Metacognitive Therapy and Neuro-physiotherapy as a Treatment for Functional Movement Disorders (ReMAP-FMD)
Conversion Disorder
About this trial
This is an interventional treatment trial for Conversion Disorder focused on measuring functional movement disorders, feasibility study, Physiotherapy, Metacognitive behavioral therapy
Eligibility Criteria
Inclusion Criteria:
- Clinically established diagnosis of functional movement disorders (FMD) according to the revised Fahn-Williams criteria. Patients with FMD with different phenomenology, i.e. patients with functional myoclonus, dystonia, tremor and functional gait disorders will be included to guarantee generalizability and representativeness of this heterogeneous disorder.
Exclusion Criteria:
- Significant major neuropsychiatric/neurological disorder
- medical illness with known central nervous system consequences,
- acute unstable psychiatric diseases,
- pain disorders,
- paroxysmal FMD,
- isolated functional paresis,
- inability to read and speak German,
- age < 18 years. Children with FMD are excluded because they would require age-adjusted assessment and tailored treatment in a specialized neuropediatric unit.
Sites / Locations
- Department of Neurology, University Clinic Schleswig-HolsteinRecruiting
- Institute of Systems Motor Science, University Clinic Schleswig-HolsteinRecruiting
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Neuro-physiotherapy
Combination of metacognitive therapy and Neuro-physiotherapy
In intervention group I, patients will receive a one hour session of special Neuro-physiotherapy (NPT) twice per week with a total of 20 sessions over 10 weeks. In addition, patients will be instructed to a home-based training, so that they continue their training in between sessions and after completion of the 10 weeks intervention. NPT is designed to target the abnormal movements. It is based on previously established consensus recommendations and feasibility for a short (5 days) intervention was already tested. Adapted from Nielsen et al., each of our NPT sessions will include patient education, movement retraining and development of a self-management plan.
In intervention group II, patients will be treated for 10 weeks by a combination of Metacognitive behavioral therapy (MCT) and Neuro-physiotherapy (NPT) (1 hour MCT and 1 hour NPT per week with a total of 20 treatment sessions over 10 weeks). The key feature during MCT sessions will be based on an attention training technique (ATT), which prevents or interrupts self-focused attention and reduces the overall level of preoccupation with the FMD. Patients will receive at least three competing sounds. Patients will be asked to practice the training with their eyes open and focused on a visual fixation point. Patients' self-reliance will be strengthened by an individualized cognitive self-training explained and practiced with the MCT therapist including an audio tape of the ATT training. This should be continued daily at home in between sessions and after completion of the 10 weeks intervention. Self-training will be documented in a daily training diary.