Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder 2023 Kozlowska et al

Abstract

Previous studies suggest that subjective distress in children with functional neurological disorder (FND) is associated with stress-system dysregulation and modulates aberrant changes in neural networks. The current study documents illness-promoting psychological processes in 76 children with FND (60 girls and 16 boys, aged 10.00−17.08 years) admitted to the Mind–Body Program. The children completed a comprehensive family assessment and self-report measures, and they worked with the clinical team to identify psychological processes during their inpatient admission. A total of 47 healthy controls (35 girls and 12 boys, aged 8.58–17.92 years) also completed self-report measures, but were not assessed for illness-promoting psychological processes.

Children with FND (vs. controls) reported higher levels of subjective distress (total DASS score, t(104.24) = 12.18; p ˂ 0.001) and more adverse childhood experiences across their lifespans (total ELSQ score, t(88.57) = 9.38; p ˂ 0.001). Illness-promoting psychological processes were identified in all children with FND. Most common were the following: chronic worries about schoolwork, friendships, or parental wellbeing (n = 64; 84.2%); attention to symptoms (n = 61; 80.3%); feeling sad (n = 58; 76.3%); experiencing a low sense of control (helplessness) in relation to symptoms (n = 44; 57.9%); pushing difficult thoughts out of mind (n = 44; 57.9%); self-critical rumination (n = 42; 55.3%); negative/catastrophic-symptom expectations (n = 40; 52.6%); avoidance of activities (n = 38; 50%); intrusive thoughts/feelings/memories associated with adverse events (n = 38, 50%); and pushing difficult feelings out of mind (n = 37; 48.7%). In children with FND—disabled enough to be admitted for inpatient treatment—illness-promoting psychological processes are part of the clinical presentation. They contribute to the child’s ongoing sense of subjective distress, and if not addressed can maintain the illness process. A range of clinical interventions used to address illness-promoting psychological processes are discussed, along with illustrative vignettes.

Open access, https://www.mdpi.com/2227-9067/10/11/1724

 

"5. Centrally Important Interventions: Used with All Children and Their Families

5.1. Setting Up Positive Expectations
In the results section, we saw that illness-promoting cognitive processes and negative expectations pertaining to FND symptoms are common in children with FND. “Expectations shape—at least in part—the manner in which the brain processes a broad range of sensory, motor, interoceptive, and emotion-related information” (p. 86) [20]. The child’s expectations will thus be reflected in her body, thoughts, and feelings and can potentially, through a range of mind–brain–body pathways, affect the course of her symptoms [24,25,27,38,39]. Likewise, expectations that a child (and the family) hold toward treatment are a powerful contributor to the treatment process and to clinical outcomes [81]. In our interactions with the child and family—from the very first contact—we work to shape positive expectations with regard to the treatment process and the likelihood of good treatment outcomes. This process of setting up positive expectations needs to be embedded in the therapeutic relationship and will depend on the clinician’s capacity to connect with the child and family to create mutual trust and acceptance."

...

"Vignette: Meera (use of positive suggestion through hypnosis)

Meera was a 17-year-old adolescent with FND—paralysis of her legs and in one arm, with comorbid postural orthostatic tachycardia syndrome, fatigue, and social anxiety—that had not improved with treatment and that left her wheelchair-bound. On presentation Meera was hopeless and was clear that she did not expect anything to work. She did not expect to get better. To shift these expectations the therapist provided psychoeducation about the treatment outcomes for FND: she made explicit positive predictions about Meera’s likelihood of recovery. The therapists then focused on and amplified small gains that Meera was making, thereby redirecting Meera’s attention away from her perceived failures. The therapist then used hypnosis designed to build positive expectancies for the future (adapted from a Michael Yapko protocol for patients with depression). The work emphasized the idea that past (negative) experiences do not predict the future. Meera’s sense of agency and hope increased as she built the links between her actions today and her future outcome. The therapist used a mixture of general suggestions (e.g., “Every choice you make today will help to contribute to what tomorrow is like for you.”) and concrete suggestions (e.g., “Every time you choose to do your physio exercises you are helping yourself get better and better.”)."

 

You just can tell that they're witches by the way they were dunked in water

 

Could just as easily be replaced with:

Actually, this one works even better given, you know, ugh:

The whole thing is completely back-asswards. These people are not serious.

 

I thought pushing difficult thoughts and feelings out of your mind was supposed to be a positive thing in the context of "functional" illnesses, since negative thoughts/feelings are considered to reinforce the catastrophic thinking. But here they consider pushing negative thoughts/feelings away to be illness-promoting. Of course they have no evidence that these are "illness-promoting" rather than "generated by illness." It's all nonsense.

 

Heads they win. Tails they win. No tossing they also win.