Intolerance of Uncertainty (IU) has never been explored in functional motor disorder (FMD) or any functional neurological disorder but perceptions of control are theoretically relevant.
Objective
To evaluate if IU changes in people with FMD completing intensive 1-week motor retraining treatment, and if IU change associates with outcome.
Methods
A consecutive cohort of 45 FMD patients completed a 1-week intensive outpatient motor retraining treatment. At program beginning and end, patients self-rated IU using the Intolerance of Uncertainty Scale-12 (IUS-12) and four functional impairment measures. Paired t-tests analyzed program changes in IU and functional outcomes. Linear regressions analyzed association strength between IU change and outcome.
Results
IU improved with FMD treatment (p < 0.001). Pre- to post-treatment IU was improved in 32/45 (71%), stable in 5/45 (11%), and worsened in 8/45 (18%). Age, symptom duration, and FMD phenotype did not predict IU improvement. Self-rated function improved across measures with treatment (p < 0.001). Program change in IU positively predicted outcome on 3 of 4 measures.
Conclusions
IU improves with FMD rehabilitation, even without explicit psychological focus of treatment, regardless of age or FMD phenotype. Improving IU associates with positive FMD treatment outcomes suggesting an important treatment target in FMD.
AybekS.LidstoneS. C.NielsenG.MacGillivrayL.BassettiC. L.LangA. E.EdwardsM. J. (2020). What is the role of a specialist assessment clinic for FND? Lessons from three national referral centers. The Journal of Neuropsychiatry and Clinical Neurosciences, 32(1), 79–84. https://doi.org/10.1176/appi.neuropsych.19040083
2.
AybekS.PerezD. L. (2022). Diagnosis and management of functional neurological disorder. BMJ (Clinical Research Ed.), 376, o64. https://doi.org/10.1136/bmj.o64
3.
BavolarJ.KacmarP.HricovaM.SchrötterJ.Kovacova-HolevovaB.KöverovaM.RaczovaB. (2023). Intolerance of uncertainty and reactions to the COVID-19 pandemic. The Journal of General Psychology, 150(2), 143–170. https://doi.org/10.1080/00221309.2021.1922346
4.
BuhrK.DugasM. J. (2009). The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation. Behaviour Research and Therapy, 47(3), 215–223. https://doi.org/10.1016/j.brat.2008.12.004
5.
CallisterM. N.KlandermanM. C.BodduS. P.MoutvicM. A.GeisslerE. N.TraverK. J.StaabJ. P.HassanA. (2023). Outpatient motor retraining for functional movement disorder: Predictors of a favorable short-term response. Movement Disorders Clinical Practice, 10(9), 1377–1387. https://doi.org/10.1002/mdc3.13844
6.
CarletonR. N.NortonM. A. P. J.AsmundsonG. J. G. (2007). Fearing the unknown: A short version of the intolerance of uncertainty scale. Journal of Anxiety Disorders, 21(1), 105–117. https://doi.org/10.1016/j.janxdis.2006.03.014
7.
CuocoS.ScannapiecoS.CarotenutoI.PicilloM.PellecchiaM. T.BaroneP.ErroR. (2023). Higher health service costs associated with delayed diagnosis of functional neurological disorder. The Journal of Neuropsychiatry and Clinical Neurosciences, 35(1), 86–91. https://doi.org/10.1176/appi.neuropsych.21110288
8.
FobianA. D.LongD. M.SzaflarskiJ. P. (2020). Retraining and control therapy for pediatric psychogenic non-epileptic seizures. Annals of Clinical and Translational Neurology, 7(8), 1410–1419. https://doi.org/10.1002/acn3.51138
9.
FobianA. D.SzaflarskiJ. P. (2021). Identifying and evaluating novel treatment targets for the development of evidence-based interventions for functional neurological disorder. Epilepsy & Behavior Reports, 16, 100479. https://doi.org/10.1016/j.ebr.2021.100479
10.
FreestonM. H.RhéaumeJ.LetarteH.DugasM. J.LadouceurR. (1994). Why do people worry?Personality and Individual Differences, 17(6), 791–802. https://doi.org/10.1016/0191-8869(94)90048-5
11.
GilmourG. S.LidstoneS. C. (2023). Moving beyond movement: Diagnosing functional movement disorder. Seminars in Neurology, 43(1), 106–122. https://doi.org/10.1055/s-0043-1763505
HallettM.AybekS.DworetzkyB. A.McWhirterL.StaabJ. P.StoneJ. (2022). Functional neurological disorder: New subtypes and shared mechanisms. The Lancet. Neurology, 21(6), 537–550. https://doi.org/10.1016/S1474-4422(21)00422-1
14.
JacobA. E.KaelinD. L.RoachA. R.ZieglerC. H.LaFaverK. (2018). Motor retraining (MoRe) for functional movement disorders: Outcomes from a 1-week multidisciplinary rehabilitation program. PM&R, 10(11), 1164–1172. https://doi.org/10.1016/j.pmrj.2018.05.011
15.
JungilligensJ.Paredes-EcheverriS.PopkirovS.BarrettL. F.PerezD. L. (2022). A new science of emotion: Implications for functional neurological disorder. Brain: A Journal of Neurology, 145(8), 2648–2663. https://doi.org/10.1093/brain/awac204
16.
KesbyA.MaguireS.BrownlowR.GrishamJ. R. (2017). Intolerance of uncertainty in eating disorders: An update on the field. Clinical Psychology Review, 56, 94–105. https://doi.org/10.1016/j.cpr.2017.07.002
17.
