Counseling Today, Member Insights

Treating psychogenic nonepileptic seizures

By Jason Wright August 26, 2016

Imagine what it’s like to suffer from seizures that can strike anytime, anywhere. Imagine losing your driver’s license, job and social life because of seizures that seem to be uncontrollable. Imagine the emotional turmoil that ensues as these seizures take over more and more of what you once enjoyed, considered necessary or maybe even took for granted.

Now imagine your neurologist or epileptologist telling you there is no medical reason for your condition. The seizures have a psychological origin and are your brain’s way of coping with Branding-Images_seizuresemotional stress. Unlike what your primary care physician told you, your condition isn’t epilepsy, meaning all those drugs you’re taking to treat epilepsy are absolutely worthless.

Finally, imagine dealing with the skepticism of your family and friends now that they know these seizures are “all in your head — the doctor even said so.” This is a snapshot of what it is like for people who suffer from psychogenic nonepileptic seizures (PNES).

My first case

It was a Tuesday afternoon at my clinic, one of the week’s two “walk-in” days in which both regular and new clients could see a clinician without an appointment. On this particular day, a young woman in her 20s (I’ll call her Charleen) walked in, trembling and barely able to speak. All our clinicians were busy, but the receptionist told her that if she had a seat, someone would be with her shortly. The front office staff said she seemed slightly disoriented and not fully able to explain why she was in our office or who had referred her.

After I finished another client’s session, I walked into the waiting room and introduced myself. Charleen made no eye contact, and about a minute into our conversation, she told me she had to leave and return home to “take her dogs out.” She assured me that she would be back, however. Later that day, she called the office and made an appointment with me for the following week.

During that appointment, Charleen told me she had been suffering from PNES and anxiety, and that a local mental health agency had referred her for those conditions. She had left so abruptly the day she walked in because she was on the verge of having a seizure episode and didn’t want to have it in my office. She then tearfully proceeded to tell me about her life, and losses, with PNES, which included the experiences mentioned at the beginning of this article.

Although I was aware of PNES, I had never worked with anyone diagnosed with the condition. With more than 20 years of experience as a licensed counselor, however, I had extensive experience with clients struggling with anxiety. There were no other places that worked with PNES within a reasonable distance for Charleen, so I agreed to become her counselor. I began reading everything I could get my hands on related to PNES, starting with Psychogenic Non-epileptic Seizures: A Guide, by Lorna Myers, and even attended an online training given by Myers.

My work with Charleen progressed nicely, and I began to contact other referral sources in my area for more PNES cases. The treatments I used were bringing impressive results to a condition that, as I found out later, many clinicians feared. As the successes continued, I contacted Myers, director of the PNES Treatment Program and the Clinical Neuropsychology Program at the Northeast Regional Epilepsy Group in New York, to be placed on the national referral registry for PNES. Given the dearth of providers for PNES, I began getting referrals from other states. My zeal for working with PNES sufferers has continued to grow since that time.


Although the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not include the acronym PNES, it does describe the condition as a conversion disorder (functional neurological symptom disorder) “with attacks or seizures” (F44.5). Professionals treating the condition most often use the acronym PNES, but NEAD (nonepileptic attack disorder) is also used on occasion.

The DSM-5 diagnostic criteria for psychogenic seizures include “altered voluntary motor or sensory function” that do not have a medical or neurological origin and are “not better explained by another medical or mental disorder” and that cause “clinically significant distress” in all facets of life. The term pseudo-seizures is often used to describe this condition. This is inaccurate, however, because there is nothing fake (or pseudo) about these seizures. PNES is not the same as malingering (looking for secondary gain) or factitious disorder (an attraction to being ill). Individuals who experience PNES subjectively believe and feel that they do not have control over their condition.

Several tests can help rule out seizures with a medical origin. The gold standard for diagnosing PNES, however, is the video EEG, a test that measures brain waves. During a video EEG, the person is admitted to an inpatient facility and observed for an extended period of time (generally multiple days). Whenever a seizure occurs, the brain’s electrical activity is analyzed. When a seizure has a medical origin, the EEG will display abnormal brain wave activity. In the case of PNES, brain wave activity remains unchanged during the seizure. Currently, this is the only way to reliably diagnose PNES.

