Treatments for PNES

1. Treatments for PNES Urmi Vaidya-Mathur, LCSW

2. Topics that we will cover • Anxiety • Depression • Treatment the symptoms of anxiety and depression

3. 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 How do we treat PNES?

4. 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

5. 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 How do we measure success?

6. 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

7. A review of anxiety • Anxiety types • Tracking anxiety • Becoming a thought detective • Worry words

8. Anxiety Types Generalized Anxiety Disorder (GAD) Panic Disorder Posttraumatic Stress Disorder (PTSD)

9. 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

10. 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

11. 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

12. 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

13. What are the behavioral interventions available to treat PNES ? • Monitoring thoughts/feelings • Using relaxation techniques • Mindfullness based treatment

14. 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?

15. 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?

16. 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?

17. Be your own buddy: talk to yourself calmly like a friend would Take the negative thought and come up with an opposite/positive thought

18. Relaxation Techniques • There are many forms of relaxation that one can practice: • Yoga • Meditation • Exercise • Mindfulness

19. 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).

20. 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.

21. PMR Muscle Groups: • 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 • Entire right arm • Left hand • Left forearm and hand • Entire left arm • Abdomen • Chest • Neck and shoulders • Face

22. 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

23. 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

24. Three Cs • 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

25. 2. Check You want to check the thought, is it positive or negative? Can you prove or disprove the thought.

26. 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.

27. 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

28. THANK YOU!