A case series of Acceptance and Commitment Therapy (ACT) for reducing symptom interference in functional neurological disorders

Abstract

There is limited high-quality evidence supporting psychological treatments for functional neurological disorders (FNDs), and what evidence exists suggests that the impact of such treatments could be improved. One way to increase effectiveness is to utilize approaches that can have impact across heterogeneous FND presentations. Acceptance and Commitment Therapy (ACT) targets a transdiagnostic process called psychological flexibility and is used effectively to integrate multidisciplinary treatments in other clinical contexts. Here, we present a consecutive case series (N = 8) of a relatively brief (6 to 10 sessions) ACT intervention, delivered face to face by a clinical psychologist in an outpatient neuropsychology service. Treatment aimed to reduce symptom interference and improve mood via improvements in psychological flexibility. Service users presented with a range of FND symptoms (e.g., syncope, limb paralysis, and paraesthesia). Following treatment, 5 participants showed reliable improvements in symptom interference (Work and Social Adjustment Scale), 2 to the extent of clinical significance; 4 had reliable improvements in mood (Clinical Outcomes in Routine Evaluation-10), and 2 within the range of clinical significance. There were no reliable deteriorations in symptom interference or mood. Marked variation was apparent on the measure of psychological flexibility (Acceptance and Action Questionnaire II), with 4 reliable improvements, 3 within the range of clinical significance, and also 2 reliable deteriorations. These promising results suggest that further investigation of an ACT approach to FND is warranted. Future studies should include measures of psychological flexibility with greater comprehensibility.

Systematic review of psychotherapy for adults with functional neurological disorder

“…We identified 19 relevant studies, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] the characteristics and full author list of which are outlined in table 1. Elsewhere these studies are referred to by the first author's surname followed by the year of publication.…”

Feasibility randomised controlled trial of online group Acceptance and Commitment Therapy for Functional Cognitive Disorder (ACT4FCD)

“…The copyright holder for this this version posted February 21, 2023. ; https://doi.org/10.1101/2023.02. 20.23286183 doi: medRxiv preprint…”

“…[17] There is evidence that ACT effectively reduces distress and disability in chronic pain [18] and long-term medical conditions [19] while it has also been recommended for the treatment of functional neurological disorders generally. [13, 20] ACT can be delivered in one-to-one or group formats. It is feasible and acceptable to deliver to patients with psychosis in a brief group format [21] and can be effectively delivered online through guided and unguided modules of learning.…”

The use of acceptance and commitment therapy in managing psychological symptoms in paediatric functional non-epileptic attacks: A clinical report

“…Limited research to date has looked at the possible application of ACT to epilepsy and FNEA in adults although recent research suggests that ACT-informed treatments are effective in addressing recurrent and impairing functional somatic syndromes (FSS) in adolescents (Kozlowska et al, 2018). The extant literature has mainly focused on the use of ACT in treating epilepsy in adults (Lundgren et al, 2008) although small case studies and case series (Graham, O’Hara & Kemp, 2017; Graham, Stuart, et al, 2017) have indicated that ACT shows promise in the management of functional neurological disorders but again this research is solely focused on adult populations.…”