In some cases, individuals who suffer from psychogenic seizures may also have epilepsy or experience other medically oriented seizures. In their paper “Defining psychogenic non-epileptic seizures,” Selim Benbadis and Valerie Kelley write that “about 10 percent of patients with PNES also have epilepsy.”

Traumatic experiences and treatment options

In most cases, sufferers of psychogenic seizures have endured at least one significant traumatic experience in their past, often including sexual victimization. Whatever the traumatic experience may be, psychogenic seizures are believed to serve as a psychological shut-off valve of sorts when sufferers become emotionally distressed. The stress may be due to external circumstances (e.g., social anxiety, job stress) or internal stimuli (e.g., flashbacks from traumatic experiences, hallucinations). It is common for PNES to occur comorbidly with other psychiatric conditions such as posttraumatic stress disorder (PTSD), dissociative disorders and anxiety disorders.

What can counselors do to help those suffering from psychogenic seizures? There are several treatment options to consider.

Psychoeducation: Psychoeducation is extremely important for those suffering from PNES because many of the clients who seek counseling do so only after years of unsuccessful treatment for epilepsy or other medically oriented conditions. They are typically referred to counseling after finally being successfully diagnosed by an epileptologist or neurologist but still may not have a proper understanding of how something that seems to have a medical origin is actually psychological in nature. Proper education for clients and their loved ones will help minimize the confusion and stigma that are often associated with this condition.

Journaling and mindful awareness: This phase of treatment involves clients learning two vital exercises: keeping a seizure journal and mindful awareness.

Before individuals become incapacitated by psychogenic seizures, they generally report a variety of prodromal symptoms, including trembling, headaches, dizziness and fatigue. The typical response one feels when a seizure is approaching is to become more anxious. This response is logical, especially considering the havoc and disruption the seizures have caused in the person’s life previously. However, an increase in stress is exactly what makes psychogenic seizures more likely to occur (stress and anxiety typically activate the seizure to begin with). Therefore, learning how to be mindful of prodromal symptoms is vital for the person to do what is necessary to avoid progression to a full-blown seizure — namely, by practicing anxiety and stress reduction.

Keeping a record (a journal) of seizure activity and each seizure’s antecedents will provide the client and counselor alike with vital information regarding when and where seizures are most likely to occur. This also keeps the client and counselor informed on therapeutic progress. Seeing one’s successes on paper can be inherently motivating and help foster the confidence that is so beneficial in combating anxiety and stress.

Anxiety/stress reduction: The next phase of treatment includes a variety of well-established and empirically verified interventions aimed at minimizing stress and reducing anxiety. This can be extremely effective in halting seizure progression.

I have found that a combination of deep breathing, progressive muscle relaxation and positive visualization can help reduce anxiety significantly. This intervention is the first choice for many of my clients suffering with PNES. Cognitive restructuring, including the recognition of stress-inducing schemata, identification of limited thought patterns and utilization of balancing thoughts that directly counter stress-inducing schemata, can also be effective in controlling anxiety and stress. Learning conflict resolution skills and receiving anger management counseling may be helpful for clients whose stress occurs more as anger. In short, by helping clients find the interventions that keep their stress levels low, counselors will give those who suffer with PNES the best chance to gain control over their seizures.

Biological considerations: Despite the psychological and emotional antecedents to psychogenic seizures, it is also important to consider physiological themes during treatment. Dietary factors are an element that deserves strong consideration in the treatment of nonepileptic seizures. When these issues affect seizure activity, they are referred to as physiogenic seizures.

I have found that many clients who suffer from psychogenic seizures also struggle with physiogenic seizures. For example, many PNES clients who regularly consume coffee will acknowledge that caffeine makes their seizures more likely and that reducing or eliminating its use is beneficial. This is most likely because caffeine stimulates the nervous system, increasing the possibility of elevated stress and anxiety levels and, thus, psychogenic seizures. In addition, avoiding foods with a high glycemic index will help to ensure that blood sugar levels remain stable. Unstable blood sugar levels can lead to hypoglycemia (low blood sugar), which, according to the Epilepsy Foundation, can trigger nonepileptic seizures.

