Seven studies (495 participants) were included: four RCTs (n=318), one cross-sectional study (n=27) and two longitudinal studies (n=150).
Psychoeducation.
One RCT (n=38) that included participants with a seizure frequency of between 2 and 2.5 seizures per month assessed the effectiveness of a 2-day family or patient psychoeducational programme. The results at post-treatment and 4-month follow-up showed that the programme significantly reduced fear of seizures, as measured by the Sepulveda Epilepsy Education programme questionnaire, but not self-reports of anxiety, depression, or other psychosocial measures. No change in seizure frequency was observed.
Relaxation.
Self-invented relaxation techniques and muscle relaxation training were assessed in one cross-sectional study (n=27) and one RCT (n=16). The results of the cross-sectional study showed that the 7 participants who used self-invented relaxation techniques reported less pathology on hypochondrias, psychasthenia, paranoia, social introversion and schizophrenia dimensions, as assessed by the Minnesota Multiphasic Personality Inventory (MMPI), compared with 20 control participants. The RCT examined the effectiveness of muscle relaxation training, in particular the effect of stress on seizures. The results showed that no significant improvement on the Washington Psychosocial Seizure Inventory was found post-treatment or at 6-month follow-up for the intervention group compared with the controls. Seizure reductions were observed in 3 of the 4 patients who practised relaxation at least 15 days per month.
Behaviour therapy.
Behaviour therapy was assessed in one RCT (n=220) and one longitudinal study (n=67). The results of the RCT that assessed a comprehensive care programme (delivered on either an in- or out-patient basis), compared with a waiting-list control group, showed no significant differences between the groups in terms of two different measures of quality of life and seizure frequency at follow-up. The results of the longitudinal study that assessed behaviour therapy delivered in a self-help group showed mixed results. On one of the outcome measures (the MMPI), the results for men decreased linearly, whereas the mean scores for women increased at 2 months and then decreased after 4 months of participation. The results from the other two psychological measures employed were not reported.
Counselling.
One longitudinal study (n=83) examined the effect of individual counselling. No objective psychological outcome measures were assessed in the study, although the majority of the participants expressed satisfaction with the service and reported improvements in their problems at follow-up.
Cognitive rehabilitation.
One RCT (n=50) compared the effectiveness of either cognitive retraining or cognitive compensation methods with a waiting-list control group. Both of these methods showed improvement at follow-up compared with the control. The compensation method was more effective in improving self-reported neuropsychological outcomes and quality of life.