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Zahedan J Res Med Sci. 2018 December; 20(12):e68475. doi: 10.5812/zjrms.68475.

Published online 2018 December 26. Research Article

Comparison of Alexithymia, Perceived Stress and Emotion Regulation


Between Patients with Epileptic and Non-Epileptic Seizures
Mitra Mirlohian 1 and Sayed Abbas Haghayegh 2, *

1
M.A. of Clinical Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran
2
Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran
*
Corresponding author: Assistant Professor of Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran. Tel: +98-3142293030, Email:
abbas.haghayegh@gmail.com

Received 2018 March 10; Revised 2018 September 13; Accepted 2018 November 12.

Abstract

Background: Different psychological factors may explain the differences between epileptic and non-epileptic seizures. Accordingly,
the present study was conducted to compare alexithymia, perceived stress, and emotion regulation between patients with epileptic
and non-epileptic seizures.
Methods: In the present cross-sectional research, 82 patients (39 with epileptic seizures and 43 with non-epileptic seizures) were
selected. Using the Toronto Alexithymia Scale (TAS) (Bagby et al., 1994), Perceived Stress Scale (PSS) (Cohen et al., 1983) and cognitive
emotion regulation questionnaire (CERQ) (Garnefski and Kraaij, 2006), the required data were collected and then analyzed using
the SPSS-19 software.
Results: According to the results, patients with non-epileptic seizures had significantly higher scores in TAS, especially in the sub-
scales of difficulty identifying feelings and externally oriented thinking, PSS and CERQ, especially in the subscales of catastrophizing
and other-blame and lower scores in CERQ’s subscales of acceptance, positive reappraisal, and positive refocusing compared to pa-
tients with epileptic seizures (P < 0.05). The non-epileptic seizure group score was higher in the event acceptance subscale (as a
positive emotion regulation) (P < 0.05).
Conclusions: The results of this study showed that patients with epileptic seizures have a more favorable condition in terms of
alexithymia, emotion regulation, and perceived stress compared to those with non-epileptic seizures.

Keywords: Epileptic Seizure, Non-Epileptic Seizure, Alexithymia, Perceived Stress, Emotion Regulation

1. Background mal electrical discharge. Non-epileptic seizures create se-


rious problems for physicians in the treatment of patients
Seizure is an attack phenomenon, which occurs due (3).
to abnormal, severe, and synchronized discharges of a set
of neurons in the central nervous system. Seizures can Differentiating non-epileptic seizures from epileptic
have epileptic or non-epileptic causes. Epileptic seizure seizures is a major diagnostic challenge for clinicians and
is transient changes in brain function due to excessive the rate of misdiagnosis is up to 20% to 30% (4). Misdi-
and hyper-synchronous nervous activity that may lead to agnosis of non-epileptic seizures with epileptic seizures
uncontrolled body movements or changes in the level of often leads to unnecessary interventions and treatment
consciousness. Epileptic seizures occur due to excessive with antiepileptic drugs with negative consequences (5).
and abnormal cell activity of cortical neurons in the brain Chronic non-epileptic seizures are a challenge in epilepsy
membrane (1). Unpredictability and the chronic nature of diagnosis (6). The results show that the accuracy of correct
this disease can influence physical, psychological, and so- diagnosis between these two types of epilepsy depends
cial functioning of the patient (2). Non-epileptic seizures on the experience of professionals (7-9). Brown and Reu-
may occur as a result of changes in the electrical activity ber found that non-epileptic seizures do not have a brain
of the brain, yet this electrical disturbance is not of epilep- cause and are physiological or psychological, and the pa-
tic seizure type (1). Uliaszek et al. have acknowledged that tient’s personality traits affect response to treatment and
non-epileptic seizures are similar to epilepsy in terms of the number of seizures (10). In a study aiming at evaluat-
appearance yet are not accompanied by the brain’s abnor- ing the efficacy of psychological disorders in management

