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TIME Trial Helps Patients with Epilepsy and Mental Health Conditions

PRCHN Affiliated Faculty Dr. Martha Sajatovic, Professor of Psychiatry and Neurology, received a Special Interest Grant from the Centers for Disease Control and Prevention (CDC) for a behavioral study to test a self-management program for people with both epilepsy and mental health conditions. Dubbed TIME (Targeted Self-Management for Epilepsy and Mental Illness), this curriculum-guided program consists of 12 weekly manualized group sessions and four follow-up telephone sessions meant to reinforce the concepts taught. TIME is intended to improve both mental health and epilepsy outcomes among individuals with these comorbid conditions.

The Centers for Disease Control (CDC) created the Special Interest Projects (SIPs) program to support supplemental projects in health promotion and disease prevention research. The SIP mechanism, created in 1993, allows Prevention Research Centers (PRCs) such as the PRCHN to compete for research projects sponsored by CDC organizational units and other Health & Human Services agencies. A SIP is a health promotion and disease prevention research project that focuses on a topic of interest or a gap in knowledge or research. It can also support the development of effective state and local public health interventions and policies. CWRU is a collaborating center of the CDC’s Managing Epilepsy Well (MEW) Network, and the TIME Trial is a part of that work.

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 newfound knowledge into practice.

The TIME program was developed with input from a community advisory board and then tested in 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 for 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%. As one participant described it, “TIME showed me how in everyday life I can take control over my life by the smallest of gestures.”

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. TIME is a novel, group-based self-management approach that 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.