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Information about epilepsy |
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(c) 2006 Robert J. Mittan, Ph.D. |
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the S.E.E. program |
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Sepulveda Epilepsy Education: The Efficacy of a Psychoeducational Treatment Program in Treating Medical and Psychosocial Aspects of Epilepsy 1David C. Helgeson, 2Robert Mittan, 1Siang-Yang Tan, and 3Sirichai Chayasirisobhon 1Graduate School of Psychology, Fuller Theological Seminary, Pasadena; 2Sepulveda VA Medical Center and UCLA School of Medicine, Los Angeles, 3Kaiser Permanente Medical Center, Anaheim, California. Epilepsia, 31(1), 75-82, 1990
Background The Commission for the Control of Epilepsy and Its Consequences stated the greatest unmet need in epilepsy care is patient and family education and psychosocial treatment. This study investigated the long-term therapeutic outcomes of the Seizures & Epilepsy Education (S.E.E.) program, formerly known as Sepulveda Epilepsy Education. S.E.E. is a two-day-long patient and family educational program designed to provide medical education and psychosocial therapy for large audiences (100-800 people at a time.) S.E.E. was designed as a cost-effective way of delivering psychosocial treatment to large numbers of affected persons. The question was whether such an innovative approach could effectively accomplish its goals.
Subjects and Methods This study used a prospective, randomized, matched control design with long-term follow up (4 months.) The treatment group (N=20) received baseline assessments, and testing immediately after exposure to the S.E.E. program and again 4 months after exposure. The wait list control group (N=18) received baseline assessments and testing again at 4 months. Both groups received a 50-item true false test specifically designed to evaluate the S.E.E. program (S.E.E. Post-Test, SPT), the Washington Psychosocial Seizure Inventory (WPSI), the Beck Depression Inventory (BDI), Lubin’s Depression Adjective Checklist (DACL), the State-Trait Anxiety Inventory (STAI), the Acceptance of Disability Scale (ADS), and Sherer’s Self-Efficacy Scale (SES). The study was carried out independently. Dr. Mittan had no role in subject selection, data collection, data analysis, or in writing the article. The group attending the S.E.E. program showed the following significant results, sustained at 4 month follow up:
The usual pattern of results in outcome research evaluating psychosocial treatment interventions is that patients show improvement immediately following the intervention, but over time these benefits deteriorate back to baseline. This study found a different result. Not only did the treatment group show immediate improvement, but the treatment group showed even further improvement at long-term follow-up. This was found for the following variables: Continuing improvement in Overall Psychosocial Functioning (WPSI)
This unusual finding has been recently replicated by another independently conducted study of the S.E.E. program (Shore, et al, submitted.) During the same period, the control group showed declines in adjustment. Depression is a significant problem in epilepsy. Overall, the treatment group showed a decrease in BDI depression scores from 8.05 at baseline to 6.25 at 4 month follow up. The control group showed an increase in depression over the same time (10.56 to 11.06 at follow up.) However not all subjects in the control and experimental groups were depressed. There were 9 control and 7 treatment group subjects that scored in the depressed range at baseline. At 4 month follow up, all of the depressed treatment group subjects scored in the non-depressed range (from 13.57 at baseline to 8.14 at follow up). All of the control group subjects continued to score in the depressed range. Medication compliance is a particularly important and troublesome problem in epilepsy treatment. This study looked at compliance through the measurement of blood serum concentrations of antiepileptic medications at baseline and four month follow up. Figure 1 presents these results: Table 1
The treatment group showed a significant and sustained increase (p < 0.05) in blood serum concentrations of antiepileptic medications from baseline to 4 month follow up. There was a mean increase of 70% four months after the program. Over the same period the control group showed a mean decline in blood serum levels of 18%. Seizure frequencies were not significantly changed from baseline to follow up for either group.
Discussion The Seizures & Epilepsy Education (S.E.E.) program (formerly known as Sepulveda Epilepsy Education) is a two-day long patient and family education program designed for large audiences. The results of this study are very encouraging. This “one shot” intervention resulted in significant and sustained improvements in patients’ psychosocial adjustment, level of depression, and medical self-management. The results demonstrate it is possible to create long-term changes in medication compliance through a single intervention. Considering the relative lack of psychosocial treatment resources for patients and families with epilepsy, the finding that this brief therapeutic intervention can create sustained psychosocial improvement is important. Notable was patients continued to improve at long-term follow up, a very unusual finding for any psychosocial treatment intervention. Also notable, for statistical significance to be reached with such a small experimental population, the program had to exert very large long-term therapeutic effects. Further study to confirm and expand upon these results was recommended by the authors.
Note A second independent study recently completed (Shore, et al, submitted) shows a similar pattern of results, including sustained psychosocial improvement and continued improvement in psychosocial functioning at long-term follow up.
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