Epilepsy and anxiety- targeting a vicious cycle:
Comparison of cognitive behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR) therapy and wait-list in targeting epilepsy-related anxiety and posttraumatic stress

Anxiety disorders are present in about 14-25% of people with epilepsy. The
unpredictable and uncontrollable nature of epilepsy often results in anxiety
and posttraumatic stress symptoms, which may provoke new seizures.
Psychological interventions may be beneficial to break this vicious cycle. The
current study aims to compare cognitive behavioural therapy (CBT), eye movement
desensitization and reprocessing (EMDR) therapy and a wait-list condition in
treating posttraumatic stress and/ or anxiety symptoms related to epilepsy.

Case series study (10 persons with epilepsy-related anxiety symptoms and/ or
posttraumatic stress):
-To examine the potential effects of EMDR therapy in terms of reducing anxiety,
from pre-treatment to post-treatment.

Randomized controlled trial (75 persons with epilepsy-related anxiety symptoms
and/ or posttraumatic stress):
-To examine the efficacy of CBT and EMDR therapy in comparison to a wait-list
condition in terms of reducing anxiety and physiological stress and
consequently in reducing seizure frequency and severity and improving quality
of life, from pre-treatment to post-treatment.

-To compare the efficiency of CBT and EMDR therapy in persons with
epilepsy-related anxiety symptoms and/ or posttraumatic stress, in terms of the
number of sessions needed to reduce the level of subjective distress related to
the most disturbing memory or scenario.

A case series study with repeated measurements will first be conducted,
followed by a randomized controlled trial with a repeated measures design.

CBT and EMDR therapy will be delivered using a maximum of 10 sessions of 90
minutes by experienced therapists. CBT and EMDR are both standardized
trauma-focused treatments. CBT is intended to reduce the level of distress
related to the traumatic event or scenario and correct dysfunctional thoughts
using imaginal exposure. EMDR therapy is intended to reduce the level of
distress related to a traumatic event or scenario (flash-forward) through
working memory taxation.

The case series study includes three time points (i.e. before treatment,
directly after treatment, and 3 months after treatment). Participants will be
requested to complete online questionnaires regarding demographics, treatment
expectation, disease characteristics, seizure severity, anxiety and PTSD
symptom severity (30 minutes at baseline; 15 minutes at later time points).
Participants will be asked to indicate their level of anxiety and seizure
occurrence on a daily basis (2-3 minutes per diary registration).

The randomized controlled trial includes four time points (i.e. before
treatment, directly after treatment, 3 and 6 months after treatment).
Participants will be requested to complete online questionnaires regarding
demographics, treatment expectation, disease characteristics, seizure severity,
anxiety, PTSD symptom severity, quality of life, personality, depression,
chronic everyday stress and psychopathology (60 minutes at baseline; 30-45
minutes at later time points). During CBT and EMDR therapy, participants will
be asked to wear an ECG sensor to collect measures of physiological stress
(heart rate variability). Furthermore, during the study participants will be
asked to indicate their level of anxiety and seizure occurrence on a daily
basis (2-3 minutes per diary registration).

CBT and EMDR therapy will be provided by experienced therapists and are already
part of the standard psychological treatment at SEIN. There is a minimal risk
of a (temporary) increase in seizure frequency as the participants actively
need to confront their most disturbing memories or scenarios. This can be a
trigger for seizures for some people with epilepsy. The participants will be
informed, and in case of a seizure occurring during therapy, the patient and
therapist will decide whether the session can continue. If the participant
feels that the sessions are too burdensome he or she can withdraw from the
study at any time. The ECG sensor is wearable and miniaturised, thus minimising
discomfort. In case of discomfort, the ECG sensor may be removed. Participants
in the treatment conditions are expected to benefit from study participation in
terms of reduced levels of anxiety and stress. We expect that their reduced
anxiety and stress level will lead to a decreased seizure frequency and
increased quality of life.