The effectiveness of specialist cognitive behavioural therapy for functional neurological disorder: a service evaluation.

Introduction: Functional neurological disorder (FND) is a common and disabling condition associated with high levels of functional impairment and psychological distress. Psychological therapies such as cognitive behavioural therapy (CBT) are increasingly recommended as part of multidisciplinary care, but evidence from real-world clinical settings remains limited. Methods: This retrospective observational cohort study evaluated outcomes from a specialist CBT programme for adults with FND using routinely collected clinical data. Self-report measures of depression, anxiety, psychological distress, functional impairment, physical functioning, pain, and six cognitive-behavioural responses were collected before, during, and at the end of treatment. Linear mixed-effects models were used to examine change over time, with correction for multiple testing. Results: Data from 234 patients were analyzed (70.5% female; mean age 40.9 years). Despite low completion of measures at follow up, significant improvements were observed in psychological distress, functional impairment, and five of the six cognitive-behavioural response domains across treatment, whereas no significant change was seen in physical functioning or pain measures. Sensitivity analyses excluding patients who received three or fewer sessions produced a consistent pattern of results. Conclusions: These findings suggest that specialist CBT for FND delivered in routine clinical practice is associated with meaningful improvements in distress, functioning, and key cognitive-behavioural maintenance processes, supporting its role within multidisciplinary care.