Inpatient cognitive analytic therapy for functional neurological disorder: A mixed methods four-phase single-case experimental design.

Abstract

Objectives: To evaluate the effectiveness of inpatient cognitive analytic therapy (CAT) for functional neurological disorder and associated suicidality.

Design: A single case experimental A-B-C plus follow-up design. Intervention phases (A-B-C) were conducted on a psychiatric ward, with the 1-month follow-up (FU) phase in the community.

Methods: The intervention was eight-session CAT. The ABC phases of the SCED were synchronized with the reformulation, recognition and revision phases of the CAT. Idiographic anxiety, depression, burden, emotion regulation, distrust and frequency counts of epileptic and functional seizures were measured daily for N = 61 days across all the phases of the study. Recognition and revision of target problems (TPs) and target problem procedures (TPPs) were rated at each session. The PHQ-9 and GAD-7 were completed at assessment, end of therapy and follow-up. A change interview was conducted at the point of discharge from the ward and at follow-up.

Results: The number of seizure-free days did not change markedly. Recognition and revision of TP and TPPs increased positively over time and according to the phase of CAT. Daily depression significantly improved, but there was less change in other idiographic measures. There was a reliable improvement in PHQ-9 and GAD-7 scores. Personal changes at end of therapy and at follow-up were described in the change interview as important, impactful and unlikely without therapy.

Conclusions: The outcome picture was complex, with evidence of significant change on some indices and little change on others. This suggests a partially effective intervention. Inpatient CAT and also CAT as an FND intervention both seem to hold promise, but clearly more controlled research is needed.