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A Novel Treatment Protocol (Nocebo Hypothesis Cognitive Behavioural Therapy; NH-CBT) for Functional Neurological Symptom Disorder/Conversion Disorder: A Retrospective Consecutive Case Series

Published online by Cambridge University Press:  21 February 2018

Matt Richardson Open the ORCID record for Matt Richardson [Opens in a new window] ,
Gina Isbister  and
Brad Nicholson
Matt Richardson*
Affiliation:
ISIS Rehabilitation Centre, Southern District Health Board, Dunedin, New Zealand
Gina Isbister
Affiliation:
ISIS Rehabilitation Centre, Southern District Health Board, Dunedin, New Zealand
Brad Nicholson
Affiliation:
ISIS Rehabilitation Centre, Southern District Health Board, Dunedin, New Zealand
*
Correspondence to Dr Matt Richardson, Clinical Psychologist, ISIS Rehabilitation Centre, Private Bag 1921, Dunedin 9054, New Zealand. E-mail: [email protected]
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Abstract

Background: Theories concerning the aetiology of functional neurological symptom disorder (FNSD; also known as conversion disorder) have historically inferred that psychological factors or dissociative states underlie patients’ symptoms. Current psychological models of functional neurological symptoms suggest that some type of ‘top-down’ representations/beliefs are activated automatically (without conscious awareness), leading to symptoms. It is assumed that these representations or beliefs are similar to the idea ‘I am neurologically damaged’, as in our clinical experience, almost all patients have some reason to doubt the integrity of their neurological system. Aims: It was hypothesized that FNSD arises from a belief of being neurologically damaged (via a mechanism akin to a nocebo response), and an interdisciplinary treatment protocol was developed consistent with this hypothesis, transparently sharing this theory with participants. Method: A retrospective consecutive case series design was utilized, measuring functional independence and symptom remission. Results: Of the 13 episodes of care, 12 resulted in complete or almost complete symptom remission. Length of stay in rehabilitation was also reduced compared with previous treatment attempts. Conclusions: It appears as if the treatment protocol may be very effective, and further controlled study appears warranted.

Keywords

somatizationbeliefsbodily sensationscognitive behavioural interventions
Type
Brief Clinical Report
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 4 , July 2018 , pp. 497 - 503
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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