Psychobehavioral therapy for epilepsy

• Psychobehavioral therapy has been applied as alternative therapy for epilepsy.
• Most therapies aim at enhancing psychological well-being and seizure control.
• We reviewed the application, possible mechanisms, and effectiveness of these therapies.
• Implications for future trial designs were proposed.

Growing evidence suggests a bidirectional interaction between epileptic seizures and psychological states, fuelling the interest in the development and application of psychobehavioral therapy for people with epilepsy (PWE). The objective of this article is to review the various psychobehavioral therapies in regard to their application, hypothesized mechanisms, and effectiveness. Most psychobehavioral therapy aims at improving psychological well-being and seizure control. Behavioral approaches, cognitive–behavioral therapy (CBT), and mind–body interventions are the most widely applied approaches for PWE. Cognitive–behavioral therapy, mind–body approaches, and multimodel educative interventions have consistently demonstrated positive effects on enhancing well-being. Nevertheless, the effects on seizure control remain inconsistent, partly attributable to small clinical trials and inadequate control groups. Assessor-blinded randomized controlled trials with sufficient power and carefully defined therapeutic components corresponding with objective and subjective outcome measures are recommended for future trial designs.