Copyright © 2018, Zahedan Journal of Research in Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons
Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in
noncommercial usages, provided the original work is properly cited.
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Mirlohian M and Haghayegh SA

of non-epileptic seizures it was revealed that 47% of people seizures and 16% and 13% in those with epileptic seizures,
with epilepsy also suffer from other psychiatric disorders, respectively (19).
and results of 10 other studies showed that 82% of peo- Emotion regulation is defined as strategies to repre-
ple, who completed treatment in psychology, had a seizure sent individual ways of dealing with stressful situations
reduction of 50% (11). A study from France showed that and events (20). Research findings by Baslet et al. (21),
people with psychological disorders had a higher rate of Quinn et al. (22), found that psychological non-epileptic
seizure decline (82%) and freedom from seizures (47%) in seizure is accompanied by problems, such as excessive
non-epileptic seizure compared with those, who did not arousal and unexpected experiences of need for indepen-
have psychological disorders (9). dence and avoidance.
Alexithymia is a multidimensional problem in diffi- Although comparison of the psychological indices be-
culty in identifying feelings and distinguishing physical tween epileptic and non-epileptic seizures has been an im-
feelings of emotional arousal, which refers to reduced abil- portant research topic in the field of epilepsy, research is
ity to identify and diagnose emotions (12). Laurie et al. limited in this regard. Besides, sometimes there are limita-
(2015) in a research entitled ‘quality of life, physical role tions in studies that have been done in this field. For exam-
and alexithymia in two groups of patients with epileptic ple, findings by Urbanek et al. showed that patients with
seizures and non-epileptic seizure’, showed that patients non-epileptic seizures earn higher scores on alexithymia
with non-epileptic seizures had significantly lower alex- and this is due to poor understanding of negative emo-
ithymia compared to patients with epilepsy experience tions and beliefs about feelings. However, in this study, dif-
(13). Research results of Uliaszek et al. showed that patients ficulty in describing feelings, which is one of the subscales
with non-epileptic seizures had more difficulty to identify of this structure, has not been studied (15).
and describe their feelings as well as higher levels of con-
scious thoughts than the benchmark group. The level of 2. Objectives
alexithymia and negative beliefs of emotions in patients
with non-epileptic seizures was associated with the sever- This study was designed and carried out to compare
ity of seizure, reported by the patients (3). Alexithymia is a alexithymia, perceived stress, and bad emotional dysregu-
common problem in epilepsy (14). Poor understanding of lation in patients with non-epileptic seizures and epileptic
emotions and negative beliefs about emotions are two im- seizures.
portant predictors for non-epileptic seizures (15). Plug et al.
found that the metaphors used by patients with epileptic 3. Methods
seizures to describe their attacks were internal, describing
it as randomly happening, while people with non-epileptic 3.1. Population and Sample
seizures described these cases as the space or place, which In terms of purpose, this research project was catego-
were used (16). rized as a comparative research. It should be noted that
Stress is a circular sequence that begins with an initial in this study, dependent variables consisted of emotional
assessment of the threat level and continues with the ef- collapse, perceived stress, and emotional ill-regulation.
fect of physiological and emotional changes (17). One of The independent variable was membership of individuals
the factors that can influence seizures, is the intensity of in epileptic or non-epileptic seizures. The study popula-
the stress perceived by the individual. Everyday stress and tion included all patients with a diagnosis of non-epileptic
crisis are threats of physical and mental health (18). Pa- seizures and epileptic seizures in specialized public and
tients with non-epileptic seizures often report more stress- private clinics of neurology, during years 2015 to 2016
ful and disturbing experiences as compared to the con- in Isfahan. Firstly, with coordination of a neurology ex-
trol group and use less efficient use of coping strategies pert from a private hospital and a public policlinic, us-
(17). Severe psychological trauma during childhood and ing convenience sampling, two groups of epileptic and
the associated stress is more common in people with non- non-epileptic seizure (n = 50) were selected; according to
epileptic seizures compared to the general population (16). analysis of variances, 30 subjects were necessary in each
The findings by Novakova et al. showed that anxiety (a con- groups and according to probable drop-out and decree of
struct close to stress) is a unique predictor of depression power estimation, 50 participants selected for each group.
in patients with non-epileptic seizures. The statistical re- The participants, who had the research inclusion criteria
sults (after controlling for all variables) showed depression from 10th March 2015 to 10th August 2016, and criteria for
as 45% and anxiety as 60% in patients with non-epileptic diagnosis and discrimination of these two seizures, were

