A Novel Integrative Psychotherapy for Psychogenic Nonepileptic Seizures Based on the Biopsychosocial Model: A Retrospective Pilot Outcome Study

Shiri Ben-Naim*, Aryeh Dienstag, Sara A. Freedman, Dana Ekstein, Yasmin Abo Foul, Moran Gilad, Or Peled, Avigail Waldman, Sivan Oster, Moriya Azoulay, Shir Blondheim, Shahar Arzy, Renana Eitan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Psychogenic nonepileptic seizures (PNES) represent one of the most sizable treatment challenges in neuropsychiatry. Although the underlying mechanism is far from being understood, several interventions have been suggested. However, patients with comorbid psychiatric diagnoses and epilepsy are excluded from most intervention studies. Objective: To To present a within-group posttreatment vs pretreatment study representing the retrospective clinical results of an integrative psychotherapy model. Methods: We present the clinical results of 22 patients with PNES diagnosed in an epilepsy center and treated in our neuropsychiatry clinic using an integrative rehabilitative psychotherapy. Therapy included presenting the diagnosis, psychoeducation, seizure reduction behavioral techniques, and coping with past and present stressors. Insomuch as integrative biopsychosocial psychotherapy is based on an individualized treatment protocol for each patient, treatment was individualized and case specific. Results: By the end of treatment, 36% of patients had become seizure free and a further 54% achieved a major seizure reduction (reduction of more than 70%). Seventy-two percent of patients kept at least 70% seizure reduction at follow-up. Global Assessment of Functioning scores improved from a mean of 43.09 to a mean of 72.81 at the end of treatment and 69.72 at follow-up. In addition, we present 3 case descriptions that emphasize the individualized nature of psychotherapeutic decisions. Conclusions: Our results support the feasibility and effectiveness of biopsychosocial based integrative psychotherapy for PNES and set principles for future treatment and prospective clinical trials in the field of individualized psychotherapy.

Original languageAmerican English
Pages (from-to)353-362
Number of pages10
Issue number4
StatePublished - 1 Jul 2020

Bibliographical note

Funding Information:
The authors wish to thank Prof. Laura Goldstein and her team from King's College, London, for sharing their knowledge and experience regarding PNES with us.

Publisher Copyright:
© 2020 Academy of Consultation-Liaison Psychiatry


  • biopsychosocial model
  • comorbid epilepsy
  • dissociative seizures
  • integrative treatment
  • psychogenic nonepileptic seizures
  • psychotherapy


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