Taking Control of Your Functional Cognitive Symptoms: Workbook-A Novel Intervention.

Abstract

Objective: Functional cognitive disorder (FCD) is a subtype of functional neurological disorder (FND). FCD may include various cognitive symptoms, precipitants, and comorbid conditions (such as other FNDs, concussion, fatigue, or fibromyalgia). However, no widely available behavioral health interventions exist for FCD. The authors developed a therapist-guided and patient-led treatment for veterans and civilians with FCD.

Methods: A well-known evidence-based treatment for functional seizures (an FCD-adjacent condition often with cognitive symptoms) was adapted to fit hypothesized mechanisms of FCD. The process used a health research format following the guidance for reporting intervention development studies. Key processes included determining the broad intervention framework, obtaining detailed FCD-specific content based on expert consensus, collecting evidence, developing theory, conducting target population-centered approaches, considering specialty subgroups, and gathering feedback from veteran and civilian stakeholders.

Results: The authors created a comprehensive 14-chapter manualized therapist-guided neurobehavioral therapy protocol for FCD symptoms independent of etiology, the Taking Control of Your Functional Cognitive Symptoms: Workbook. Initial feasibility, tolerability, and utility were assessed with two target-population stakeholders with FCD (one civilian patient and one veteran patient), with both reporting a Patient Global Impression of Change scale rating of 1 (indicating that their condition had very much improved).

Conclusions: This promising new multimodality behavioral health intervention can be considered to be in stage 1 (i.e., intervention generation, refinement, modification, adaptation, and pilot testing). Further pilot testing is being conducted and will need to be followed by traditional efficacy testing (in stage 2).