2 Zahedan J Res Med Sci. 2018; 20(12):e68475.


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Mirlohian M and Haghayegh SA

checked symptoms (such as eyes’ cornea twisting, having 3.2.3. Cognitive Emotion Regulation Questionnaire
froth in the mouth, spastic, tonic and colonic movements, This questionnaire is a self-report questionnaire de-
EEG results, and prolactin levels measurement test, mea- signed in 1999 by Garnefski et al. and it was published in
sured 20 minutes after the seizure). In addition, risk of low 2001. The questionnaire is based on theoretical and prac-
blood sugar or syncope should be eliminated. Form of con- tical constructs. In this questionnaire, strategies of self-
sent to participate in the research was given to the partici- blaming, blaming others, rumination and catastrophiz-
pants, and they were provided with the relevant question- ing are regarded as negative emotion regulation strategies
naire. Due to sample loss (failure to answer or not answer- and strategies of acceptance, renewed attention to plan-
ing the questionnaire), the final sample was reduced to ning, positive re-evaluation, positive reassessment, and
39 cases of epileptic seizures and 43 cases of non-epileptic adopting a perspective are positive emotion regulation
seizures. The study inclusion criteria included providing strategies. Internal reliability of the Persian version was
an informed consent to participate in the research and ed- validated using Cronbach’s alpha for positive strategies
ucational level of above secondary school, and the exclu- and negative strategies as 0.91 and 0.87, and it was calcu-
sion criteria were not responding to more than 5% of ques- lated as 0.93 for the total inventory (26).
tions per questionnaire.
3.3. Procedure
After approval of proposal for implementing the re-
3.2. Instruments
search in the institute, two groups of epileptic and non-
3.2.1. Alexithymia Questionnaire epileptic seizure (n = 50) that qualified for inclusion cri-
This questionnaire was developed by Taylor in 1986 teria were selected. The questionnaire booklet (includ-
and in 1994 it was revised by Bagby et al. The question- ing research purpose and how to respond to the question-
naire includes 20 items in three subscales, including dif- naire) was prepared and patients were asked to complete
ficulty identifying feelings (DIF), difficulty describing feel- the questionnaires up to ten days and return them to the
ings (DDF), and externality-oriented thinking (EOT). To secretary at the health center. After collecting the data, and
check the reliability of this scale, Cronbach’s alpha for the finally scoring on the basis of the scoring instruction of
total scale (α) was obtained as 0.81, and for the three com- the questionnaire, data was compiled in the statistical soft-
ponents, it was calculated as 1 = 0.78, 2 = 0.75, and 3 = ware.
0.66. For determining validity of the scale, its correla-
3.4. Statistical Analysis
tion with the stress questionnaire was calculated as 0.23.
The Farsi version was validated by Pourhosein et al. Cron- Data obtained from the research were analyzed using
bach’s alpha coefficient for TAS-20 score, difficulty identi- SPSS-19 software by descriptive statistics and inferential
fying feelings, difficulty describing feelings, and thoughts analysis (after study of normality and equality of variances
with externality-oriented thinking was obtained as 0.83, presumptions), including MANOVA. Since the purpose of
0.80, 0.73, and 0.71, respectively. The retest reliability for this study was to examine three dependent variables and
the total score was 0.79 and it was obtained between 0.62 two independent variables, the ‘MANOVA’ method was
and 0.79 and for the three sub-scales (23). used, because in the multivariable variance analysis, two
or more dependent variables are assessed by one or more
independent categorical variables.
3.2.2. Perceived Stress Scale
This scale was developed in 1983 by Cohen et al. and
4. Results
has three versions 4-10-14, which is used to measure general
perceived stress in the past month. It measures thoughts Demographic characteristics and descriptive indexes
and feelings about stressful events, control, domination, are given in Table 1. The mean and standard deviation of
and coping with experienced stress. A higher score shows age were 36/05 ± 10.22 for epileptic and 34.81 ± 12.9 for non-
greater perceived stress. Cronbach’s alpha coefficient for epileptic groups. Also, the mean and standard deviation of
this scale was calculated as 0.74. In order to calculate the disease duration were computed as 8.23 ± 2.75 for epileptic
validity of the scale, its correlation coefficient was calcu- and 7.20 ± 2.79 for non-epileptic participants.
lated with semiotic sizes as between 0.52 to 0.76. In the val- As the results of Table 2 show, most means of compo-
idated Persian version, Cronbach’s alpha was calculated as nents of Alexithymia, negative regulation, and perceived
0.81 (24). Content validity of this questionnaire was veri- stress of non-epileptic group were lower than epileptic
fied by 10 experts (25). cases.

