VA Mind Brain Program
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The vision of the VA Mind Brain Program is to provide healing, hope, and wellness for Veterans with neuropsychiatric conditions, including Functional Neurological Disorders, such as psychogenic non-epileptic seizures (PNES).
Our primary focus is to educate and train multi-disciplinary clinicians in an evidence-based psychotherapy to deliver whole-person care for Veterans with these complex conditions.
Origin:
September 2021, VA Neurology Program Office
Adoptions:
11 successful, 3 in-progress
Partners:
Epilepsy Centers of Excellence, Neurology, Parkinson’s Disease Research, Education, & Clinical Centers
Recent Updates
Overview
The problem
VHA has a shortage of trained clinicians to address the needs of thousands of Veterans with neuropsychiatric conditions. Approximately 7,000 Veterans have PNES, a functional neurological disorder (FND), in which neurological symptoms (in this case, seizures) occur as a result of an underlying psychological conflict or stressor. Many Veterans are lost betwee
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VHA has a shortage of trained clinicians to address the needs of thousands of Veterans with neuropsychiatric conditions. Approximately 7,000 Veterans have PNES, a functional neurological disorder (FND), in which neurological symptoms (in this case, seizures) occur as a result of an underlying psychological conflict or stressor. Many Veterans are lost between Neurology and Mental Health and do not receive adequate treatment of their symptoms.
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The solution
The VA Mind Brain Program staff educate and train clinicians across the VHA to improve knowledge and care of Veterans with neuropsychiatric diagnoses, including PNES, with this evidence-based, whole-person psychotherapy (neuro-behavioral therapy or NBT). Trained clinicians are able to effectively treat patients with PNES and other neuropsychiatric disorders.
Files
- Neuro-behavioral therapy information and TMS NBT training links VA Mind Brain Program Fact Sheet and NBT Training
The results
In sites with NBT-trained clinicians, Veterans with PNES receive coordinated care and are offered appropriate treatment options for their symptoms. Completion of NBT is associated with fewer seizures and improved functioning.
Images
Above:
Treatment of psychogenic nonepileptic seizures (PNES) with NBT using video telehealth
Files
- Study results showing reduced PNES in Veterans treated with NBT via telehealth Treatment of psychogenic nonepileptic seizures (PNES) using video telehealth
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Videos
Above:
VA Epilepsy Center of Excellence video on psychogenic non-epileptic seizures or PNES.
Implementation
Timeline
-
1 month (start-up)
Clinician will receive supervisory approval, complete initial training (TMS courses, readings), contact referring providers for possible appropriate patients (with guidance from Mind Brain Program staff), and work with local administration to set up clinics if needed. -
8-12 months (training)
Local clinician will complete neuro-behavioral therapy training (NBT) and provide NBT to local patients with neuropsychiatric conditions.
Departments
- Mental health care
- Social work
- Psychiatry
- Psychology
- Pain management
- Polytrauma and traumatic brain injury
- Neurology
Core Resources
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PROCESSES |
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Links
- Therapist Guide offers therapists, physicians, and other healthcare professionals a comprehensive approach to improving seizure control and enhancing the quality of lives of their patients diagnosed with epileptic and nonepileptic seizures (NES). Treating Nonepileptic Seizures - Therapist Guide
- Offers a comprehensive approach to improving seizure control and enhancing quality of life. Taking Control of Your Seizures Workbook
Optional Resources
| Resource type | Resource description |
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PEOPLE |
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Support Resources
| Resource type | Resource description |
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PEOPLE |
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PROCESSES |
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TOOLS |
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Risks and mitigations
| Risk | Mitigation |
|---|---|
| Identifying clinicians who can allocate time for training and ongoing treatment of these patients. | Request from leadership to appoint "Mind Brain Program Champions" with appropriate FTE allocation for this work. |
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email Kristen.Mordecai@va.gov with questions about this innovation.
About
Origin story
Dr. W. Curt LaFrance, Jr., a neurologist and psychiatrist who studies and treats patients with neuropsychiatric conditions, including PNES and FND, has been approached by many clinicians around the world over the years who described their sense of helplessness when seeing these complex patients. Further, countless patients with PNES and other FNDs described
...
Dr. W. Curt LaFrance, Jr., a neurologist and psychiatrist who studies and treats patients with neuropsychiatric conditions, including PNES and FND, has been approached by many clinicians around the world over the years who described their sense of helplessness when seeing these complex patients. Further, countless patients with PNES and other FNDs described their frustration with not having treatment for their seizures or symptoms.
After years of individually training civilian hospital clinicians, Dr. LaFrance was asked by the VA Epilepsy Centers of Excellence (ECoE) and the VA National Tele-Mental Health Center (NTMHC) to bring these resources to the VA, recognizing that a nationally coordinated approach was needed to meet the needs of this underserved population. Since then, in 2021, he was charged with creating the VA Mind Brain Program, which addresses unmet patient needs within the VA and connect VA clinicians and researchers to reduce the gap in the treatment of PNES and other neuropsychiatric conditions.
Original team
W. Curt LaFrance, Jr., MD, MPH
Director, VA Mind Brain Program
Kristen Mordecai, Ph.D.
Neuropsychologist, VA Mind Brain Program
Anna Blanken, Ph.D.
Psychologist, VA Mind Brain Program
M. Raquel Lopez, MD
Epileptologist, VA Mind Brain Program
April Mizell
Administrative Officer
To call this Cognitive-Behavioral Therapy is really quite insulting. This psychosomatic work has been around for over a hundred years in Psychoanalysis and more formalized with current neuroscience for over 20. https://npsa-association.org/
Thank you for your message, Dr. Kurtz. Neuro-behavioral therapy (NBT) is a multi-modal psychotherapy that builds on and includes aspects of various therapies, including CBT, MI, ACT, psychodynamic and others. While previous studies of the intervention refer to NBT as “cognitive behavioral-informed psychotherapy,” used for seizures and motor FND, “NBT” better captures the neurobehavioral approach of the multi-modal intervention. If you would like more information on the NBT outcomes and fMRI biomarker studies, we are happy to forward that to you or discuss further.