Cognitive Behavior Therapy for Functional Neurological Disorder: A Systematic Review of Therapeutic Structure and Clinical Impact

Abstract

Cognitive Behavioral Therapy (CBT) is widely used in the management of Functional Neurological Disorder (FND); however, its reported efficacy varies across studies. Existing systematic reviews often rely on limited or outdated evidence and do not sufficiently differentiate the impact of session structure, therapeutic approach, and delivery format. This review aims to evaluate the clinical effectiveness of CBT for FND by examining variations in session formats, therapeutic components, and modes of delivery, and to explore its applicability in non-Western contexts, particularly in Pakistan. In accordance with PRISMA guidelines, this systematic review included randomized controlled trials (RCTs), prospective studies, and case series investigating CBT for FND across Western and Eastern settings. Findings were interpreted within the bio-psycho-social framework. Most studies implemented a structured 12-session, weekly CBT protocol lasting approximately 60 min per session. Interventions primarily involved manualized CBT emphasizing psychoeducation and cognitive restructuring. Treatment was predominantly delivered individually in face-to-face outpatient settings, although some studies incorporated group formats or combined CBT with physiotherapy. Overall, CBT demonstrated improvements in symptom severity, functional outcomes, and psychosocial wellbeing. The evidence supports CBT as an effective intervention for FND symptom management. However, its impact appears influenced by cultural and healthcare contexts, underscoring the importance of culturally sensitive and region-specific adaptations, particularly for implementation in Pakistan.