Feasibility trial of a self-help digital intervention for functional cognitive disorder

Functional cognitive disorder is the cognitive subtype of functional neurological disorders. Symptoms are associated with a high level of distress and typically arise due to various risk factors including abnormal focused attention, high memory expectations and poor metacognition. Easily accessible specialized treatments for functional cognitive disorder are needed. Digital interventions are less costly and scalable and allow individuals to engage in self-care in a flexible manner. In this study, we aimed to (i) evaluate the feasibility and safety of a novel self-help digital intervention based on principles of cognitive behavioural therapy and related approaches, (ii) explore preliminary effects of this intervention and (iii) learn about participants' experience with the intervention. Patients were recruited via a neuropsychiatry clinic. They autonomously completed a 6-week intervention, with phone and email technical support, and were assessed at baseline and at the end of the intervention, using self-reported questionnaires. Besides feasibility outcomes, main measures were the metamemory in adulthood questionnaire, subjective memory complaints, clinical global impression of change, Brief Illness Perception Questionnaire, Behavioural Responses to Illness Questionnaire, Compensatory Cognitive Strategies Questionnaire, depressive and anxiety symptoms, work and social functioning and quality of life. A within-group design was employed. Means, standard deviations and effect sizes were estimated. Post-treatment semi-structured interviews were conducted to further explore the acceptability and usability of the programme. Of the 38 patients eligible, 37 completed the baseline questionnaires (97% recruitment rate). Thirty started the intervention (54% female, mean age 50.4). Four dropped out (4/30, 13%), with 23/30 (77%) completing three or more modules, and the attrition rate was 37%. Twenty-seven treatment-related negative effects were reported (5% of total). Overall satisfaction with the programme was high with 62% (16/26) reporting feeling 'satisfied' or 'very satisfied'. Sixteen (62%) reported improvement in their cognitive symptoms ('minimally improved', 'much improved' and 'very much improved'). Paired t-tests showed significant improvements on illness perceptions (mean change -6.65, P = 0.001), depressive symptoms (mean change -2.96, P = 0.008) and quality of life (mean change 10.06, P = 0.03) at post-treatment. Five patients were dissatisfied with the lack of personalization and found the content unhelpful, with some experiencing increased anxiety. While the intervention met most of its feasibility benchmarks, efficacy needs to be explored in a future randomized controlled trial. Self-help digital therapy may be a flexible and cost-effective option to increase availability and accessibility of specialized treatment for functional cognitive disorder, within a stepped care model, as a complement to other multidisciplinary face-to-face interventions.