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This three-arm randomized trial evaluated Re-PROGRAM, a 5-session internet-based intervention combining lifestyle factors, seizure management techniques and elements of cognitive behavioural, acceptance and commitment, and dialectical behaviour therapy, in adults with functional seizures. A total of 107 participants were randomized 1:1:1 to the self-guided intervention, the therapist-guided intervention or standard care, with 96 included in the full analysis. Compared with standard care, the self-guided arm reduced monthly seizure frequency overall (rate ratio 0.35, 95% CI 0.18–0.69; P=0.006), with sustained effects at 6 weeks (RR 0.37), 6 months (RR 0.31) and 12 months (RR 0.35). The therapist-guided arm did not achieve a significant reduction in seizures, and the two active arms did not differ significantly (RR 0.67, 95% CI 0.33–1.36). The self-guided arm also improved anxiety at all time points. No adverse events occurred in any arm. The program may offer a scalable option where specialist psychological care is unavailable.
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This three-arm randomized trial evaluated Re-PROGRAM, a 5-session internet-based intervention combining lifestyle factors, seizure management techniques and elements of cognitive behavioural, acceptance and commitment, and dialectical behaviour therapy, in adults with functional seizures. A total of 107 participants were randomized 1:1:1 to the self-guided intervention, the therapist-guided intervention or standard care, with 96 included in the full analysis. Compared with standard care, the self-guided arm reduced monthly seizure frequency overall (rate ratio 0.35, 95% CI 0.18–0.69; P=0.006), with sustained effects at 6 weeks (RR 0.37), 6 months (RR 0.31) and 12 months (RR 0.35). The therapist-guided arm did not achieve a significant reduction in seizures, and the two active arms did not differ significantly (RR 0.67, 95% CI 0.33–1.36). The self-guided arm also improved anxiety at all time points. No adverse events occurred in any arm. The program may offer a scalable option where specialist psychological care is unavailable.
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