Remote CBT Reduces Depression, Seizures in Epilepsy

Pauline Anderson

December 05, 2012

San Diego, California — A cognitive-behavioral therapy (CBT) course that includes a mindfulness component and is offered by phone and over the Internet significantly decreased the incidence of major depression and even reduced seizure severity in patients with epilepsy, a new randomized controlled trial has shown.

CBT teaches patients to be aware of how thoughts influence mood. The mindfulness component helps patients to let go of negative thoughts and to live in the moment.

The course, called Project UPLIFT, offers an intervention that doesn't require attending group therapy sessions, something that might be attractive to patients with epilepsy who no longer have a driver's license, are immobile, or worry about taking an antidepressant drug along with their epilepsy medications.

"The program reaches people who are hard to reach, whether they're in rural areas or are mobility limited," said study lead researcher, Nancy Thompson, PhD, associate professor, Rollins School of Public Health at Emory University in Atlanta, Georgia.

She added that from a prevention standpoint, the program "averts the onset of the disability" associated with developing depression, eliminates the "tangible and intangible costs" of treating depression, and "provides people with skills to manage further adverse events in their life."

The study results were presented here at the American Epilepsy Society (AES) 66th Annual Meeting.

Telephone or Web

The study included 130 patients aged at least 21 years from 4 states (Georgia, Washington, Texas, and Michigan) who had mild to moderate depression and who did not have suicidal ideation. They were randomly assigned to receive treatment-as-usual waitlist condition (including antidepressants) or the intervention (mindfulness CBT).

The UPLIFT program is delivered in eight 1-hour sessions (although web discussions can go on longer) to groups of 7. They're led by a facilitator trained in mental health and by a person with epilepsy. The telephone option is operated through conference calls, and the web course uses an interactive platform.

In each of the 8 sessions, participants discuss and learn various aspects of the therapy. "They move from monitoring thoughts, to challenging and changing thoughts, to learning relaxation methods, to talking about being in the present moment as a calm place," said Dr. Thompson. "Then they move on to how to reward themselves for making a behavioral change and how to learn to notice pleasure as well as distress. Finally, the 8th session is making a relapse action plan and a commitment about why they'd like to keep up the practice."

The study had a crossover design, so all participants were exposed to the intervention and the control. About 70% of the study patients attended all sessions.

The study showed that during the study the incidence of major depression as determined by the Beck Depression score was 10.7% in the treatment-as-usual group compared with 0% among those participating in UPLIFT (P =.028).

Measures of knowledge and skills increased in both groups but significantly more so for patients in the program (P = .046). Satisfaction with life also improved more for patients in the course (P = .010).

The training also appeared to be associated with reduced seizure severity and number of seizures, although the reductions didn't reach statistical significance.

Dose-Response Relationship

The efficacy of the program was dose related — the more sessions patients participated in, the greater the benefits. For example, depression scores increased an average of 1.3 points on the Beck scale if they attended only 0 to 4 sessions but decreased by 3.0 points if they attended 5 to 7 sessions and by 4.6 points if they attended all 8 sessions.

Other measurements, including the number of seizures, knowledge and skills, and satisfaction with life, also showed a relationship to the number of sessions attended, said Dr. Thompson.

To date, 13 facilitators have been trained, although the "goal is to have someone trained in every state," said Dr. Thompson.

Sima I. Patel, MD, epileptologist, MINCEP Epilepsy Care, Minneapolis, Minnesota, is something of a convert. After hearing about the program for the first time at this year's AES meeting, she is now inspired to investigate getting a trained facilitator in her own clinic.

"I think it's a great idea and I will discuss this with my colleagues to see if we can get a nurse clinician involved and trained," she told Medscape Medical News.

It's important for patients with epilepsy — or any chronic disease — to manage day-to-day stressors, said Dr. Patel, who advises her own patients to do deep breathing exercises as a way of coping with daily stressors.

"Sometimes in clinical setting we don't have time," she said, adding that programs like UPLIFT give patients a "sense of empowerment," which is especially important for patients with epilepsy, many of whom feel they have little control over their lives.

The study was funded by the National Center for Minority Health and Health Disparities.

American Epilepsy Society (AES) 66th Annual Meeting. Platform C.06. Presented December 4, 2012.