If you’ve been told your seizures are “not epileptic,” you might feel confused, invalidated, or even dismissed.
The episodes are real. The shaking, staring, collapsing, or loss of control feels real. And yet your EEG is normal. Your neurologist says it isn’t epilepsy.
So what is happening?
Psychogenic Non-Epileptic Seizures (PNES) are episodes that look like epileptic seizures but are not caused by abnormal electrical activity in the brain. Instead, they are linked to psychological distress, trauma, stress, or overwhelming emotional states.
This does not mean you are “faking.”
It does not mean you are choosing the symptoms.
And it absolutely does not mean the episodes aren’t real.
PNES is a nervous system response — not a neurological misfire.
Your Brain Is Protecting You (Just in an Over-the-Top Way)
Think of PNES as your brain’s alarm system going into overdrive.
When stress, trauma, or internal emotional overwhelm builds beyond what feels manageable, the nervous system can discharge that intensity physically. The body essentially “short-circuits” as a protective mechanism.
For some people, that discharge looks like panic attacks.
For others, it looks like dissociation.
For some, it presents as seizure-like activity.
It is your brain trying to cope.
How CBT Fits In
Cognitive Behavioral Therapy (CBT) is often recommended because PNES is highly connected to:
• stress sensitivity
• trauma history
• emotional avoidance
• fear of bodily sensations
• hypervigilance to physical symptoms
CBT helps by targeting the cycle that keeps episodes going.
There are typically three overlapping components:
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Understanding the trigger cycle
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Reducing fear of internal sensations
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Increasing tolerance of emotional and physical discomfort
Using ERP for the Sensorimotor Loop
One helpful approach comes from the sensorimotor OCD protocol, specifically Exposure and Response Prevention (ERP).
Even though PNES is not OCD, there is often a similar loop:
You notice a body sensation.
You become hyper-aware of it.
Anxiety spikes.
Your nervous system escalates.
The episode becomes more likely.
The more you monitor, brace, avoid, or try to suppress sensations, the louder the alarm gets.
ERP helps you do something counterintuitive:
Instead of fighting or scanning for symptoms, you gradually learn to allow sensations without escalating fear.
This may include:
• Practicing noticing body sensations without immediately trying to control them
• Reducing reassurance-seeking or body checking
• Allowing mild physical sensations to be present without bracing
• Learning that sensations are uncomfortable but not dangerous
When your brain learns that body sensations are safe — even intense ones — the cycle begins to weaken.
Addressing Emotional Avoidance
For many people with PNES, there is also a history of emotional suppression. You may have learned to push down anger, grief, fear, or vulnerability.
If emotions don’t get processed, the body sometimes carries them.
CBT can include:
• Identifying emotional triggers
• Learning to name and tolerate feelings
• Processing trauma when appropriate
• Building stress regulation skills
As emotional tolerance increases, the nervous system becomes less reactive.
What Treatment for PNES Often Looks Like
Effective CBT for PNES typically includes:
Psychoeducation — Understanding how the nervous system works
Trigger mapping — Identifying patterns around episodes
Exposure work — Gradually reducing fear of sensations
Response prevention — Reducing safety behaviors and monitoring
Stress reduction skills — Breathing, grounding, and nervous system regulation
Trauma-informed care when indicated
The goal is not to “stop seizures by force.”
The goal is to retrain your brain to feel safe in your body again.
Recovery Is Possible
Research shows that many people with PNES improve significantly with psychological treatment — especially when they fully understand the diagnosis and feel validated.
If you’re experiencing PNES, you are not broken. Your brain is doing its best to protect you.
With the right support, you can teach it a calmer, safer way to respond.
If you’re a clinician working with PNES, remember: validation first. These symptoms are involuntary and deeply distressing. From there, CBT — especially approaches that target fear of internal sensations and emotional avoidance — can be powerful tools for change.
If you or someone you love is navigating PNES and looking for CBT support, Light On Anxiety specializes in evidence-based approaches that help you feel better, faster — with anxiety treatment that works.
