Impact of expressive writing in patients experiencing seizures

A randomised controlled trial to investigate if Focused Expressive Writing reduces symptoms in patients with epilepsy and Non-Epileptic Attack Disorder?

Supervisors

Professor Markus Reuber MD PhD FRCP,
Academic Neurology Unit,
University of Sheffield,
Royal Hallamshire Hospital,
Glossop Road
Sheffield, S10 2JF
Markus.Reuber@sth.nhs.uk

Professor Brendan Stone
University of Sheffield
School of English Literature, Language and Linguistics, Room 3.27,
Jessop West, 1 Upper Hanover Street,
Sheffield, S3 7RA
b.stone@sheffield.ac.uk

Dr Ian Brown
CPsychol AFBPsS Clinical Psychology Unit,
Department of Psychology,
The University of Sheffield,
Western Bank,
Sheffield, S10 2TN
ian.brown4@nottshc.nhs.uk

Rationale

Epilepsy is a chronic neurological disorder characterised by recurrent seizures, which result from excessive electrical discharge in the brain. About 30% of patients with epilepsy have significant psychiatric co-morbidity (especially anxiety and depression). Non-epileptic attacks (NEAs) superficially resemble epileptic seizures but are the consequence of processes of dissociation from unbearable emotions (especially anxiety), stressful situations, physical sensations, thoughts or memories. Most patients with NEAD have a history of serious trauma. This study will combine Focused Expressive Writing (FEW) with techniques of narrative analysis. Focused Expressive Writing about traumatic, stressful or emotional events has been found to result in improvements in both physical and psychological health, in non-clinical and clinical populations. In the FEW paradigm, participants are asked to write about such events for 15–20 minutes on 3–5 occasions. Those who do so generally have significantly better physical health and socio-behavioural psychological outcomes compared with those who write about neutral topics (Penneaker & Beall, 1986). Narratological analysis, informed by structuralism and poststructuralism, is a means by which to understand and highlight the subtexts, contradictions, and contexts of narrative. It generates insights into frequently overlooked, yet central, concerns of texts through a systematic analysis of the use of language, history, form, and voice, and of the representation of identity (Genette, 1997; Currie, 2011). FEW has been shown to benefit numerous physical and psychological disorders (Baikie & Wilhelm, 2005,,Smythe & Helm, 2003). However, it has not been tested on people with epilepsy or NEAD, nor has it been combined with a linguistic and narrative analysis with the concomitant potential to generate deeper contextual insights and understandings, both into individual conditions, and the benefits of FEW itself.

Research Question

1) Can FEW have a positive impact in improving the health related quality of life (HRQoL) of patients with epilepsy and NEAD?
2) Can FEW reduce epileptic or non-epileptic seizures.
3) Does narrative analysis of FEW texts produce insight into and understanding of the specific causes of NEAD in individual patients; and do the findings of this analysis suggest further means by which this condition can be managed?

Method

The research will be a 2×2 design. Adult participants will be recruited from neurology outpatient clinics and will have diagnosis of epilepsy or NEAD; they will be randomised to control or experimental group. Participants will either engage in FEW or writing about emotionally neutral topics. Self-report questionnaires will measure HRQoL, anxiety, depression, seizure frequency / severity and healthcare usage at baseline, three and six months follow-up. Utilising structuralist and postructuralist narratology, a narrative analytic approach will be conducted on the writing produced by the participants, with interpretative emphasis placed on the diegetic levels of the texts; use of tense; lexis; pronouns; the construction and presentation of identity; the negotiation of temporality; and the relationship between memory, history, and the present.

Requirements of the student

The student may have a background in English, Psychology, Sociology or may have completed another undergraduate course offering suitable preparation for this project. They will help to develop the FEW task, recruit participants and administer the task. They will collect the self-report data and carry out the quantitative analysis of the findings. They will acquire qualitative and narratological analytic skills and carry out a comparative analysis of the writing of patients in the epilepsy and NEAD groups. The student will help to communicate the findings to scientific audiences in the fields of English, Psychology, Psychotherapy and Medicine.