LidstoneS. C.Costa-ParkeM.RobinsonE. J.ErcoliT.StoneJ., & FMD GAP Study Group. (2022). Functional movement disorder gender, age and phenotype study: A systematic review and individual patient meta-analysis of 4905 cases. Journal of Neurology, Neurosurgery, and Psychiatry, 93(6), 609–616. https://doi.org/10.1136/jnnp-2021-328462
18.
McLoughlinC.HoeritzauerI.CabreiraV.AybekS.AdamsC.AltyJ.BallH. A.BakerJ.BullockK.BurnessC.DworetzkyB. A.FinkelsteinS.GarcinB.GelauffJ.GoldsteinL. H.JordbruA.HuysA.-C. M.LaffanA.LidstoneS. C., … McWhirterL. (2023). Functional neurological disorder is a feminist issue. Journal of Neurology, Neurosurgery & Psychiatry, 94(10), 855–862. https://doi.org/10.1136/jnnp-2022-330192
19.
McLoughlinC.McWhirterL.PisegnaK.TijssenM. A. J.TakL. M.CarsonA.StoneJ. (2024). Stigma in functional neurological disorder (FND)—A systematic review. Clinical Psychology Review, 112, 102460. https://doi.org/10.1016/j.cpr.2024.102460
20.
MorrissJ.AbendR.ZikaO.BradfordD. E.MertensG. (2023). Neural and psychophysiological markers of intolerance of uncertainty. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 184, 94–99. https://doi.org/10.1016/j.ijpsycho.2023.01.003
21.
MorrissJ.ZujD. V.MertensG. (2021). The role of intolerance of uncertainty in classical threat conditioning: Recent developments and directions for future research. International Journal of Psychophysiology: Official Journal of the International Organization of Psychophysiology, 166, 116–126. https://doi.org/10.1016/j.ijpsycho.2021.05.011
22.
NicholsonC.EdwardsM. J.CarsonA. J.GardinerP.GolderD.HaywardK.HumblestoneS.JinaduH.LumsdenC.MacLeanJ.MainL.MacgregorL.NielsenG.OakleyL.PriceJ.RanfordJ.RanuJ.SumE.StoneJ. (2020). Occupational therapy consensus recommendations for functional neurological disorder. Journal of Neurology, Neurosurgery, and Psychiatry, 91(10), 1037–1045. https://doi.org/10.1136/jnnp-2019-322281
23.
NielsenG.StoneJ.LeeT. C.GoldsteinL. H.MarstonL.HunterR. M.CarsonA.HoltK.MarsdenJ.Le NovereM.NazarethI.NobleH.ReuberM.StrudwickA.-M.Santana SuarezB.EdwardsM. J., & Physio4FMD study group. (2024). Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): A pragmatic, multicentre, phase 3 randomised controlled trial. The Lancet. Neurology, 23(7), 675–686. https://doi.org/10.1016/S1474-4422(24)00135-2
24.
NielsenG.StoneJ.MatthewsA.BrownM.SparkesC.FarmerR.MastertonL.DuncanL.WintersA.DaniellL.LumsdenC.CarsonA.DavidA. S.EdwardsM. (2015). Physiotherapy for functional motor disorders: A consensus recommendation. Journal of Neurology, Neurosurgery, and Psychiatry, 86(10), 1113–1119. https://doi.org/10.1136/jnnp-2014-309255
25.
O’MahonyB.NielsenG.BaxendaleS.EdwardsM. J.YogarajahM. (2023). Economic cost of functional neurologic disorders: A systematic review. Neurology, 101(2), e202–e214. https://doi.org/10.1212/WNL.0000000000207388
26.
SandhuT. R.XiaoB.LawsonR. P. (2023). Transdiagnostic computations of uncertainty: Towards a new lens on intolerance of uncertainty. Neuroscience and Biobehavioral Reviews, 148, 105123. https://doi.org/10.1016/j.neubiorev.2023.105123
27.
SerranováT.Di VicoI.TinazziM. (2023). Functional movement disorder: Assessment and treatment. Neurologic Clinics, 41(4), 583–603. https://doi.org/10.1016/j.ncl.2023.02.002
28.
SharmaV. D.JonesR.FactorS. A. (2017). Psychodynamic psychotherapy for functional (psychogenic) movement disorders. Journal of Movement Disorders, 10(1), 40–44. https://doi.org/10.14802/jmd.16038
29.
SoltaniS.NoelM.NevilleA.BirnieK. A. (2022). Intolerance of uncertainty in pediatric chronic pain: Dyadic relationships between youth and parents. The Journal of Pain, 23(9), 1581–1593. https://doi.org/10.1016/j.jpain.2022.04.004
30.
TinazziM.MorganteF.MarcuzzoE.ErroR.BaroneP.CeravoloR.MazzucchiS.PilottoA.PadovaniA.RomitoL. M.EleopraR.ZappiaM.NicolettiA.DallocchioC.ArbasinoC.BonoF.PascarellaA.DemartiniB.GambiniO., … GeroinC. (2020). Clinical correlates of functional motor disorders: An Italian multicenter study. Movement Disorders Clinical Practice, 7(8), 920–929. https://doi.org/10.1002/mdc3.13077
31.
WilsonE. J.StapinskiL.DueberD. M.RapeeR. M.BurtonA. L.AbbottM. J. (2020). Psychometric properties of the intolerance of uncertainty scale-12 in generalized anxiety disorder: Assessment of factor structure, measurement properties and clinical utility. Journal of Anxiety Disorders, 76, 102309. https://doi.org/10.1016/j.janxdis.2020.102309
