Anxiety and avoidance in psychogenic nonepileptic seizures: the role of implicit and explicit anxiety
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This study examined implicit and explicit anxiety in individuals with epilepsy and psychogenic nonepileptic seizures (PNESs) and explored whether these constructs were related to experiential avoidance and seizure frequency. Based on recent psychological models of PNESs, it was hypothesized that nonepileptic seizures would be associated with implicit and explicit anxiety and experiential avoidance. Explicit anxiety was measured by the State-Trait Anxiety Inventory; implicit anxiety was measured by an Implicit Relational Assessment Procedure; and experiential avoidance was measured with the Multidimensional Experiential Avoidance Questionnaire. Although both groups with epilepsy and PNESs scored similarly on implicit measures of anxiety, significant implicit-explicit anxiety discrepancies were only identified in patients with PNESs (p<.001). In the group with PNESs (but not in the group with epilepsy), explicit anxiety correlated with experiential avoidance (r=.63, p<.01) and frequency of seizures (r=.67, p<.01); implicit anxiety correlated with frequency of seizures only (r=.56, p<.01). Our findings demonstrate the role of implicit anxiety in PNESs and provide additional support for the contribution of explicit anxiety and experiential avoidance to this disorder.
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PNES are paroxysmal events that are often preceded by involuntary experience avoidance behavior.
“These seizures are paroxysmal events, that are often preceded by involuntary experience avoidance behavior (15).”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [15]
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“Therapies which directly target experiential avoidance, such as acceptance and commitment therapy (ACT), or DBT (which also addresses cognitive dissonance, as noted above [80]), may be useful in augmenting treatment for patients with PNESs [87].”
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- Authors
- Dimaro, L. V., Dawson, D. L., Roberts, N. A., Brown, I., Moghaddam, N. G., & Reuber, M.
- Affiliations
- Rampton Hospital (GB)
- University of Lincoln (GB)
- Arizona State University (US)
- University of Sheffield (GB)
- Royal Hallamshire Hospital (GB)
- Corresponding author
- Dimaro, Lian V.
- Dawson, David L.
- Roberts, Nicole A.
- Brown, Ian
- Moghaddam, Nima G.
- Reuber, Markus
- Venue
- Epilepsy & Behavior
- Publisher
- Elsevier BV
- Published
- 2014-04
- Volume
- 33
- Pages
- 77-86
- ISSN
- 1525-5050 (ISSN-L)
- OpenAlex
- W2131271367
- Cited by
- 80
- References
- 89
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 10 · 2022: 6 · 2021: 9 · 2020: 12 · 2019: 7 · 2018: 7 · 2017: 1 · 2016: 11 · 2015: 11
- FWCI
- 5.83
- Type
- journal article
- Language
- en
- Open access
- green
- figshare.com
- Licence
- Locations
- Epilepsy & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Lincoln Repository (University of Lincoln) (acceptedVersion)
- Figshare (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Epilepsy research and treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- psychogenic non-epileptic seizures, experiential avoidance, seizure frequency, epilepsy, Implicit Relational Assessment Procedure, State-Trait Anxiety Inventory
- MeSH terms
- Adult, Anxiety, Epilepsy, Female, Humans, Male, Middle Aged, Prospective Studies, Psychophysiologic Disorders, Seizures, Somatoform Disorders, Young Adult
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