Three sessions of intensive short-term dynamic psychotherapy (ISTDP) for patients with dissociative seizures: a pilot study

Abstract

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of several Functional Neurological Disorders (FND) including dissociative seizures. However, its implementation in secondary mental health and specialist services within the English National Health Service (NHS) is scarce. The aim of this pilot study was to explore the estimates of the therapeutic effects of a 3-session course of this treatment as well as establish safety and acceptability for a complex patient group. The study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Participants completed self-report outcome measures at the start, at the end and 1 month following the completion of therapy. Three open-ended questions examined their therapy experiences qualitatively and these were analysed through thematic analysis. All participants who started the treatment (N = 17) completed the intervention and attendance rates were very high (95%). No serious adverse effects were observed and the CORE-OM and BSI showed improvements both at the end of the treatment and at follow-up. Healthcare utilisation was also reduced, including acute medications, A&E attendances and crisis-line usage. The results provide preliminary support for the safe use of ISTDP in this complex group of participants, but further evidence from controlled and randomized studies is warranted.

Keywords:

• ISTDP
• dissociative seizures
• psychodynamic
• functional
• neurological
• NHS

Acknowledgements

This study was funded by the Research Capability Funding programme of the NHS Liverpool Clinical Commissioning Group (CCG).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Practitioner points

• Mental health care pathways for dissociative seizures are underdeveloped, often leading to delays in appropriate intervention.

• ISTDP is safe and acceptable for secondary adult mental health patients with dissociative seizures

• ISTDP can contribute to health outcome improvements along with reduced healthcare utilisation for patients with dissociative seizures.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Additional information

Funding

This work was supported by the Liverpool Clinical Commissioning Group (LCG) [LCCG_RCF20-21_07].