Self Management Interventions
There are evidence-based self-management programs and depression treatment interventions that are available to help improve the quality of life for people with epilepsy and their families. These interventions were developed by researchers at the Prevention Research Center’s Program. These programs have been evaluated in randomized control studies. Results from these studies found that after participating in these programs, adults with epilepsy had experienced improvements in specific outcomes such as medication adherence, self-efficacy, emotional well-being, and reductions in symptoms of depression. The Community Preventive Services Task Force recommends collaborative care models such as PEARLS based on strong evidence of effectiveness.
Managing Epilepsy Well (MEW) Network Evidence-Based Programs
- WebEase (Web Epilepsy, Awareness, Support, and Education)
- UPLIFT (Using Practice and Learning to Increase Favorable Thoughts)
- PEARLS (Program to Encourage Active, Rewarding Lives)
WebEase (Web Epilepsy, Awareness, Support and Education) is an interactive, online self-management program for adults with epilepsy. On the basis of behavioral science principles shown to be effective in helping people adopt or maintain healthy behaviors, WebEase guides participants to think about personally motivating factors that can help them to take medications as prescribed, manage stress, and get a good night’s sleep—all important behaviors to help minimize seizures. WebEase is for any adult living with epilepsy who is interested in improving his or her self-management skills. The program is made available for free through a partnership with the national Epilepsy Foundation.
DiIorio C, Bamps Y, Escoffery C, Reisinger-Walker E. Results of a randomized controlled trial: evaluating WebEase, an online epilepsy self-management program. Epilepsy and Behav. 2011;22(3):469-474.
DiIorio C, Escoffery C, McCarty F, Yeager KA, Henry TR, Koganti A, Reisinger E, Wexler B. Evaluation of WebEase: an epilepsy self-management Web site. Health Education Research, 2009;24(2):185-197.
Reisinger EL, Welxer B, DiIorio C, Escoffery C, McCarty F, Yeager KA. Content and characteristics of goals created during a self-management intervention for people with epilepsy. Journal of Neuroscience Nursing, 2009;41(6):312-321.
Escoffery C, Yeager KA, McCarty F, Henry TR, Koganti A, et al. WebEase: development of a Web-based epilepsy self-management intervention. Prev Chronic Dis. 2009;6(1).
Escoffery C, DiIorio C, Yeager, KA, McCarty F, Robinson E, Reisinger E, Henry, TR, Koganti A. Use of computers and the Internet for health information by patients with epilepsy. Epilepsy and Behav. 2008;12:109-14.
The PEARLS program is intended for adults with epilepsy who suffer from minor depression, major depression, and/or dysthymia. Delivered by a trained counselor in the client's home, PEARLS consists of eight 50-minute sessions of problem solving treatment, behavioral activation, and psychiatric consultation. This collaborative care intervention includes a multidisciplinary team of doctors, nurses, and social workers. Research has shown that adults with epilepsy assigned to the PEARLS intervention achieve lower depression severity scores and lower suicidal ideation over 12 to18 months than patients who receive usual care. With past CDC support, PEARLS investigators have developed and offer a 2-day PEARLS training program for providers and administrators to learn about how to use PEARLS methods and implement PEARLS in their communities.
The Community Preventive Services Task Force recommends collaborative care models such as PEARLS for the management of depressive disorders based on strong evidence of effectiveness in improving depression symptoms, adherence to treatment, response to treatment, and remission and recovery from depression. The Task Force also finds that collaborative care models provide good economic value based on the weight of evidence from studies that assessed both costs and benefits. This type of intervention improves depression outcomes and is applicable to adult populations in most settings.
For more information: http://www.pearlsprogram.org
Chaytor N, Ciechanowski P, Miller JW, Fraser R, Russo J, Unutzer J, Gilliam F. Long-term outcomes from the PEARLS randomized trial for the treatment of depression in patients with epilepsy. Epilepsy and Behavior 2011;20(3):545-549.
Ciechanowski P, Chaytor N, Miller J, Fraser R, Russo J, Unutzer J, Gilliam F. PEARLS depression treatment for individuals with epilepsy: a randomized controlled trial. Epilepsy and Behavior 2010;19(3):225-231.
Project UPLIFT for Treatment is an 8-week program delivered through the Internet or by telephone to groups of people with epilepsy and comorbid depression. Project UPLIFT combines cognitive behavioral therapy and mindfulness to reduce depressive symptoms; improve life satisfaction and quality of life; increase self-compassion, purpose in life, sleep time and quality; and enhance knowledge and skills related to mindfulness and depression. Intervention groups are co-facilitated by a trained peer with epilepsy and a graduate student, both under the supervision of a licensed, clinical psychologist. A randomized-control trial found that depressive symptoms decreased significantly, knowledge/skills increased significantly, and other benefits were achieved. With funding from the National Institutes of Health, Project UPLIFT has been modified into a depression prevention intervention.
Project UPLIFT provides training for licensed mental health professionals in all 50 US states to implement Project UPLIFT in their community and to train peer-facilitators in delivering Project UPLIFT to people living with epilepsy and depression. Training sessions last 10 weeks and require attending a one-hour weekly class delivered by phone. All participant training material are provided free. Successful participants will also receive Continuing Education (CE) credits for their participation in all 10 training sessions.
Thompson NJ, Walker ER, Obolensky N, Winning A, Barmon C, DiIorio C, Compton M. Distance delivery of mindfulness-based cognitive therapy for depression: Project UPLIFT. Epilepsy and Behavior 2010;19(3):247-254.
Walker ER, Obolensky N, Dini S, Thompson, NJ. Formative and process evaluations of a CBT and mindfulness intervention for people with epilepsy and depression. Epilepsy and Behavior 2010;19(3):239-246.