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A psychological perspective

Mindfulness

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Mindfulness refers to intentionally focusing attention on the present moment and accepting this experience with openness, curiosity and without judgement.

Such awareness of the present moment can be achieved through a number of techniques and strategies that include a meditative component, ranging from focusing attention on one's own bodily sensations, thoughts and emotions, to sounds, shapes and phenomena from the environment, as well as practicing more formal and structured forms such as meditation, yoga and mindful movement ( Kabat-Zinn, et al., 2011).

MBT increases awareness of the context and triggers of functional neurological symptoms, while exploring personal values and how they guide behavioural choices.

Some examples of Mindfulness-Based Therapies( MBTs):

  • Dialectical Behaviour Therapy (DBT)

  • Mindfulness-based stress reduction( MBSR),

  • Acceptance and Commitment Therapy (ACT)

  • Mindfulness-Based Cognitive Therapy( MBCT)

    All these psychotherapeutic approaches have mindfulness as a common point, but they differ in the way they use mindfulness strategies.

MBT (mindfulness-based therapy) model for patients with FND

  • Include:

    • Understanding FND

    • Symptom identification

    • Identification of triggers and maintainers of symptoms (e.g. boom and bust cycle).

    • Understanding stress (a simplified mechanism to make it easier for the patient to understand)

    • Teaching stress management strategies (e.g. stimulate the patient's creativity by asking them to come up with as many ideas as possible to help relieve stress; tell them that all ideas are welcome, even those that seem impossible at first sight. Later, go through the list of ideas together and rank them in order of reality, effectiveness and accessibility).

    • Introduction to mindfulness (What is mindfulness, how does it work, what does it improve...)

    • Integrating mindfulness into daily life (e.g. the patient's task is to choose a daily, habitual activity (e.g. brushing teeth/drinking coffee) and do it in a mindful way from now on).

    • Identifying different emotions, what is their purpose

    • Learning to accept the full range of emotions

    • Learning to regulate emotion-triggered behaviour

    • Identification of negative automatic thoughts linked to the FND

    • Learning techniques to change the attitude towards thoughts (observer vs. reactor)

    • Learning techniques to prevent the symptoms from getting worse again

How can mindfulness help improve FND symptoms?

Although there is a lack of systematic studies examining the efficacy of mindfulness-based therapies for different subtypes of functional neurological disorders, their potential efficacy is assumed, as they have been shown to affect psychopathological mechanisms that are also implicated in FND. These include emotion regulation (Basso et al, 2019; Lindsay et al., 2018; Wu et al., 2019) and attention (Brandmeyer et al., 2019; Lutz et al., 2008; Sumantry and Stewart, 2021). 

The problem with mindfulness techniques is the high level of metacognition required to implement them, which can affect the effectiveness of their application. In the future, it would be useful to study for which type of FND patients mindfulness-based psychotherapy is most effective, so that treatment can be individualised as much as possible.

    • Baslet, G., Ridlon, R., Raynor, G., Gonsalvez, I., and Dworetzky, B. A. (2022). Sustained improvement with mindfulness-based therapy for psychogenic nonepileptic seizures. Epilepsy & Behavior, 126, 108478.

    • Basso, J. C., McHale, A., Ende, V., Oberlin, D. J., and Suzuki, W. A. (2019). Brief, daily meditation enhances attention, memory, mood, and emotional regulation in non-experienced meditators. Behavioural brain research, 356, 208-220.

    • Brandmeyer, T., Delorme, A., and Wahbeh, H. (2019). The neuroscience of meditation: classification, phenomenology, correlates, and mechanisms. Progress in brain research, 244, 1-29.

    • Kabat-Zinn, J., Siegel, D., Hanh, T. N., and Kornfield, J. (2011). The mindfulness revolution: Leading psychologists, scientists, artists, and meditation teachers on the power of mindfulness in daily life. Shambhala Publications

    • Lindsay, E. K., Chin, B., Greco, C. M., Young, S., Brown, K. W., Wright, A. G., ... and Creswell, J. D. (2018). How mindfulness training promotes positive emotions: Dismantling acceptance skills training in two randomized controlled trials. Journal of personality and social psychology, 115(6), 944.

    • Lutz, A., Slagter, H. A., Dunne, J. D., and Davidson, R. J. (2008). Attention regulation and monitoring in meditation. Trends in cognitive sciences, 12(4), 163-169.

    • Sumantry, D., and Stewart, K. E. (2021). Meditation, mindfulness, and attention: A meta-analysis. Mindfulness, 12, 1332-1349.

    • Wu, R., Liu, L. L., Zhu, H., Su, W. J., Cao, Z. Y., Zhong, S. Y., ... and Jiang, C. L. (2019). Brief mindfulness meditation improves emotion processing. Frontiers in neuroscience, 13, 1074.