Treatments for PNES
Urmi Vaidya-Mathur, LCSW
Topics that we will cover
1. Anxiety
2. Depression
3. Treatment the symptoms of anxiety and
depression
How do we treat PNES?
• PNES is treatable
• Psychological/psychiatric
evaluation
• Psychopharmacology for
mood/anxiety symptoms
• Individual treatment:
therapy, CBT, PE,
mindfullness based
treatment
• Group therapy focusing
on assertiveness, coping
with stress, identifying
stress and verbalization
What is the best prognosis?
• An early diagnosis/early referral for an
evaluation at an epilepsy center
• An individual’s capacity for insight
• Mental health professional contacts patient
as soon as diagnosis is delivered
• Treatment is offered by a professional
familiar with the disorder
How do we measure success?
• Seizure
reduction/elimination
• Improvement in
psychiatric symptoms
(ex:depression/anxiety/
trauma)
• Resumption of daily
activities
• Improvement in one’s
quality of life
• Increased
assertiveness
• Increased
independence
• Better coping with
stress
• Improved self care
• Increased insight
What is “Anxiety”?
Fear is normal in situations of danger. But it
can be excessive and become a disorder.
There are many ways in which anxiety
presents itself within an individual and
treatments can vary
A review of anxiety
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Anxiety types
Tracking anxiety
Becoming a thought detective
Worry words
Anxiety Types
• Generalized Anxiety Disorder (GAD)
• Panic Disorder
• Posttraumatic Stress Disorder (PTSD)
GAD
• Long lasting almost constant state of
tension and worry
• Feel restless, irritable, edgy, fidgety
• Get tired easily
• Tense muscles (back, neck, shoulders)
• Poor sleep and concentration
• Shortness of breath
Panic Disorder
• Periods of intense fear (tachicardia, perspiring,
shortness of breath, lightheadedness, thoughts
of losing control, numbness, pain in chest,
choking)
• Fear of death (heart attack), ER visits
• Hypersensitivity to bodily sensations and
misinterpretation
– Especially important for people with physical
problems as they are already very “in tune” with their
bodies
Panic Disorder, continued
• About 10 minutes duration
– Start abruptly and end quickly
– Often come “out of the blue”
• However, once people have the first one they often
begin to fear having another one and this
excessive fear and worry can actually trigger
another attack.
Important rule out in PNES
PTSD
• Results from exposure to an overwhelming
stress (war, rape, assault, abuse).
• Triad of symptoms: avoidance,
hyperarousal, intrusions
• Natural and unnatural causes (man-made
are typically harder to recover from)
• Trauma can change the structure and
function of brain cells
What are the behavioral
interventions available to treat
PNES ?
• Monitoring thoughts/feelings
• Using relaxation techniques
• Mindfullness based treatment
How can we monitor our thoughts?
• Sit quietly…
• What are you feeling? Breathing, posture,
physical feelings, emotions?
• Feeling words: afraid, nervous, insecure,
uneasy, worried, out of it, shaky, uptight?
• What are you thinking? What just
happened before the feeling, how does
this affect future?
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What am I upset about?
What’s the worst that could happen?
How might this affect me?
How would this affect how others see me?
Does this remind me of my past?
What would my parents say about this?
How does this affect how I see myself?
• Have I thought this before? Did it come
true?
• Do I have experiences that contradict this?
• Is this as awful as I am imagining?
• A year from now, how important will this
be?
• Do I know anyone who dealt with this
effectively? Can someone help me?
• Be your own buddy: talk to yourself calmly
like a friend would
• Take the negative thought and come up
with an opposite/positive thought
Relaxation Techniques
• There are many forms of relaxation that
one can practice:
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Yoga
Meditation
Exercise
Mindfulness
Exercise: Progressive Muscle
Relaxation (PMR)
Step One: Tension.
The process of applying tension to a muscle is
essentially the same regardless of which muscle
group you are using.
First, focus your mind on the muscle group; for
example, your right hand. Then inhale and
simply squeeze the muscles as hard as you can
for about 8 seconds (e.g., make a tight fist with
your hand).
PMR
Step Two:Releasing the Tension.
This is the best part because it is actually pleasurable.
After the 8 seconds, just quickly and suddenly let go.
Let all the tightness and pain flow out of the muscles as
you simultaneously exhale.
Feel the muscles relax and become loose and limp,
tension flowing away like water out of a faucet. Focus on
and notice the difference between tension and
relaxation.
PMR
Muscle Groups:
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Right foot
Right lower leg and foot
Entire right leg
Left foot
Left lower leg and foot
Entire left leg
Right hand
Right forearm and hand
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Entire right arm
Left hand
Left forearm and hand
Entire left arm
Abdomen
Chest
Neck and shoulders
Face
MINDFULNESS
• Mindfulness Based Cognitive Therapy
(MBCT)
mindfulness and mindfulness
medication focus on becoming aware of all
incoming thoughts and feelings and
accepting them, but NOT attaching or
reacting to them
Goal of MBCT
• The goal is to interrupt the automatic
reactions they have to experiences and to
teach participants to focus LESS on
reacting to the incoming stimuli and
instead to accept and observe them
without judgement
Three Cs
1. Catch
You want to be able to catch the negative thought
that has entered your mind.
You want to stop and be aware of the thought
2. Check
You want to check the thought, is it
positive or negative? Can you prove or
disprove the thought.
3. Correct
Once you have “caught” the thought
and spent a moment to “check” your
response or feelings to the thought/stimuli
you want to then modify the way you
identify the thought based on the present
moment not your past experiences nor
your past reactions.
PROJECT UPLIFT
• NEREG offers a distance based 8 week
course to help build the skills needed to
combat depression with mindfullness.
• For more information contact:
uvmlcsw@gmail.com
THANK YOU!