Use of the Overcoming Functional Neurological Symptoms: A Five Areas Approach Workbook in a Therapist-Led Skills Group Format.

Abstract

Objective: Given limited access and long wait times for individualized behavioral health care focused on functional neurological disorder (FND), FND-specific group psychotherapy formats may offer patients early access to tools that could help alleviate symptoms. In this pilot study, the authors investigated the utility of using a well-known, evidence-based, and FND-focused self-help cognitive-behavioral therapy (CBT) workbook in a therapist-led skills group format for patients with primary functional movement disorder (FMD).

Methods: Six patients with primary FMD received a 10-week therapist-led CBT psychotherapy skills group based on the workbook Overcoming Functional Neurological Symptoms: A Five Areas Approach. Basic metrics of feasibility, tolerability, utility, and exploratory Patient-Reported Outcomes Measurement Information System (PROMIS) measures were compared pre- and postintervention. Pregroup guidelines and postgroup summary (summary of skills, supplemental tools, and FND next steps checklist) were included.

Results: Feasibility and tolerability metrics were sound, and three of the six patients had significant improvement in at least two of the 11 PROMIS measures. The PROMIS measures with the greatest improvement included fatigue, anxiety, depression, self-efficacy in managing symptoms, social interactions, emotions, and medications and treatments. Further, the Patient Global Impression of Change (PGIC) may alternatively be used to capture group outcomes, because two of the participants whose PROMIS scores did not change (despite reported benefits) provided PGIC ratings of 1 and 2 (very much improved and much improved, respectively).

Conclusions: These findings suggest that this therapist-led FND skills group intervention format has feasibility, tolerability, and early utility. However, further research is necessary to establish its efficacy.