Cognitive‐Behavioural Therapy in the Treatment of Functional/Dissociative Neurological Symptoms: State of the Art
DOI:
https://doi.org/10.51338/rppsm.508Keywords:
Cognitive Behavioral Therapy, Conversion Disorder, Dissociative DisordersAbstract
Introduction: The functional/dissociative neurological symptoms (F/DNS) generate disability and decrease productivity and quality of life. The therapeutic approach is still unclear; cognitive-behavioural therapy (CBT) seems to yield positive results. This review aims to summarize evidence on the effectiveness of CBT on the treatment of F/DNS.Methods: Non-systematic review of the literature; search on the PubMed/Medline database, using PRISMA guidelines for scoping reviews, with terms related to F/DNS and CBT.
Results: Several studies describe advantages of CBT in the treatment of functional tremor; postural-perceptive persistent dizziness; non-epileptic psychogenic seizures; several functional movement disorders; and F/DNS in general, with improvement in primary (reduction in physical symptoms) and secondary outcomes (functioning level, quality of life, mental state, anxiety/depression, service use). Some studies analysed psychological interventions globally, and not CBT specifically. One review about neuromodulation for the treatment of F/DNS states that its efficacy is unproven; they speculate that the combination with CBT might be promising.
Discussion: Recent studies state that, globally, there is little high-quality evidence; they consider that some studies have a high risk of bias and lack an appropriate analysis of the quality of evidence. Some contradictions between studies have been found, for example regarding improvement of functioning level and reduction of the number of convulsions. However, most studies report some evidence on the efficacy of CBT in the treatment of different F/DNS, regarding primary and secondary outcomes, some in combination with physiotherapy and other psychotherapeutic modalities, reinforcing the importance of a multidisciplinary approach.
Conclusion: The studies conducted to date exhibit significant methodological issues, including a low number of included patients and patient heterogeneity, making it challenging to compare studies and obtain high-quality methodological research. Although there is no consensus on the best therapeutic approach, and despite the low methodological quality existing thus far, CBT is the approach that has shown the best results (in primary and secondary outcomes) in the treatment of F/DNS. Additional studies with methodological rigor are needed to validate the positive results obtained thus far.
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