Psychological interventions for functional/dissociative seizures: A systematic review

AI Summary

Cognitive behavioural therapy has the strongest evidence supporting efficacy for functional/dissociative seizures.
Several interventions show promise, including diagnosis communication, psychoeducation, psychodynamic and mindfulness therapies, but evidence for specific patient subgroup matching is lacking.
Large, high quality trials with longer follow up are required to establish optimal treatments and achieve durable outcomes.

TL;DR (AI Generated)

Current psychological interventions including diagnosis communication, psychoeducation, psychotherapy, hypnosis, and behavioural therapies have yet to show sufficient evidence of long-lasting successful treatment for FDS.

Existing evidence suggests that several psychological interventions may be effective, with cognitive behavioural therapy demonstrating the strongest evidence base.

Basic summary

Epilepsy Behav. 2026 Nov 13;186:111345. doi: 10.1016/j.yebeh.2026.111345. Online ahead of print.

ABSTRACT

OBJECTIVE: Functional/dissociative seizures (FDS) have limited treatment options despite the major societal and personal impact of this condition. The efficacy of psychological interventions varies considerably and is influenced by social, economic, and personal factors. To guide future research on the condition, a systematic review of the published literature on the psychological treatments available for FDS was conducted. Current psychological interventions including diagnosis communication, psychoeducation, psychotherapy, hypnosis, and behavioural therapies have yet to show sufficient evidence of long-lasting successful treatment for FDS. The frequency and impact of FDS requires continued treatment development beyond the limited options currently available. Such treatments have been systematically reviewed for this purpose.

METHODS: A comprehensive literature search was carried out using the keywords: dissociative seizures, functional seizures, NEA, non-epileptic, pseudoseizures, psychogenic seizures, psychological treatment, hysterical seizures, and pseudoepileptic. Studies evaluating psychological treatments for FDS were included. Studies including patients with comorbid seizure disorders were also included.

RESULTS: A total of 55 studies (58 publications) met the inclusion criteria. A wide variety of psychological interventions for FDS have been investigated. Existing evidence suggests that several psychological interventions may be effective, with cognitive behavioural therapy demonstrating the strongest evidence base. Promising findings were also reported for diagnosis communication, psychoeducation, psychodynamic therapy, mindfulness-based therapy, behavioural therapy, and combined treatment approaches.

CONCLUSION: While a range of psychological treatments may be beneficial, cognitive behavioural therapy currently possesses the strongest evidence supporting its efficacy. However, no clear evidence suggests whether a particular intervention is most appropriate for specific patient subgroups. Structured diagnosis communication and psychoeducation appear to be valuable early interventions but may require additional psychological therapy to maintain treatment gains. Large studies of high methodological quality with longer follow-up periods are required to establish the most effective forms of treatment.

PMID:43025181 | DOI:10.1016/j.yebeh.2026.111345

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