Abstracts

Rationale: It is well-established that humans use a complex system of cognitive biases or ‘positive illusions’ that foster emotional wellbeing. These include an inflated assessment of one’s abilities and personal control over life events and an overly optimistic view of the future. The aim of this study was to examine the role of positive illusions in patient adjustment to drug-resistant epilepsy and expectations of surgical treatment. We hypothesised that a failure to generate positive illusions about epilepsy would be associated with poorer adjustment, as indicated by lower mood and HRQOL, and higher motivation to undergo surgery, as indicated by greater expectations of post-surgical life.Methods: We prospectively assessed 93 patients (57% female; mean age=41yrs, SD=13; mean FSIQ=101, SD=13) with drug-resistant focal epilepsy (76% temporal focus; mean seizure onset=21yrs, range=1-63) admitted for surgical characterisation. From patient families, we also recruited a socio-demographically matched control sample of people with no neurologic or psychiatric history (n=57; 50% parents, 42% partners, 8% siblings/children). Since no measures exist to capture positive illusions in people with epilepsy, we purpose-built an interactive computer program to assess these and expectations of surgery. Participants also completed standardised questionnaires assessing mood and HRQOL.Results: 53% of patients had positive illusions about their epilepsy, including feeling proud about it (92%) and accepting it as part of themselves (76%), believing they can control it (37%), and seeing it as a gateway to life (35%). Supporting our hypotheses, patients with no illusions (47%) reported higher levels of depression (p<.001) and anxiety (p=.002) compared to patients with positive illusions and healthy controls, with no difference between the latter two groups. Similarly, patients with no illusions reported poorer overall quality of life (p=.02), had less positive perceptions of their health (p=.01), reported poorer social functioning (p=.002), emotional wellbeing (p=.003) and cognitive functioning (p=.03), and described more physical pain (p=.05). They also had significantly higher expectations that surgery would improve their personal independence, cognition, health, and standard of living than patients with positive illusions (p=.001). There were no differences on clinical or socio-demographic variables between the patient groups (p>.05).Conclusions: Positive illusions can be disrupted in people with epilepsy, negatively impacting their sense of self, perceived control over life events, and future optimism. This was associated with lowered mood and HRQOL, suggesting that positive illusions may constitute the psychological mechanism maintaining subjective quality of life. Paradoxically, this may increase the gap between patient perceptions of their current life and the life they expect after surgery, leading to inflated expectations of surgery, and potentially heightening the risk of post-operative adjustment difficulties and poor outcomes.