Richardson Matt, Kleinstäuber Maria, Wong Dana
Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Puāwai Rehabilitation Unit, Wakari Hospital, Dunedin, New Zealand.
Mov Disord. 2025 Jul;40(7):1331-1342. doi: 10.1002/mds.30195. Epub 2025 May 12.
A previous case series showed that Nocebo Hypothesis Cognitive Behavioral Therapy (NH-CBT) is a promising treatment for Functional Neurological Symptom Disorder (FNSD).
To further evaluate the potential efficacy of NH-CBT in participants with FNSD (motor type).
This phase IIb pilot, randomized, parallel group trial compared the efficacy of NH-CBT (n = 20) with an active control condition (n = 19). Self-report scales of motor and other physical symptoms, psychological variables, and blinded assessor ratings of participants' mobility were administered at baseline, and at 8- and 16-week follow-ups. The primary outcome and endpoint of this trial was the Physical Functioning scale of the Short Form-36 Health Questionnaire (SF-36 PF) at the end of treatment.
Regarding the primary endpoint (SF-36 at the end of treatment), we did not identify a significant between-group effect (d = 0.21, 95% CI: -0.42-0.84). Significant between-group effects in favor of NH-CBT were identified for several secondary outcomes (motor symptoms: d = 0.67, 95% CI: 0.02-1.32; mobility: d = 0.70, 95% CI: 0.05-1.35; symptom perception "concern": d = 0.66, 95% CI: 0.01-1.31). Changes in outcomes within the NH-CBT group showed large effects (d > 0.80) for the primary outcome (SF-36 PF) and the majority of secondary measures post-treatment. A significantly greater proportion of NH-CBT (85%) than control participants (47%) showed full recovery of motor symptoms (P = 0.013).
NH-CBT resulted in large within-group effects on the primary outcome as well as the majority of secondary measures in the NH-CBT group and a greater proportion of fully recovered participants compared with an active control treatment. These promising findings warrant a definitive trial. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
先前的病例系列研究表明，反安慰剂假说认知行为疗法（NH-CBT）是治疗功能性神经症状障碍（FNSD）的一种有前景的疗法。
进一步评估NH-CBT对FNSD（运动型）患者的潜在疗效。
这项IIb期试点随机平行组试验比较了NH-CBT组（n = 20）和积极对照组（n = 19）的疗效。在基线、8周和16周随访时，采用运动及其他身体症状的自我报告量表、心理变量以及对参与者活动能力的盲法评估。本试验的主要结局和终点是治疗结束时简短36项健康调查问卷（SF-36）的身体功能量表（SF-36 PF）。
关于主要终点（治疗结束时的SF-36），我们未发现显著的组间效应（d = 0.21，95%CI：-0.42 - 0.84）。在几个次要结局方面发现了有利于NH-CBT的显著组间效应（运动症状：d = 0.67，95%CI：0.02 - 1.32；活动能力：d = 0.70，95%CI：0.05 - 1.35；症状感知“担忧”：d = 0.66，95%CI：0.01 - 1.31）。NH-CBT组内结局的变化在治疗后对主要结局（SF-36 PF）和大多数次要指标显示出较大效应（d > 0.80）。与对照组参与者（47%）相比，NH-CBT组中运动症状完全恢复的参与者比例显著更高（85%）（P = 0.013）。
与积极对照治疗相比，NH-CBT在NH-CBT组对主要结局以及大多数次要指标产生了较大的组内效应，且完全康复的参与者比例更高。这些有前景的发现值得进行确定性试验。© 2025作者。《运动障碍》由威利期刊有限责任公司代表国际帕金森和运动障碍协会出版。
