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» Neurobehavioral / Cognitive Behavioral Therapy (CBT)

Neurobehavioral / Cognitive Behavioral Therapy (CBT)

The neurobehavioral / cognitive behavioral therapy (CBT) was developed by Dr. Donna J. Andrews and her associate Dr. Joel Reiter at the Andrews/Reiter Epilepy Research Program. The therapy focuses on identifying seizure triggers and learning techniques to prevent seizures through self control:

According to Andrews/Reiter:
The Andrews/Reiter approach sees epilepsy as a behavioral disorder with functional symptoms. The seizures are triggered by emotional reactions and stressful situations. The seizures are not caused by damage to the brain. Rather the damage has lowered the threshold at which the brain can no longer handle or recover from an Overload on its circuitry. When the overload threshold is passed, a seizure occurs. In some cases it may take weeks or even months to reach the threshold, in others as little as 30 seconds. Instead of shutting down brain functioning through drug therapy to prevent seizures, a self-discovery process is implemented relating the personal responsibility of the individual to the occurrence of their seizures. It minimizes or eliminates drug therapy, and reestablishes personal dignity by allowing the individual to achieve a normal and productive life.

In private correspondence with Dr. Andrews, she related that:

According to Dr. Donna J. Andrews:
In the first 7 years the process was applied to all seizure types. We found that it worked well with uncontrolled Tonic/Clonic, Complex Partial, absence, and Secondary generalized, but it did not work well with myoclonic and atonic.

Efficacy

Total seizure control was achieved by 18 of the 23 patients in the left-hemisphere group, or 78.2% of this sample and by 17 of the 21 patients in the right-hemisphere group, or 80.9% of this sample. Seizure control was achieved by 35 out of 44 patients in the two groups, or 79.5% for the total population treated in the brief therapy model. Those patients identified as having achieved control had been seizure-free for 6 months or longer.

...

Both groups showed a significant reduction in seizure frequency following treatment. The proportional reduction in seizures was calculated for each patient, this proportion was converted to a percentage, and then computed as the mean per cent for each group of patients. The mean per cent of reduction of seizures in both groups is greater than 90%. The mean for the left-hemisphere group is 95.7% and the mean of the right-hemisphere group is 93.7%.

According to Andrews/Reiter:
This work began as a private investigation of the potential for a behavioral approach to the treatment of epilepsy. Several disciplines were used for this investigation: neurology, psychiatry, psychology and biofeedback. This first exploration in 1980 involved five patients with an average history of 15 years of uncontrolled seizures. Since then approximately 2300 people have been treated and the success rate for complete control is over 80%.

In private correspondence with Dr. Andrews, she related that:

According to Dr. Donna J. Andrews:
We review records free of charge. After that review we tell the patient what category that they fall within (i.e. potential for full recovery vs. some percentage, or unknown). ... You might find it interesting that the people who fall in the better than 90% chance of recovery are often the patient who have the most seizures.

Potential Adverse Events

There are no known adverse events. This therapy does not involve any invasive or unnatural processes.

Cost

At this point in time, it is not expected that insurance companies cover CBT for epilepsy. For the chart, I scored CBT with a 5 to reflect complete out of pocket expenses. If your insurance company will cover your treatments in whole or part, you might consider adjusting this score upwards accordingly when viewing the chart.

Type

Patients are required to take ownership of learned techniques for managing their own specific triggers. While it requires active participation at the initiation of the therapy, it is expected that the techniques eventually become a habitual and unconscious part of daily life. For the chart, CBT was scored as requiring continuous, passive participation.

Latency

According to the study published in Seizure (referenced above), ~50% seizure control is attained on average within 2-3 months and full seizure control can occur somewhere between 6-18 months.

Special Notes

The Andrews/Reiter Epilepy Research Program is a non-profit outfit.

You can also learn many of the neurobehavioral therapy techniques from this book: Epilepsy - A New Approach: What medicine can do, what you can do for yourself.

Return to the chart of alternative epilepsy treatments.

This page last modified September 26, 2011.

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