Within the biological sphere of consideration, many patients find psychiatric medications to be beneficial. This is likely because the correct medications will help foster an emotional/mental state that reduces the likelihood of seizures occurring. It is important to note, however, that psychiatric medications do not treat the seizures directly. As is the case with other conditions, when a client with PNES is receiving treatment from a psychiatrist or other provider, it is very important for the counselor to keep open lines of communication with all said providers. In some cases, a change in psychiatric medications, or the addition of other medications, may result in an increase in seizure activity. It is necessary for the counselor to know what medication changes may have preceded the client’s seizure surge.

Working through trauma: A final phase to strongly consider when treating PNES is helping clients work through traumatic experiences. This phase of treatment can include a wide range of established interventions such as journaling, the empty chair, autogenic training, systematic desensitization and even family therapy, although many other effective interventions also exist for this stage. Myers suggests that the use of prolonged exposure may be helpful in the treatment of PTSD and may also be used to treat psychogenic seizures. At times, treatment will be more challenging depending on how many comorbid conditions are present.

In my experience, I have found that some clients will gain considerable control over their seizures before this final phase and will even opt out of this phase of treatment. As a client-centered clinician, I must respect a client’s choice to end therapy before this stage, although I always explain the potential benefits (and drawbacks) of engaging in this material.


As a clinician, I have found working with those suffering from PNES to be a very rewarding experience. It is a wonderful thing to watch these clients gain more confidence and hope as they slowly and methodically reduce their seizures and begin to regain what they lost while buried in the throes of their unfettered condition.

In their article “Psychogenic (non-epileptic) seizures: A guide for patients and families,” Selim Benbadis and Leanne Heriaud suggest that the competent treatment of PNES will result in the elimination of seizures in 60 to 70 percent of adults, and the results for children and adolescents may be even more impressive. The treatment of PNES is evolving as research continues. But the numerous empirically validated treatment options currently available to competent counselors can be just what PNES clients need to begin the journey of gaining hope and confidence, reducing seizure activity and taking back their lives from the grip of psychogenic seizures.




Jason Wright is a licensed professional counselor and licensed marriage and family therapist at the HumanKind Counseling Center in Lynchburg, Virginia. He holds a doctorate in counseling. Contact him at

Letters to the editor:

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines, sample articles and tips for getting published in Counseling Today, go to




Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.


  1. emily bennette

    I like that you pointed out that you need to think about reducing your stress if you are having neurological problems. It does seem like that would make your condition worse. It might be good to talk to your doctor about treatment options that are stress free.

  2. Peter

    Phenytoin helps control certain types of seizures such as complex partial seizures, grand mal seizures, and seizures that occur during or after brain surgery.

  3. Kelly

    I know a young man in Rutland, VT in desperate need of your help. He lost his job as an LNA last year after being diagnosed with PNES. He has had to be taken by ambulance to the local hospital multiple times this week. His seizures are growing in length and intensifying…

    1. Jason Wright

      Hi Kelly,

      There are therapists who treat the condition, but they are few and far between. The Northeast Regional Epilepsy Group maintains a referral registry of clinicians (by state) who treat the condition: Once there, click on “PNES Information,” and then “Referral Sites” in the drop down menu. If you have any other questions you may reach me at my e-mail address above.

      Jason Wright

  4. John Anderson

    Dr. Jason Wright,
    My wife was recently been diagnosed with PNES and it has been exactly as you described in your opening statements of this article. As we are working through this we are struggling to find a clinician of your mindset anywhere near us. We live in northern Utah near the Idaho border. I searched for clinicians near me and there isn’t one listed in our state or any of the neighboring states. What avenue would you recommend?

    1. Counseling Today

      Hello John, The author’s email is listed at the bottom of this article — feel free to reach out to him directly.

    2. Mariah Arnett

      John Anderson,
      Have you found any drs locally that have provided any help? We are in Ogden and desperate for help for my 16 year old who is struggling with PNES. Drs are turning us away. ERs are no help and send her home. Her neurologist hasn’t been helpful. We are lost and cannot find any relief.

