Evidence map›Paper›PMID 34196269›Full record

Trial reportHealth technology assessment (Winchester, England)2021

Cognitive-behavioural therapy compared with standardised medical care for adults with dissociative non-epileptic seizures: the CODES RCT.

Laura H Goldstein, Emily J Robinson, Izabela Pilecka, Iain Perdue, Iris Mosweu, Julie Read, Harriet Jordan, Matthew Wilkinson, Gregg Rawlings, Sarah J Feehan and 19 more

Registry-linked trialOpen access · diamondAbstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Health technology assessment (Winchester, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02325544 (COgnitive Behavioural Therapy Versus Standardised Medical Care for Adults With Dissociative Non-Epileptic Seizures), which is not on this map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
1.7field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02325544 nacompletednot on this map

COgnitive Behavioural Therapy Versus Standardised Medical Care for Adults With Dissociative Non-Epileptic Seizures: A Multicentre Randomised Controlled Trial (CODES)

TypeinterventionalSponsorKing's College LondonRan2014 to 2018Enrolled368ConditionsConvulsion, Nonepileptic, Conversion Disorder, Dissociative DisorderArmsCognitive Behavioral Therapy, Standardized Medical Care
3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 21 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. The economic burden of functional neurological disorder.Philosophical transactions of the Royal Society of London. Series B, Biological sciences · 2026
    Review
  5. Article
  6. The Journal of neuropsychiatry and clinical neurosciences · 2026
    Article
  7. Review
  8. Article
  9. Article
  10. Review
  11. The Financial Burden of Functional Neurological Disorders.Current neurology and neuroscience reports · 2023
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors at 10 institutions in 1 country.

Laura H GoldsteinDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0001-9387-3035
Emily J RobinsonDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0002-6692-5415
Izabela PileckaDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0001-7350-4873
Iain PerdueDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0002-8078-8146
Iris MosweuKing's Health Economics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.ORCID 0000-0001-6797-2478
Julie ReadDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0003-4450-4529
Harriet JordanDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0002-7268-7310
Matthew WilkinsonCanterbury Christ Church University, Salamons Institute for Applied Psychology, Tunbridge Wells, UK.ORCID 0000-0002-7309-2909
Gregg RawlingsSchool of Clinical Psychology, University of Sheffield, Sheffield, UK.ORCID 0000-0003-4962-3551
Sarah J FeehanDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0003-3986-2698
Hannah CallaghanDepartment of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.ORCID 0000-0002-4864-6666
Elana DayDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0002-7840-2320
James PurnellDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0003-2448-8824
Maria Baldellou LopezDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0003-0001-2573
Alice BrockingtonDepartment of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.ORCID 0000-0001-8469-9231
Christine BurnessThe Walton Centre NHS Trust, Liverpool, UK.ORCID 0000-0001-9062-0630
Norman A PooleDepartment of Neuropsychiatry, St George's Hospital, South West London and St George's NHS Mental Health NHS Trust, London, UK.ORCID 0000-0002-3187-6430
Carole EastwoodDepartment of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0002-8173-0376
Michele MooreCentre for Social Justice and Global Responsibility, School of Law and Social Sciences, London South Bank University, London, UK.ORCID 0000-0002-9686-1504
John Dc MellersSouth London and Maudsley NHS Foundation Trust, London, UK.ORCID 0000-0002-1253-2835
Jon StoneDepartment of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.ORCID 0000-0001-9829-8092
Alan CarsonDepartment of Clinical Neuroscience, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.ORCID 0000-0002-7425-0964
Nick MedfordSouth London and Maudsley NHS Foundation Trust, London, UK.ORCID 0000-0001-6739-6001
Markus ReuberAcademic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK.ORCID 0000-0002-4104-6705
Paul McCroneKing's Health Economics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.ORCID 0000-0001-7001-4502
Joanna MurrayDepartment of Health Services & Population Research, Institute of Psychiatry,Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0002-7348-7505
Mark P RichardsonDepartment of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0001-8925-3140
Sabine LandauDepartment of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0002-3615-8075
Trudie ChalderDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.ORCID 0000-0003-0775-1045
King's College London · GBUniversity of Edinburgh · GBSouth London and Maudsley NHS Foundation Trust · GBCanterbury Christ Church University · GBLondon South Bank University · GBRoyal Hallamshire Hospital · GBSheffield Teaching Hospitals NHS Foundation Trust · GBSt George's Hospital · GBUniversity of Liverpool · GBUniversity of Sheffield · GB

Funding

Department of Health
6 · The paper itself

Abstract

backgroundDissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited.

objectivesTo evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive-behavioural therapy for adults with dissociative seizures.

designThis was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial.

settingThis took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive-behavioural therapy services.

participantsAdults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017.

interventionsStandardised medical care consisted of input from neurologists and psychiatrists who were given guidance regarding diagnosis delivery and management; they provided patients with information booklets. The intervention consisted of 12 dissociative seizure-specific cognitive-behavioural therapy 1-hour sessions (plus one booster session) that were delivered by trained therapists, in addition to standardised medical care.

main outcome measuresThe primary outcome was monthly seizure frequency at 12 months post randomisation. The secondary outcomes were aspects of seizure occurrence, quality of life, mood, anxiety, distress, symptoms, psychosocial functioning, clinical global change, satisfaction with treatment, quality-adjusted life-years, costs and cost-effectiveness.

resultsIn total, 698 patients were screened and 368 were randomised (standardised medical care alone, LIMITATIONS: Unlike outcome assessors, participants and clinicians were not blinded to the interventions.

conclusionsThere was no significant additional benefit of dissociative seizure-specific cognitive-behavioural therapy in reducing dissociative seizure frequency, and cost-effectiveness over standardised medical care was low. However, this large, adequately powered, multicentre randomised controlled trial highlights benefits of adjunctive dissociative seizure-specific cognitive-behavioural therapy for several clinical outcomes, with no evidence of greater harm from dissociative seizure-specific cognitive-behavioural therapy. FUTURE WORK: Examination of moderators and mediators of outcome.

trial registrationCurrent Controlled Trials ISRCTN05681227 and ClinicalTrials.gov NCT02325544.

fundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in

Indexed as

Cognitive Behavioral TherapyQuality of LifeAdultCost-Benefit AnalysisHumansQuality-Adjusted Life YearsSeizuresTreatment OutcomeCOGNITIVE–BEHAVIOURAL THERAPYCONVERSION DISORDERCOST–BENEFITS ANALYSISDISSOCIATIVE DISORDERSEPILEPSYMEDICALLY UNEXPLAINED SYMPTOMSNEUROLOGYNEUROPSYCHIATRYNON-EPILEPTIC SEIZURESQUALITATIVE RESEARCHQUALITY-ADJUSTED LIFE-YEARSQUALITY OF LIFERANDOMISED CONTROLLED TRIALSEIZURESTHERAPEUTIC ALLIANCE

Identifiers

PMID34196269
PMCPMC8273679
OpenAlexW3175563503

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.