CBT Model in FND (Functional Neurological Disorder) Context
Context / Trigger:
Entering a social situation (e.g., a family gathering, public place, workplace).
"I canât control my symptoms."
"What if others think Iâm exaggerating or faking?"
"Everyone will stare and notice something is wrong."
"If my symptoms appear, Iâll lose control."
Perceived Social Risk (Beliefs / Appraisals):
Fear of negative judgment and rejection from others.
Belief that symptoms will be interpreted as weakness, laziness, or deceit.
Attention Bias (High & Abnormal Symptom Monitoring):
Hyperfocus on bodily sensations (tremors, weakness, numbness).
Over-monitoring for potential âtriggersâ of symptoms.
Increased internal scanning â amplifies severity of symptoms.
Reliance on safety/protective behaviours to manage perceived threat.
Symptoms (Physical & Emotional):
Exacerbation of FND symptoms (seizures, tremors, paralysis episodes, dissociation).
Somatic stress symptoms: sweating, rapid heartbeat, sleep disturbance, muscle tension.
Protective Behaviours (Safety Strategies):
Avoiding social situations entirely.
Withdrawing/dissociating when symptoms rise.
Exaggerating control strategies (e.g., stiffening muscles, over-resting).
Internal suppression of anxiety rather than adaptive coping.
Dependence on others for reassurance.
CBT-Based Techniques & Strategies for FND:
Redirect attention to the present moment (body scan, breath awareness).
Reduce over-monitoring of symptoms.
Challenge dysfunctional beliefs (e.g., âTheyâll think Iâm fakingâ â âMost people donât know about FND and are more focused on themselves.â).
âIf your best friend had FND, would you see them as weak or fake?â
Build self-compassion and reduce shame.
Graded Exposure / Systematic Desensitisation:
Gradually face social situations (small â larger).
Pair with relaxation skills to reduce avoidance.
Drop protective behaviours (e.g., test attending a short event without leaving early).
Collect evidence: âWhat actually happened?â
Emotion & Stress Regulation Skills:
Breathing techniques, progressive muscle relaxation, or vagus nerve stimulation.
đ This model shows how thoughts, attention, and behaviours interact with FND symptoms in social contexts, and how CBT targets each level to break the cycle.
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A CBT Tool for FND - Click Me