  5. Sandy

    I wish I could find a someone in the Charlotte, NC area. I went to see someone and he was a good Christian counselor. I had seen him for 6 weeks and although we did discuss some stresses and other items in my life, I asked him if he could tell me how to deal with these issues. I never got an answer so decided not to go to anymore sessions, I was paying cash and it seemed to be a waste of money and time. If you are aware of a clinic or individual counselor working in Charlotte or Mount Holly area and it would be helpful.

    1. Anne Spalding


      Were you able to find someone to help you? I live in that area and just had what I believe was a PNES episode, with ER visit and cardiologist visit. I’m seeking someone to talk to and work with.

  6. sharon bojan

    I am in desperate need for help. My 13 year old daughter recently was diagnosed with PNES. We need to find treatment. She spent 4 days at a hospital , having several episodes, but the EEG showed no brain abnormalities. We cant believe this came out of nowhere and are lost on what to do next. There are few Drs. In the Chicago area that work with PNES and all have waiting lists. She can not go to school until we get them under control. If anyone can help with information , or lead us in the right direction, I would be so grateful.

    1. Janet Roe

      I too live in NC near Greensboro and Winston Salem but find no doctors specializing in PNES. Have you had any success finding anyone in Charlotte?

    2. Vicki M.

      Hello, I am also in NC. My daughter recently had her third grand-mal seizure within a 16 month time period. I feel very confident it is PNES rather than Epilepsy, but have had to put her on Keppra and she is not allowed to drive. She is 22 and all three seizures have followed very stressful life events. We are setting an appointment up with the Center for Integrated Medicine through Wake Forest. They appear to take a holistic approach to treating various disorders, and have a neurologist, psychiatrist and nutritionist within the group, as well as alternative treatments such as acupuncture, mind/body .therapies and pain management. I feel hopeful they might be able to help.

    3. Candy Adams

      Hi Sharon,

      My 16 year old niece was recently diagnosed with PNES. How is your daughter? What was her treatment plan?

      Thank you,

    4. Julie Perry

      Have you found anyone in Chicago yet? My daughter has had it for 1,1/2 years. Love sone help for her.

  7. Christina

    My son needs help.
    He has lived with PNES for too long he is now 17yo and we are in California.
    Southern California
    He went threw a program called MEND and it wasn’t really useful after all the money we spent..
    Please help

    1. A.E.

      I can recommend a therapist in SoCal, in Encinitas CA:
      The Lang Center for Somatic Psychotherapy
      Encinitas, California 92024
      (505) 395-5542

  8. Tiffany

    PNES is terrible! It all started one day I was 32 and I just couldn’t think straight or remember much.. I was forgetting to pump gas after I paid.. stuff like that! Then the blackouts started and then the seizures, oh the seizures! Multiple times daily I was falling down I was busting my face & being a danger to myself. Then there was no driving, then my drs took me out of work, which meant no $$$) I was diagnosed with PNES and then the neurologist says u don’t have seizures you can go back to work just take a break when you seize and then start again!! I’m a nurse could you imagine this?? No one here specializes,no one will medicate properly, nothing.. SSI says nope, it continues. They did find an angioma said it’s nothing.. the hallucinations, black outs & seizures just come and come!! That’s life with PNES.

  9. Christina Garcia

    Looking for help in san Bernardino county in southern California. Help for my 18yo son. Please not the mend program at lomalinda. We did that course and it didnt help him much

  10. Christina Garcia

    I need help for my 18yo son that has suffered over 10yrs with this stupid illnesse!
    We are in san Bernardino county in the high desert and have no leads on anyone near that will help him.. Please

  11. Aimee

    After 20 years of being treated for epilepsy, the last 8 of which were seizure free, I was diagnosed with PNES. Since October I have lost the ability to drive, independence, had to have my parents move in to help, and just recently lost my job. I was HAPPY and relatively successful in my life at the time this all started again. Add to this all, the fact that I love in a very small town with a lack of councilling options and I feel utterly hopeless. Reading up on all of this isnt helping me get to the bottom of why my body has turned on me. I have had a lot of trauma but have always just dealt with it and moved on. I’m not sure what else I should have been doing.

