A Novel Treatment Protocol (Nocebo Hypothesis Cognitive Behavioural Therapy; NH-CBT) for Functional Neurological Symptom Disorder/Conversion Disorder: A Retrospective Consecutive Case Series.

Abstract

Theories concerning the aetiology of functional neurological symptom disorder (FNSD; also known as conversion disorder) have historically inferred that psychological factors or dissociative states underlie patients' symptoms. Current psychological models of functional neurological symptoms suggest that some type of 'top-down' representations/beliefs are activated automatically (without conscious awareness), leading to symptoms. It is assumed that these representations or beliefs are similar to the idea 'I am neurologically damaged', as in our clinical experience, almost all patients have some reason to doubt the integrity of their neurological system. It was hypothesized that FNSD arises from a belief of being neurologically damaged (via a mechanism akin to a nocebo response), and an interdisciplinary treatment protocol was developed consistent with this hypothesis, transparently sharing this theory with participants. A retrospective consecutive case series design was utilized, measuring functional independence and symptom remission. Of the 13 episodes of care, 12 resulted in complete or almost complete symptom remission. Length of stay in rehabilitation was also reduced compared with previous treatment attempts. It appears as if the treatment protocol may be very effective, and further controlled study appears warranted.