Abstracts

Rationale: Clinical Practice Guidelines for depression and anxiety recommend CBT as an equivalent and sometimes more effective treatment than medication. We report a pilot project adapting an existing 10-week group intervention, CBT Basics II, for epilepsy patients. The effectiveness and acceptability of the program to epilepsy patients were evaluated. Methods: 7 epilepsy patients (6 women, 1 man; M age = 43.7 yrs, SD = 9.9) referred by neurologists to address primary depression (n = 3) or anxiety (n = 4) participated. 6 of the 7 participants had at least 1 seizure per month. All were on at least one anticonvulsant medication. 3 were on an antidepressant, 2 were on an anxiolytic, and 1 was on an antipsychotic. 57.1% were married and 71.5% completed high school or greater. 28.6% were employed. Procedure: CBT Basics II is a weekly 10-session group program for depression and/or anxiety. Sessions 1-4 focus on behavioural interventions; Sessions 5-7 focus on cognitive techniques; Sessions 8 and 9 focus on advanced behavioural skills; session 10 targets relapse prevention. Participants were recruited from the epilepsy program psychology service waiting list. Charts were reviewed and interviews conducted by telephone for inclusion (epilepsy and depression and/or anxiety) and exclusion criteria (current suicidal ideation or psychosis; primary non-epileptic events; moderate-severe cognitive impairment; primary Axis II personality disorder; and unstable/severe seizures). Psychological symptom change was assessed through questionnaires (Beck Depression Inventory-II, Beck Anxiety Inventory, Automatic Thoughts Questionnaire, Cognitive Therapy Awareness Scale, and Quality of Life in Epilepsy) administered at sessions 1 (pre-group) and 10 (post-group). The acceptability of the group was explored through anonymous written evaluations at session 10. Reason for not enrolling, drop out rates, and attendance were also monitored. Results: Paired-samples t-tests were used to explore changes in affective symptoms and cognitive therapy skill acquisition. There were improvements in depression (M pre = 27.3, M post = 15.71; t(6) = 3.88, p < .01), negative automatic thoughts (M pre = 77.7, M post = 62.0; t(6) = 3.08, p < .05), and overall quality of life (M pre = 37.7, M post = 43.7, p < .05). No changes were observed for anxiety or cognitive therapy knowledge, despite reports of improvements on evaluation forms. Regarding acceptability, only 2 (11.7%) of all potential participants contacted (n = 17) said they would not participate in a group program. There were no drop-outs. Participants attended an average of 8 sessions (range = 6-10). Three (42.9%) believed the group should have been longer and 4 (57.1%) said the sessions were “too rushed.” Conclusions: CBT Basics II is a promising intervention for patients with epilepsy and co-morbid depression and/or anxiety. Alternate measures for assessing anxiety and cognitive therapy knowledge may be required to enhance sensitivity to change. Future research will modify the program to reduce content and increase time for skill practice and discussion in session.