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Mirlohian M and Haghayegh SA

Table 1. Frequency and Percentage of Demographic Characteristics of Participantsa Table 2. Mean and Standard Deviation of Variables Among the Two Groups
Variable Epileptic Non-Epileptic Variables Mean ± SD Min Max
Gender Component of Alexithymia
Male 21 (53.8) 13 (30.2) Difficulty identifying feelings
Female 18 (46.2) 30 (69.8) Epileptic 17.12 ± 2.75 13 23
Educational level Non-epileptic 30.32 ± 3.24 16 35
Below high school 19 (48.7) 11 (25.6) Difficulty describing feelings
Diploma 18 (46.2) 23 (53.5) Epileptic 13.79 ± 3.41 10 19
Bachelor and 2 (5.1) 9 (20.9) Non-epileptic 12.39 ± 1.62 10 16
higher
Externality-oriented thinking
Marital status
Epileptic 21.33 ± 2.22 19 28
Single 16 (41) 19 (44.2)
Non-epileptic 25.93 ± 4.69 20 33
Married 21 (53.8) 22 (51.2)
Total alexithymia
Widow 2 (5.1) 2 (4.7)
Epileptic 52.25 ± 5.17 43 62
Economic status
Low 34 (87.2) 36 (85.4) Non-epileptic 68.65 ± 5.95 52 80

Moderate 5 (12.8) 7 (14.6) Emotional dysregulation (positive)

High 0 (0) 0 (0) Event acceptance

Employment status Epileptic 8.20 ± 1.82 6 11

Employed 23 (59) 22 (51.2) Non-epileptic 12.02 ± 3.18 8 19

Unemployed 16 (41) 21 (48.8) Positive re-evaluation


Epileptic 10.64 ± 3.17 6 14
Family history
Non-epileptic 10.88 ± 2.45 7 15
Yes 19 (7) 20 (51.3)
Renewed attention to planning
No 48.7 (16.3) 36 (83.7)
a
Epileptic 10.79 ± 2.35 7 14
Values are expressed as frequency (%).
Non-epileptic 10.81 ± 2.72 8 19
Positive reassessment
Epileptic 10.28 ± 2.45 6 13
4.1. Statistical Assumptions
Non-epileptic 7.65 ± 51.98 5 14
One of the assumptions of using parametric tests is Adopting perspective

the normality of scores distribution. In this research, the Epileptic 10.33 ± 1.95 7 13

Kolmogorov-Smirnov test was used to test this hypothe- Non-epileptic 7.30 ± 3.00 4 14

sis. The hypothesis for normality of scores distribution re- Dysregulation (positive)

mains in all research variables and all groups, that is the Epileptic 50.25 ± 7.05 34 63

distribution of sample grades is normal and similar to the Non-epileptic 48.67 ± 6.77 36 62
Emotional
society, and deviation and skewness are accidental (all sig-
Self-blaming
nificant levels are greater than 0.05). Also, the assumption
Epileptic 10.51 ± 1.65 8 13
of the equality of scores variances in several groups was ap-
Non-epileptic 9.69 ± 3.71 4 15
proved for the research measures. Based on the assump-
Dysregulation (negative)
tion approval for normality and equality of variances, anal-
Rumination
ysis of variances was used to obtain inferential results. Epileptic 12.92 ± 1.93 10 15
As observed in Table 3, significance levels suggest that Non-epileptic 13.55 ± 2.59 10 18
there was a significant difference between the two groups Catastrophizing
of participants in terms of Alexithymia (P < 0.05). Thus, it Epileptic 9.02 ± 1.30 7 11
was concluded that there was a difference between epilep- Non- epileptic 13.97 ± 2.07 10 17
tic and non-epileptic people, who were different in terms Blaming others

of alexithymia. According to the mean, it can be noted Epileptic 6.89 ± 1.39 5 9

that alexithymia was higher in non-epileptic people com- Non-epileptic 14.30 ± 3.36 8 19

pared to participants with epilepsy. Also, significance lev- Emotional dysregulation (negative)

els denote that there was a significant difference between Epileptic 39.35 ± 3.37 32 46

epileptic and non-epileptic groups in terms of perceived Non-epileptic 51.37 ± 5.41 40 63


Perceived stress
stress (P < 0.05). Thus, it was found that there is a differ-
Epileptic 32.35 ± 7.12 21 46
ence between epileptic and non-epileptic people in terms
Non-epileptic 40.48 ± 5.50 24 48

