FND Education Project

REFERENCE · RECOVERY TECHNIQUE

Seizure-Focused Psychological Treatment for Functional Seizures

Most likely fit: When the person wants structured help with episodes, their consequences, avoidance or other personally relevant treatment goals. [Research-supported programmes with mixed outcomes; individual components are not independently proven]

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What a seizure-focused therapy can address

CBT means cognitive behavioural therapy: working with patterns of attention, expectations, actions and circumstances. A seizure-focused programme may help you choose warning strategies, make activities more manageable or address distress where it matters to you. Referral does not mean your symptoms are imagined or that trauma must explain them. [1][2][3]

A formulation is a shared working explanation used to choose treatment. It can change when information changes. It should fit your experience rather than require you to endorse a fixed story about stress. You can ask which part of treatment targets the seizures and which part addresses another condition.

Starting with a practical goal

An example is “I want a manageable way to visit a friend, with a safe plan if an event happens.” The therapist can help identify barriers, agree a small task and review its effects. Another person may begin with recovery time or communication. You should be able to decline an exercise, ask to slow down or use shorter sessions.

If discussing symptoms brings on an episode, pause and follow the safety plan. Detailed retelling, exposure and trauma work should not be imposed. A continued seizure is not evidence that you thought incorrectly or failed at therapy.

The existing resource map and booklet plans explain learning materials. The planned booklets are not a finished treatment manual.

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With permission, ask how to support one agreed treatment goal. Help arrange transport, appointment access, quiet practice time or note-taking. Avoid becoming a therapist who checks every thought or scores compliance.

During a flare, use the agreed response and postpone problem-solving. Review what support was helpful later. The person’s choice to continue, change or stop a particular therapy deserves a discussion with their care team.

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Explicit procedure

  1. Confirm diagnostic communication, medical follow-up and an event safety plan.
  2. Ask about the person’s goals, prior treatment experiences and access needs; offer an informed choice of available approaches.
  3. Build a collaborative formulation, distinguishing hypothesis from fact and including physical and social circumstances.
  4. Choose one target and explain the proposed skill and its limits before rehearsal.
  5. Agree a feasible between-session task, with a less demanding version and a stopping rule.
  6. Review benefit, burden and adverse effects; adapt rather than interpret difficulty as resistance.
  7. Coordinate any treatment for PTSD, depression, pain or sleep with the appropriate clinician.
  8. Plan continuing support and relapse review whether or not seizure frequency changes.

Evidence, outcomes and progression

The CODES adult trial randomized 368 people. Its primary monthly seizure-frequency outcome at 12 months did not differ significantly; several secondary outcomes favoured CBT, including aspects of functioning and quality of life. Secondary comparisons were not adjusted for multiplicity. This supports a balanced discussion, not a claim that CBT reliably stops seizures. The smaller earlier trial provides pilot evidence. [2][3]

Track the person’s chosen activity, distress, safety, recovery burden and adverse effects as well as episodes. Increase task demands collaboratively, with accommodations retained where needed. This page is a referral and treatment-planning framework, not a substitute for competence in a seizure-focused psychotherapy.

Basis and evidence boundary

AAN describes psychological interventions as possibly effective. CODES and the pilot evaluate treatment packages, not proof of each worksheet, thought exercise or grounding component. [1][2][3]

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Research and Sources

Citation Full citation and source
[1] Tolchin B, Goldstein LH, Reuber M, Stone J, Perez DL, LaFrance WC Jr, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. https://doi.org/10.1212/WNL.0000000000214466 FND-CIT-0010.
[2] Goldstein LH, Robinson EJ, Mellers JDC, et al.; CODES study group. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial. The Lancet Psychiatry. 2020;7(6):491–505. https://doi.org/10.1016/S2215-0366(20)30128-0 FND-CIT-0033.
[3] LaFrance WC Jr, Baird GL, Barry JJ, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014;71(9):997–1005. https://doi.org/10.1001/jamapsychiatry.2014.817 FND-CIT-0032.

Created September 14, 2026 · Neurology, relevant therapy, lived-experience, caregiver and accessibility review pending

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —