Systematic review of psychotherapy for adults with functional neurological disorder

Abstract

Functional neurological disorder (FND) is a common and disabling disorder that is often considered difficult to treat, particularly in adults. Psychological therapies are often recommended for FND. Outcome research on psychological therapies for FND has grown in recent years but has not been systematically evaluated since 2005. This study aims to build on that by systematically reviewing the evidence-base for individual outpatient cognitive behavioural and psychodynamic psychotherapies for FND. Medical databases were systematically searched for prospective studies of individual outpatient psychotherapy for FND with at least five adult participants. Studies were assessed for methodological quality using a standardised assessment tool. Results were synthesised, and effect sizes calculated for illustrative purposes. The search strategy identified 131 relevant studies, of which 19 were eligible for inclusion: 12 examining cognitive behavioural therapy (CBT) and 7 investigating psychodynamic therapy (PDT). Eleven were pre–post studies and eight were randomised controlled trials. Most studies recruited a single symptom-based subtype rather than all presentations of FND. Effect sizes, where calculable, showed generally medium-sized benefits for physical symptoms, mental health, well-being, function and resource use for both CBT and PDT. Outcomes were broadly comparable across the two therapy types, although a lack of high-quality controlled trials of PDT is a significant limitation, as is the lack of long-term follow-up data in the majority of identified CBT trials. In conclusion, both CBT and PDT appear to potentially offer some benefit for FND, although better quality studies are needed.

Decade of progress in motor functional neurological disorder: continuing the momentum

“…As well summarised in a recent systematic review, the major advance for psychotherapy in mFND is that initial RCTs have been conducted and published-after a dearth of controlled data in decades prior. 41 Examples of the interventions are described below and summarised in table 2 and online supplemental table 1.…”

Neuromodulation for the treatment of functional neurological disorder and somatic symptom disorder: a systematic review

“…Ideally, advances in neuromodulation will parallel advances in FND/SSD neuroimaging with an ultimate goal of identifying patient-specific network dysfunction and then modulating that network with a patient-specific stimulation protocol. Another important line of work will be to combine existing evidence-based treatments such as psychotherapy48 or physical therapy49 with neuromodulatory treatment. There is increasing research uncovering the importance of state dependency for neuromodulation and such combinations could effectively ‘prime’ the networks being stimulated 13.…”

Using evidence-based psychotherapy to tailor treatment for patients with functional neurological disorders

“…Assuming that the patient has embraced the diagnosis of FND, it is likely that treatment rationale will help choose the appropriate modality. For instance, patients with pragmatic tendencies may find it easier to understand their symptoms as resulting from tangible cognitive and behavioral factors (e.g., trigger leads to distorted thinking/emotion which leads to maladaptive behavior) and a present focus may be more comprehensible than historical trauma and past emotional/interpersonal conflicts [58] . Alternatively, a patient who resonates with explanations that increased awareness and acceptance of internal states allow someone to intentionally engage in values-based behavior instead of automatized processes (e.g., FS), might prefer MBT.…”