Researchers from the Case Western Reserve University (CWRU), with funding from the Centers for Disease Control and Prevention (CDC) awarded to the CWRU Prevention Research Center (PRCHN), developed TIME (Targeted Self-Management for Epilepsy and Mental Illness). TIME is a curriculum-guided self-management program for people with both epilepsy and mental health conditions. The TIME program consists of 12 weekly manualized group sessions and 4 follow up telephone sessions meant to reinforce the concepts taught. It blends education, problem identification, goal-setting, and behavioral reinforcement. The program improves depression in people with epilepsy and mental health condition, and can boost self-confidence and self-management skills.
Mental health conditions are very common in people with epilepsy and nearly always contribute to complications and worse health outcomes. People with epilepsy and mental health conditions (EMC) also often live with stigma and social isolation because of their EMC. TIME helps people with EMC to actively participate in self-management and better cope with the stress and stigma of EMC. TIME is based upon social cognitive theory, where individuals learn by observing others, gaining knowledge, and acquiring the self-confidence to put their new-found knowledge into practice.
What group or audience was key to making that happen? The TIME program was developed with input from a community advisory board and then tested a 16-week prospective, randomized controlled trial comparing TIME vs. treatment as usual (TAU).
Based on the prospective study, TIME’s self-management approach helped reduce depression in people with EMC. There was a significant decrease in depression symptom severity as measured by a standardized scale compared to people participating in TIME. In contrast, for the comparison group participating in TAU, depressive symptoms did not change. TIME was highly acceptable to participants, with an average group session participation of 90%. One participant described the lasting impact: “I am a walking success story. My life as a whole has had many bumps and bruises. TIME showed me how, in everyday life, I can take control over my health by the smallest of gestures. When I recently had a bad bout with my health, I thought back to the skills I learned in the TIME study. I remembered to ask myself different questions and to write my concerns and alternatives solutions down so that I would not forget. By doing that I was able to identify the problem and fix it.”
The researchers who developed TIME are now making the program more broadly available to people with EMC. The Cuyahoga County Addiction and Mental Health Services (ADAMHS) Board and the Cleveland Epilepsy Association have partnered to offer TIME to people with EMC who live in the Cleveland (Northeast Ohio) region. It is expected that this example can be repeated in other communities looking to provide a greater level of epilepsy care services.