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2019 HSR&D/QUERI National Conference Abstract

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1021 — Randomized controlled trial of motivational interviewing for psychogenic nonepileptic attacks

Lead/Presenter: Benjamin Tolchin,  COIN - West Haven
All Authors: Tolchin B (PRIME Center, VA Connecticut Healthcare System, Yale School of Medicine), Baslet G (Brigham and Women's Hospital, Harvard Medical School), Martino S (PRIME Center, VA Connecticut Healthcare System, Yale School of Medicine) Suzuki J (Brigham and Women's Hospital, Harvard Medical School) Blumenfeld H (Yale School of Medicine) Hirsch LJ (Yale School of Medicine) Altalib H (PRIME Center, VA Connecticut Healthcare System, Yale School of Medicine) Dworetzk BA (Brigham and Women's Hospital, Harvard Medical School)

Objectives:
We conducted a randomized controlled trial of motivational interviewing (MI) as an intervention to improve psychotherapy adherence and outcomes, including psychogenic nonepileptic attack (PNES) frequency, quality of life, and emergency department utilization, among participants with PNEA.

Methods:
Sixty participants were randomized to receive either psychotherapy alone or MI plus psychotherapy. Participants and therapists were contacted at 16-week follow-up. Participants were considered adherent with psychotherapy if they attended at least 8 sessions within 16-weeks following referral.

Results:
Among control participants, 31.0% were adherent, whereas among MI participants, 65.4% were adherent (p = 0.015, absolute risk reduction: 34.4%, number needed to treat: 2.9). In the control arm, PNEA frequency decreased by 34.8% (SD 89.7%), whereas in the MI arm, PNEA frequency decreased by 76.2% (SD 39.2%) (p = 0.034, Cohen's d = 0.59). Among control participants, 10.7% achieved PNEA freedom, versus 30.8% of MI participants (p = 0.095). QOLIE-10 scores (a 40-point scale) improved by an average of 1.8 (SD 7.9) points among control participants, and by 7.2 (SD 10.0) points among MI participants (p = 0.047, Cohen's d = 0.60). Monthly ED visits increased by 0.06 (SD 0.47) visits per month among control participants, versus a decrease of 0.15 (SD 0.76) among MI participants (p = 0.23).

Implications:
MI improved treatment adherence, PNEA frequency, and quality of life among our participants with PNEA. Our study is limited in that it was conducted at a single quaternary care medical center, and MI was provided by a single neurologist, which may limit generalization of results.

Impacts:
PNEA are diagnosed in 29% of Veterans evaluated in epilepsy monitoring units for apparent epilepsy. Approximately 80,000 Veterans in the VA healthcare system are currently diagnosed with epilepsy and only 1% are currently evaluated in epilepsy monitoring units. Therefore there are potentially up to 23,000 Veterans with PNEA in the VA healthcare system who may benefit from motivational interviewing. Potential benefits for these Veterans include improved adherence with psychotherapy, PNEA frequency, and quality of life.