4 Zahedan J Res Med Sci. 2018; 20(12):e68475.


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Mirlohian M and Haghayegh SA

of perceived stress. According to the mean, it can be noted (29). When emotional information cannot be perceived
that perceived stress is higher in non-epileptic participants and evaluated in cognitive and perceptual processing, peo-
compared to epileptic participants. ple develop emotional and cognitive confusion and this
helplessness and inability disturbs organization of their
emotions and cognitions. These people are unable to iden-
5. Discussion
tify, perceive or describe their emotions due to lack of emo-
tional awareness and inability in cognitive processing of
The current study aimed at comparing alexithymia,
their emotions. If these emotions are not discharged and
perceived stress, and emotional dysregulation in epileptic
one cannot verbally express negative emotions, negative
and non-epileptic individuals.
psychological symptoms, such as depression and anxiety
The research findings showed that there is a significant
increase. People, who have the ability to recognize their
difference between scores of alexithymia and two com-
own feelings and emotional states effectively can better
ponents of difficulty identifying feeling and externality-
face life problems and they are more successful in compat-
oriented thinking in the two groups. Results corresponded
ibility with the environment and others, and as a result,
with Myers et al. they investigated the prevalence of alex-
these people have better mental health. Patients with alex-
ithymia in epileptic and non-epileptic seizures and predic-
ithymia have undifferentiated emotions and feelings asso-
tion of non-epileptic seizures, and showed that the men-
ciated with physiological arousal.
tal damage and pessimism in patients with non-epileptic
seizure are accompanied by alexithymia (27). The findings Research findings showed there is a significant differ-
of this study are consistent with the above research. Fur- ence between the two groups in terms of perceived stress,
thermore, a research by Davoodi and Afshari found that so that perceived stress was higher in non-epileptic pa-
high neuroticism and openness to experience and agree- tients than epileptic patients. These findings are consis-
ableness had a meaningful relationship with alexithymia, tent with the findings of Myers et al. (17). A study by My-
yet extraversion and conscientiousness was not relevant in ers et al. titled “Stress coping strategies in patients with
anticipation of alexithymia. Therefore, personality traits psychogenic non-epileptic seizures and how they relate to
can predict alexithymic characteristics in individuals (28). trauma symptoms, alexithymia, anger, and mood” showed
Another study by Baghian et al. (2014) showed a negative that these patients use emotion-focused strategies to deal
relationship between alexithymia and MS patients’ gen- with stress, which is successful in the short-term and focus
eral health; a higher the level of alexithymia in a patient on emotions rather than assessing and solving the prob-
was associated with lower general health. Research results lems; also, stress levels rise because of their alexithymia
of Isazadegan et al. suggested that there is a connection be- and cognitive distortions. Moreover, an investigation by
tween all alexithymia factors and mental health and its as- Shokouhi et al. stated that there is a meaningfully higher
pects. Studies suggest that alexithymia is associated with perceived stress in individuals with external attribution
some physical illnesses, such as pain, bladder inflamma- in different situations. Also, there is a difference in per-
tion, diabetes, hypertension, and heart diseases. Dubey ceived stress between individuals with uncontrollable at-
et al. believed that alexithymia is a risk factor for many tribution and those with controllable attribution in over-
psychiatric disorders because patients with this condition all, negative, and personal situations, which is higher in
show strong physical-emotional correlations. This impair- those with uncontrollable attribution (26).
ment prevents the adjustment of emotions, making it diffi- Stress acts as a chain sequence and it is created in the
cult to successfully adapt (29). However, this study showed individual in the initial evaluation of threat and continues
that individuals with non-epileptic seizures scored higher with physical and mental effects. Thus, it can be stated that
in having difficulty recognizing emotions and thinking since there is no brain cause in patients with non-epileptic
with an external orientation, and it was notable that the seizure, and one experiences seizure due to stressful situa-
overall score in non-epileptic seizure patients was higher tions or traumas, patients with non-epileptic seizure have
than those with epileptic seizures. more stress compared to patients with epileptic seizure.
These findings are indirectly consistent with the find- Given that external factors cause stress in individuals, and
ings of Myers et al. on accompaniment of trauma and since the reason for seizure in patients with non-epileptic
cynicism in patients with non-epileptic seizures and alex- seizure is not brain causes, thus, the number of seizures
ithymia (27). Dubey et al. believed that alexithymia is a in people with non-epileptic seizures is higher than those
risk factor for several psychiatric disorders, because people with epileptic seizures. People with non-epileptic seizures
with this problem cannot express their physical sensations do not want to experience seizure, thus, they avoid stress

Zahedan J Res Med Sci. 2018; 20(12):e68475. 5


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Mirlohian M and Haghayegh SA

Table 3. Results of Multivariate Analysis of Variances of Variables Among the Two Groups

Research variable Sum of Squares Degree of Freedom Mean of Squares F P Value Eta Square Statistical Power
a
Alexithymia 549.041 1 549.041 175.400 0.005 0.687 0.99

