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

Background

Functional cognitive disorder (FCD) is a subtype of functional neurological disorder (FND). FCD can present with various cognitive symptoms, precipitants, and comorbidities (other FNDs, concussion, fatigue, fibromyalgia, etc.). However, there are no widely available existing behavioral health interventions for FCD. The authors’ aim was to develop a therapist-guided treatment for FCD for widespread use among civilians and Veterans.

Methods

We adapted a well-known, evidence-based treatment for functional seizures (an adjacent condition often with cognitive symptoms), to fit the hypothesized mechanisms of FCD. The process is presented in GUIDED format (GUIDance for the rEporting of intervention Development). Key processes included determining broad intervention framework, detailed FCD specific content based on expert consensus, evidence, theory, target population centered approaches, specialty subgroup consideration and target population stakeholder feedback for Veteran and civilian populations.

Findings

We have created a comprehensive 14-chapter, manualized, therapist-guided neurobehavioral therapy protocol to target FCD symptoms independent of etiology – the Taking Control of Your Functional Cognitive Symptoms Workbook . Initial feasibility, tolerability, and utility were completed with 2 target population stakeholders with FCD (one civilian, one Veteran; both PGI-C rating = 1 “Very Much Improved”). The Template for Intervention Description and Replication (TIDieR) checklist is provided as a supplemental table.

Interpretation

This new promising multi-modality behavioral health intervention can be considered 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 (Stage 2).

Key Messages

• FCD is an increasingly recognized subtype of FND. Despite existing models of FCD mechanisms, there are no widely available dedicated FCD-symptom focused behavioral health interventions.

• We have created the Taking Control of Your Functional Cognitive Symptoms: Workbook , a 14-chapter manualized therapist-guided neurobehavioral therapy protocol to target FCD symptoms regardless of cause / associated conditions, which shows early feasibility and promising clinical utility.