Automatic avoidance tendencies in patients with psychogenic non-epileptic seizures

Psychogenic Non Epileptic Seizures (PNES) have been theorized to reflect a learned pattern of avoidant behavior to deal with stressors. Although such observation may be relevant for our understanding of the etiology of PNES, evidence for this theory is largely build on self-report investigations and no studies have systematically tested actual avoidance behavior in patients with PNES. In this study, we tested automatic threat avoidance tendencies in relation to stress and cortisol levels in patients with PNES and healthy controls (HCs).

The approach and avoidance (AA) task was administered to 12 patients with PNES and 20 matched HCs at baseline and following stress-induction using the Cold Pressor Test (CPT). The AA task requires participants to evaluate the emotional valence of pictures of angry and happy faces by making arm movements (arm flexion or extension) that are either affect-congruent (avoid-angry; approach-happy) or affect-incongruent (approach-angry; avoid-happy) with their intuitive action tendencies. Saliva cortisol was measured throughout the experiment.

Patients, but not HCs, showed increased approach-avoidance congruency-effects for angry faces on the AA task at baseline, with relatively slower approach of angry faces, which was overall associated with basal pre-task cortisol. This congruency-effect disappeared after the CPT.

The present findings provide an objective confirmation of previous suggestions from self-report studies indicating that PNES patients show relatively increased avoidance tendencies to social threat cues. The registering of threat avoidance behavior may prove to be a clinically valuable contribution to evaluate psychological treatment effectiveness and perhaps even PNES prognosis.