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Nocebo Hypothesis Cognitive Behavioral Therapy for Functional Neurological Symptom Disorder (Motor Type): A Pilot
Matt Richardson1,2, Maria Kleinstäuber3, Dana Wong4
1Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Summary
Nocebo Hypothesis Cognitive Behavioral Therapy (NH-CBT) showed significant improvements in motor symptoms and recovery for Functional Neurological Symptom Disorder (FNSD). While the primary outcome wasn't significant between groups, NH-CBT demonstrated substantial within-group effects and higher recovery rates.
Area of Science:
- Neurology
- Psychiatry
- Clinical Psychology
Background:
- Functional Neurological Symptom Disorder (FNSD) is a debilitating condition.
- Nocebo Hypothesis Cognitive Behavioral Therapy (NH-CBT) has shown promise in prior case series for FNSD treatment.
Purpose of the Study:
- To evaluate the efficacy of NH-CBT in patients with motor-type FNSD.
- To compare NH-CBT against an active control condition in a randomized trial.
Main Methods:
- Phase IIb, randomized, parallel group trial.
- 20 participants received NH-CBT, 19 received active control.
- Outcomes assessed at baseline, 8, and 16 weeks using self-report scales and blinded assessor ratings.
Main Results:
- No significant difference in the primary outcome (SF-36 PF) between groups.
- Significant improvements favoring NH-CBT in secondary outcomes: motor symptoms, mobility, and symptom concern.
- 85% of NH-CBT participants achieved full motor symptom recovery versus 47% in the control group.
Conclusions:
- NH-CBT demonstrated large within-group effects and a higher recovery rate for motor symptoms in FNSD patients.
- These findings support NH-CBT as a viable treatment and warrant further investigation in a definitive trial.
