Predictors of Skills-Based Psychotherapy Outcomes for Functional Neurological Disorder: A Retrospective Cohort Study

Skills-based psychotherapy is an evidence-based treatment for functional neurological disorder (FND). However, evidence supporting its real-world efficacy is limited, and no consensus exists on optimal treatment duration. The authors examined how baseline neuropsychiatric characteristics are related to outcomes among patients with FND who were receiving psychotherapy.

This retrospective cohort included 97 patients with FND who received outpatient skills-based psychotherapy between 2019 and 2023. FND symptoms included motor (79%), seizure (32%), and speech (24%) presentations. Baseline characteristics and clinician-estimated outcomes were extracted from medical records. Univariate screenings were followed by multivariate regression analyses to identify predictors of improvement.

At the end of treatment (mean±SD number of sessions=20.0 ± 17.1), 64 patients (66%) had chart-documented evidence of improvement; 20 had complete or near-complete symptom resolution. In a logistic regression, improvement was positively associated with full-time employment and negatively associated with being in a concurrent psychotherapy. After adjustment of analyses for baseline demographic factors and FND subtypes, the number of sessions attended positively correlated with improvement. Of 43 patients who received >16 sessions, 56% showed additional improvement with more treatment. Factors associated with continued improvement in univariate screenings were longer illness duration, cognitive symptoms at baseline, and not being in concurrent psychotherapy, the latter independently predicting continued improvement in prolonged treatment.

These findings indicate that skills-based psychotherapy is effective for some patients with FND in real-world outpatient settings. Prolonged treatment benefits a subgroup of patients with FND, highlighting the need for prospective studies to refine and individualize psychotherapy protocols.