame is particularly likely to contribute to the aetiology, manifestation, semiology and perpetuation of psychogenic non-epileptic seizures (PNES). Here we demonstrate how unrecognised and unaddressed shame may cause difficulties when clinicians explain the diagnosis, attempt to engage patients in psychological treatment, construct a diagnostic formulation and undertake psychotherapy. Case vignettes are used to bring theoretical considerations to life and to illustrate the complex interactions which may be observed between high shame proneness, chronic and dysregulated shame, stigma and PNES. The particular focus on shame does not mean that recent explanatory models of PNES are obsolete. Rather, we demonstrate how the inclusion of shame helps to embed the emotional, cognitive and behavioural aspects of the Integrative Cognitive Model (ICM) of PNES in a social / interpersonal context. While we describe how a number of different psychotherapeutic approaches can help to address shame-related processes we conclude that specific modalities are less important than the eventual enhancement of emotional literacy and tolerance through a healing relationship with the psychotherapist.
KW - Conversion
KW - Dissociation
KW - Functional neurological symptom disorder
KW - Psychogenic nonepileptic seizures
KW - Psychotherapy
KW - Shame
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85120652743&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85120652743&partnerID=8YFLogxK
U2 - 10.1016/j.seizure.2021.10.018
DO - 10.1016/j.seizure.2021.10.018
M3 - Review article
C2 - 34876339
AN - SCOPUS:85120652743
SN - 1059-1311
VL - 94
SP - 176
EP - 182
JO - Seizure : the journal of the British Epilepsy Association
JF - Seizure : the journal of the British Epilepsy Association
ER -