    1. Cleo

      Hi. I’m sorry to hear about your situation. Have you had your hormones thoroughly checked? I have focal seizures and tonic seizures on waking. But I also once had a diagnosis of reflex epilepsy, vision. When new neurologists did eeg when I felt I was struggling with them again, it came back normal. They wanted to send me to a psychiatrist for sexual abuse. I’ve never been sexually abused. a year later, I had another attack, only worse. I went to emergency room. Found out I had had narrow angle glaucuma all those years and I almost lost my vision in the one eye. Two laser surgeries later and no more photosensitivity. Epilepsy specialists have become arrogant and lazy. They didn’t even consider looking for a physical cause. Make sure you are well checked out. I have a very low cortisol level because my body does not produce enough ACTH. I’m not saying this is what is going on, but the body can effect the brain as much as brain effects body. And, just saying, I’m sick and tired of neurologists standing around and arguing about my diagnosis in front of me as if I’m not there. They have become dehumanising.

  12. jennifer

    Would you be able to tell me of any places that do this in Maryland? Please e-mail me, if you can. Thank you.

    1. Counseling Today

      Hello Jennifer, the author’s email is listed at the bottom of the article — feel free to reach out to him directly. Also, see the comment (above) that he left on June 5, 2017, which gives a link to referral registry of clinicians.

  13. Penny

    My 15 year old daughter was recently diagnosed with PNES. After reading and doing a lot of research on my own I am very thankful that it only took us a few months to go from the diagnoses of epilepsy to PNES. The problem is that now that we have the diagnoses there are very few resources to get her the help she needs. Also there is such a lack of education about this that everyday life becomes so difficult for the entire family. The past year we have had numerous ambulance rides, visits to the emergency room and so many test. I need a resource when it comes to dealing with the school and her education. When a child has PNES they are often dismissed and treated as more of a nuisance than a person. My daughter suffers from seizures almost daily and we are navigating our way thru treatment but I want to educate people about PNES so that someone else’s child does not have to go thru what my child has dealt with. My daughter is a strong 15 year old and everyday I am thankful for that because if she was anything but strong I think the response she receives when she explains what is happening to her would have broke her. We need to focus on getting the awareness out there and find the materials to help people understand what PNES is. Also we need a clear path for treatment so that time is not wasted on things that are not helpful.

  14. David Evans

    I have some suggestions that I highly recommend

    Avoid alcohol
    Avoid processed food
    Avoid gluten
    Avoid preservatives
    Avoid foods containing excitotoxins
    Avoid dehydration
    Limit caffeine intake
    Identify and avoid stressful situations
    Avoid trying to solve this problem inside your head. It only leads to habitual, negative, destructive, complex thought patterns that are counter-productive. If you catch yourself doing this stop it immediately.
    Mindfulness meditation
    Progressive muscle relaxation
    Deep tissue remedial massage therapy
    Om chanting
    Have tests performed on PNES biomarkers
    Sleep therapy

    Best wishes :)

  15. Vivian McCurley

    My trauma happened at 21, many years of therapy and medications later my bodies coping mechanism is breaking down, After a stay hooked up to an EEG monitoring unit for my seizures, it’s verified that their all in “my head, and I’m not making them up” well, of course I’m not! With that being said, my next plan of action is EMDR, this is supposed to have a high success rate. Today I have to give notice to my employer, give my drivers license up, stop taking baths and get good massage oil for after the seizure muscle pain. But what I don’t have to do is give up.

  16. Cleo

    I’ve had three abnormal eegs. Seizures became worse after flu. Went for eeg. They said it was normal and I probably need to see a psychiatrist because I might have been sexually abused. I wasn’t. A year later, I had photosensitive seizure but my vision was dark and the pain was bad. Went to er. Short story. I have narrow angle glaucuma and had for years. I almost lost my vision in one eye. My photosensitive seizures ended. The point is, when you are seeing neurology symptoms but no abnormal eegs, don’t send person to psychiatrist. Be a doctor and run some tests. Not only were the neurologists arrogant, but they almost cost me my sight and caused emotional pain by the things they said to me.

Comments are closed.