Table e-2 Content of CBT sessions
Session No. / Content of session1 /
- Clarification of main problem, its development, family history and background
- Describing the principles of cognitive behavioral therapy and offering rationale for CBT treatment.
- Formulation and agreement of main / current problem.
2 /
- Review seizure diaries and homework as previously agreed and discuss difficulties.
- Clarification of treatment rationale.
- Agreeing long term targets i.e. what would the patient like to do in the future that they can’t do now
- Agreement of two homework tasks, which are realistic and achievable.
Handout 1:Cognitive Behavioral Therapy and Psychogenic Nonepileptic Seizures
3 /
- Review seizure diaries and homework as previously agreed and discuss difficulties.
- Meeting with family to discuss how factors in the person’s life may be perpetuating the patient’s problems.
- Introduction to re-focusing and distraction techniques if patient can identify warning signs for their seizures.
Handout 2: Distraction and Refocusing Techniques
Handout 3: A Guide for Partners and Family Members
4 /- Review seizure diaries and homework as previously agreed and discuss difficulties.
- Identification of past or present traumas or problems, which may be contributing to seizure occurrence.
- Introduction to relaxation and breathing techniques to be used to interrupt the seizure, as a stress management technique or to manage anxiety.
- Introduction to recognizing negative thinking styles.
Handouts 4a: Progressive Muscle Relaxation Exercises
Handout 4b: Cued Relaxation
Handout 5: Breathing exercises
5 /
- Review seizure diaries and homework as previously agreed and discuss difficulties.
- Clarification of patients thinking errors e.g. overgeneralizing, catastrophizing, all-or-nothing thinking
- Review avoidant behaviour and set more goals.
- Consolidation of distraction, refocusing, relaxation and breathing techniques.
- Introduction to problem solving strategies.
Handout 6: Identifying Negative Automatic Thoughts
Handout 7: Alternatives to Negative Thoughts.
6 / Mid - treatment review
- Review seizure diaries and homework as previously agreed and discuss difficulties.
- Review progress to date.
- Identify and agree on the remaining areas to be addressed.
- Meet with the family to evaluate progress to date.
7-9 /
- Continue to monitor patient’s completion of their self-monitoring diaries and seizure frequency.
- Review homework as previously agreed and discuss difficulties.
- Continue with goal setting.
- Continue to discuss negative thoughts and how to tackle them
- Continue to discuss the role of avoidance both behavioral and cognitive
- Continue to use distraction and refocusing techniques.
- Encourage the use of problem solving strategies, for both actual and potential problems.
10 /
- Review seizure diaries and homework as previously agreed and discuss difficulties.
- Identify potential or ongoing problems and how they may be addressed using CBT techniques following discharge from active treatment.
Handout 8: Preparing for the Future.
11 /
- Review seizure diaries and homework as previously agreed and discuss difficulties.
- Review treatment to date
- Time for reflecting on the treatment process
- Discuss remaining issues.
12 /
- Review of gains made within treatment.
- Identify goals to be reviewed at for the 1 month follow-up booster session
- Reinforce positively gains made within treatment and how they were made.
Follow-up sessions (max 3) / Session agenda structured as at discharge and will include the negotiation of homework.