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Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy: a systematic review of clinically reliable improvement
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  • Published on:
    A response from Noble et al. to e-letter by the Psychology Task Force of the International League Against Epilepsy
    • Adam J. Noble, Lecturer in Psychological Sciences University of Liverpool, UK
    • Other Contributors:
      • James Reilly, Clinical Psychologist
      • James Temple, Psychology Technician & PhD candidate
      • Peter L. Fisher, Senior Lecturer in Clinical Psychology

    Dear Editor,
    Re: A response from Noble et al. to e-letter by Psychology Task Force of the International League Against Epilepsy
    Cognitive behavioural therapy (CBT) has been recommended for treating depression in people with epilepsy (PWE).[1, 2] The clinical significance of the effects of CBT for PWE has though, not been considered. We therefore systematically searched the literature for randomised controlled trials of CBT for PWE [3] and used Jacobson’s criteria [4] to empirically determine whether PWE made clinically reliable improvement. We compared this to that seen in the control arms of these trials.
    Our main findings were that the likelihood of statistically reliable improvement in symptoms of depression was significantly higher for those PWE randomised to CBT compared to control conditions. The overall proportion of PWE achieving reliable improvement was low – 30% compared to 10% in the control arms. For most PWE, symptoms were unchanged.
    The proportion of PWE who improve following CBT is limited. It should serve as a clarion call for the development of more effective treatments. Indeed, our review may have inflated CBT’s benefit since some trials included PWE without clinical distress at baseline and so it was not possible to apply Jacobson’s second, more stringent criterion and calculate for what proportion CBT also resulted in recovery.
    The Psychology Task Force of the International League Against Epilepsy submitted a response to ou...

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    Conflict of Interest:
    None declared.
  • Published on:
    Why it’s still important to consider referring patients with epilepsy (PWE) with depression for psychotherapy – including Cognitive Behaviour Therapy. Response from the Psychology Task Force of the International League Against Epilepsy
    • Milena Gandy, Clinical Psychologist & Macquarie University Research Fellow , The eCentreClinic, Department of Psychology, Macquarie University
    • Other Contributors:
      • Markus Reuber, Neurologist
      • W. Curt LaFrance Jr, Neurologist and Psychiatrist
      • Avani Modi, Pediatric Psychologist
      • Janelle, L. Wagner, Pediatric Psychologist
      • Laura H Goldstein, Professor of Clinical Neuropsychology
      • Venus Tang, Clinical Psychologist
      • Kirsten A Donald, Pediatric Neurologist
      • Kette D Valente, Pediatric Neurologist and Neurophysiologist
      • Rosa Michaelis, Neurologist and Psychotherapist

    Imagine you are an epilepsy health professional seeing a patient with clinical symptoms of depression. What should you do? If you have read Noble et al.’s [1] recent JNNP review, entitled ‘Cognitive-behavioural therapy does not meaningfully reduce depression in most people with epilepsy…’ you may have become sceptical about the potential of CBT, or psychotherapy in general, to alleviate depression in people with epilepsy (PWE). This recent systematic review pooled data from five small randomised controlled trials (RCTs), with some elements of CBT for PWE, and performed an analysis of reliable change. ‘Pooled risk difference indicated likelihood of reliable improvement in depression symptoms was significantly higher for those randomised to CBT’, but the authors focused on the finding that ‘only’ 30% of patients receiving interventions, compared to 10% of controls, could be considered ‘reliably improved’. Emphasising the fact that over 2/3 of patients did not meet this criterion for improvement, the authors suggest CBT is ‘ineffective’, has ‘limited benefit’ and could even lead to lower ‘self–esteem’ and ‘helplessness’. Notably, the latter conclusions were based on hypothetical reactions to treatment, rather than empirically supported outcomes.

    Therefore, the purpose of this letter, written by the Psychology Task Force of the International League Against...

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    Conflict of Interest:
    None declared.