Protocol Feasibility randomised controlled trial of online group Acceptance and Commitment Therapy for Functional Cognitive Disorder (ACT4FCD) 2023 Poole et al

Introduction

Functional cognitive disorder (FCD) is seen increasingly in clinics commissioned to assess cognitive disorders. Patients report frequent cognitive, especially memory, failures. The diagnosis can be made clinically, and unnecessary investigations avoided. While there is some evidence that psychological treatments can be helpful, they are not routinely available. Therefore, we have developed a brief psychological intervention using the principles of acceptance and commitment therapy (ACT) that can be delivered in groups and online. We are conducting a feasibility study to assess whether the intervention can be delivered within a randomised controlled trial. We aim to study the feasibility of recruitment, willingness to be randomised to intervention or control condition, adherence to the intervention, completion of outcome measures and acceptability of treatment.

Methods and analysis

We aim to recruit 48 participants randomised 50:50 to either the ACT intervention and treatment as usual (TAU), or TAU alone. ACT will be provided to participants in the treatment arm following completion of baseline outcome measures. Completion of these outcome measures will be repeated at 8, 16 and 26 weeks. The measures will assess several domains including psychological flexibility, subjective cognitive symptoms, mood and anxiety, health-related quality of life and functioning, healthcare utilisation, and satisfaction with care and participant-rated improvement. Fifteen participants will be selected for in-depth qualitative interviews about their experiences of living with FCD and of the ACT intervention.

Open access, https://bmjopen.bmj.com/content/13/5/e072366

 

"Disturbance of attention is thought to be responsible for the symptoms,4 as with other functional neurological disorders,5 although the underlying pathophysiological mechanisms remain unknown."

Reference 4 is to A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review, thread here A unifying theory for cognitive abnormalities in functional neurological disorders, Fibromyalgia and CFS (2018), Mark J Edwards et al.

 

So, is that implying that patients with dementia in one of its many forms [Edit: for example] actually have "Functional Cognitive Disorder" and could have better memories if only they tried harder?

And "Acceptance and Commitment Therapy"? Always sounds to me like the therapist must be telling the patient they must go and "**** off and die" please, because "we aren't going to investigate your physical health, you waste of space".

 

From the article: "The diagnosis can be made clinically, and unnecessary investigations avoided." This was arbitrarily decided decades ago to save governments money.

This decision despite abnormal results found on memory testing, MRIs, orthostatic challenges etc., that go back at least 3 decades.

No alarm bells ringing then, that increasing reports of cognitive dysfunction need more than counseling as treatment. It's just mass hysteria after all.

 

Acceptance, or what I deem giving up, is the completely wrong way to deal with cognitive, and other health difficulties.

What if we gave up with every problem we encounter? What kind of world would we live in. If we still had a world that is.

 

Literally so incapable of actually listening to patients that they fail to notice that it's failure of executive reasoning that is mostly reported. Memory problems, sure, but compared to being unable to reason it's a much more significant problem.

But they never listen. While they shout about how good they are at listening. Which may be why they are so bad at listening, because they're shouting all the time about how great and superior they are, while delivering completely incompetent copy-paste pseudoscientific nonsense.

It's the combination of extreme arrogance and pretty much being the most incompetent professionals to have ever existed that is grating. They are stuck in loops, obsessing over the same thoughts, as if magic could deliver them the answer. And so this is exactly why they are doing exactly that, projecting their own failure onto us.

 

No, I really don't think this meets those criteria. But there's always funding for cheap pseudoscience, it seems. Good science? Boring, expensive. Cheap pseudoscience? Exciting, magical, whimsical, and extremely expensive.

 

Yet more of the very dangerous idea that functional disorders can be [diagnosed] on the basis of the clinicians’ biases in order to save time and money and presumably to avoid indulging these dreadful needy hypochondriacs.

How many more people will die of treatable conditions or waste scarce time and energy uninformed about underlying conditions that are untreatable because of this propoganda?

 

So basically telling you to come to terms with having crippling/disabling brain fog.

 

If you can remember having done so.

Which... yeah. No.

I can't tell the difference between yesterday and 5 years ago. It's all a giant nightmarish blur of suffering. I have no connection to real life anymore. I have no connection at all to the life I had before. It's all gone. All of it. Every bit of it. Everything I agreed to yesterday is null and void for that reason. I don't even know if I'm a real person anymore, nothing is real.

But they don't know that. Because they're fake experts faking knowing things and they actually don't even care about anything that happens to us. Everyone is just doing their day job and nothing more.

 

I’d say reasoning is intact but it’s executive function/working memory vs load.

the classic issue is just to add in any multi tasking or multi sensory - which for us we might already have by virtue of our symptoms and environment that day.

but not if someone distracts me mid sentence with a question - which certain personalities who claim they can’t possibly understand the condition or hear to learn it but very quickly prey in on that one and use incessantly - well that blows me from being ‘ok’ to left debilitated and sounding like a prayt. So they get what they want they think. Me looking dumb and lesser instead of them being a narcissist who couldn’t resist pushing on the disability just to win a non-debate discussion.

anyway I can reason well and have capacity but doing calculations when already tired where you have to hold several things in your head and communicate

I just think it’s worth being very clear on terminology like this even if psychiatry seems to be moving to deliberately dumbing itself down and muddying this knowledge and important distinctions for whatever agenda. Like the above probably.

ps I suspect the issue is it’s under the wrong part of psychology: the one that only has its little repertoire of courses that are becoming less matched to the issue and more transdiagnostic based on bigotry from their and those they are selling it to’s own ideological led presumptions.

the issue itself should be being mapped by cognitive psychology and measured they can then at least show what/when it is worse to point at source of issues and indicate suggestions like such would for air traffic controllers doing shifts and needing to stay on form through them at the other end of the spectrum.