FND Management

Question 1

What are the main psychological approaches tried for FND

Answer 1

CBT
Psychoeducation
Motivational Interviewing
Psychodynamic

Question 2

CBT for FND?

Answer 2

Specific modifications for different FNDs, e.g. seizure-directed approach for dissociative seizures, vestibular rehab for dizziness

Question 3

CBT approach for functional movement disorder

Answer 3

• identify somatic misinterpretation, negative thoughts, illness beliefs maintaining FMD, low mood, anxiety
• Establishing alternative hypotheses for the bodily sensations, distraction techniques
• homework, reviewing avoidances etc
• formulation based

Question 4

MODEL OF CBT FOR DISSOCIATIVE
SEIZURES

Answer 4

• Seizures are viewed as dissociative responses to arousal
• occur when patient is confronted with intolerable/fearful circumstances
• Panic without panic
• seizures occur with high numbers of somatic symptoms of anxiety /panic
• Seizures then maintained by vivious circle of behavioural, cognitive, affective, physiological and social factors
• chief among these are fear and avoidance
• certain activties/behaviours or experiences are modified or avoided

Question 5

What can predict better treatment outcome in CBT for FND

Answer 5

-Employment,
-no disability benefits
-higher-level
education
-Stronger belief in diagnosis predicted better mental health-related quality of life

Question 6

Psychoeducation for dissociative seizures

Answer 6

1: Understanding DS: Engage patient, provide psychological explanation of symptoms, explain
mind–body link
2: Before and during seizures: Identify warning signs prior to seizures; teach self-management skills to
cope with seizures; identify physical sensations associated with stress,
anxiety

3: Improving life: Identify avoidance behaviours adopted because of seizures; develop
goal to reduce one type of avoidance behaviour, plan to achieve this

4: Therapy blueprint: Discuss how to improve functioning in patient’s most valued areas of
life; reflect on what they have learned about their seizures

Question 7

Four processes comprising Motivational Interviewing

Answer 7

1. Engaging
2. Focusing
3. Evoking
4. Planning

Question 8

Whats the main essence of Motivational Interviewing

Answer 8

Heavy reliance on reflective listening and emphasis on evoking and strengthening
patients’ motivations supporting psychotherapy engagement and adherence

Question 9

The Psychodynamic Approach explained:

Answer 9

Focuses on historical and early life experiences,
parenting dynamics, enduring personality traits;
> Makes links between these and current life
experiences and problematic emotions and
behaviours.
> The goal is to reshape the intrapsychic structure of
the patient to produce favourable symptom change
based on specific theories about the nature of early
childhood nurturing experiences and parenting
dynamics

Question 10

Treatment starts at diagnosis:

Answer 10

• Acknowledge the problem
• Tell them what it is
• Explain how the diagnosis was made
• Discuss possible triggers
• Discuss risk factors
• Discuss treatment options
• Make a plan to follow up

Question 11

Rehabilitation Treatment Recommendations

Answer 11

1. Initial assessment
2. Education
3. Movement and posture retraining
4. Addressing secondary problems
5. Supporting self-management
6. Follow-up

Question 12

What is Movement
Retraining?

Answer 12

-Automatic movement
-Retrain activity not impairment
-Redirect attention
-Mirror feedback
-Sequential motor learning
approach
-Guided exploration

Question 13

Treatment of functional dizziness (PPPD)

Answer 13

CBT informed vestibular rehabilitation
* CBT formulation for symptoms
* Exploring illness beliefs
* Exercises aimed at normalising maladaptive postural
strategies
* Habituation
* Graded activity
* Relaxation