Difficulty identifying feelings 3562.004 1 3562.004 390.463 0.005a 0.830 0.99


a
Difficulty describing feelings 40.057 1 40.057 5.799 0.018 0.068 0.662

Externality-oriented thinking 432.165 1 432.165 30.955 0.005a 0.279 0.99


a
Perceived stress 1351.562 1 1351.562 33.771 0.005 0.297 0.99
a
Event acceptance 298.140 1 298.140 43.261 0.005 0.351 0.99

Positive reevaluation 1.205 1 1.205 0.152 0.698 0.002 0.067

Renewed attention to planning 0.007 1 0.007 0.001 0.973 0.00 0.050

Positive reassessment 141.555 1 141.555 28.621 0.005a 0.263 0.99


a
Adopting perspective 187.886 1 187.886 28.699 0.005 0.264 0.99

Negative emotional dysregulation 2951.418 1 2951/418 141.979 0.005a 0.640 0.99

Self-blaming 13.589 1 13.589 1.592 0.211 0.020 0.239

Rumination 8.248 1 8.248 1.551 0.217 0.016 0.234

Catastrophizing 501.329 1 501.329 163.510 0.005a 0.671 0.99


a
Blaming others 1121.389 1 1121.389 163.510 0.005 0.671 0.99
a
P < 0.05.

and since they are not able to cope with the source of stress, in mutuality with the family, peers, and community, it is
they tolerate more stress and are caught by seizure, and ex- plausible to think that the intervention was able to correct
perience higher frequency of seizures. their communication network.

People with epileptic seizures, since in all situations,


The results of this research showed that there are sig-
even situations without stress, constantly monitor their
nificant differences in terms of event acceptance, positive
behavior to correct their behavioral manifestations at
reassessment, adopting perspective, negative emotional
the time of excitement, they are more successful in pos-
dysregulation, catastrophizing, and blaming others in the
itive emotion regulation than those with non-epileptic
two groups. In addition, findings of the current work
seizures. Noting that emotions occur before behaviors and
showed that total score in positive emotion regulation in
the individual’s adaptation to the requirements of phys-
patients with epileptic seizure was higher and people with
ical and social environments are optimized, people with
non-epileptic seizure gained higher score in event accep-
non-epileptic seizures experience more negative emotions
tance component. Shepherd and Wild stated that people,
during the day because they do not have the ability to reg-
who have higher physiological arousal, have fewer nega-
ulate their emotions effectively and this leads to a decrease
tive emotions and people, who express or receive more
in mental health in these people.
negative emotions are less likely to use cognitive strate-
gies (30). There is indirect compliance between this study’s Overall, the results indicated that people with non-
findings and those of Argyle (31); in their study, teaching epileptic seizures compared with those with epileptic
emotion control and correct methods for expressing those seizures are more unfavorable in terms of psychological
emotions, proper ways to deal with problems and events, factors. These findings help mental health experts, includ-
and learning the right way to communicate with individ- ing psychologists and psychiatrists to promote individ-
uals, helped patients improve their relationship with oth- ual health by identifying factors affecting seizure. Also,
ers. Also considering these trainings and altering their in- it is suggested that people with seizure should partici-
terpretation to a more logical one, they obtained a better pate in educational workshops for training emotion reg-
view of the events and this positive attitude led to fewer ulation and training improvement of individual percep-
difficulties in their relationships with others. Considering tion of stressful situations so that they have less number
problems of these patients in the field of personal relation- and duration of seizures. Limited study sample and having
ships and given the fact that the connection is systemic and physically undesirable people in the study were the limita-

6 Zahedan J Res Med Sci. 2018; 20(12):e68475.


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Mirlohian M and Haghayegh SA

tions of this study. Conducting research in a wider range Funding/Support: No funding.


(of the sample) and comparing between other psycholog-
ical variables, such as personality characteristics, is pro-
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formed the statistics analysis, drafted and revised the
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Conflict of Interests: No conflict of interest for the au-
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thors. 16. Kaplan MJ, Dwivedi AK, Privitera MD, Isaacs K, Hughes C, Bowman M.
Ethical Considerations: This article was extracted from Comparisons of childhood trauma, alexithymia, and defensive styles
in patients with psychogenic non-epileptic seizures vs. epilepsy:
a Master’s thesis with ethical considerations, and code
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15020701942062. The participants were fully aware of the Res. 2013;75(2):142–6. doi: 10.1016/j.jpsychores.2013.06.005. [PubMed:
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lowed to leave the project at any time.

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8 Zahedan J Res Med Sci. 2018; 20(12):e68475.


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