Emotion Regulation And Symptom Management: The Role Of Dialectical Behavior Therapy In Women With Functional Neurological Disorder

Abstract

This study is conducted in Pakistan, and it examined a modified version of Dialectical Behavioral Therapy aimed at dealing with Emotion Dysregulation may help women with Functional Neurological Disorder (FND). A clinical trial was done on 92 Female Participants (ages 18-55) diagnosed according to DSM5 criteria of FND. Participants were randomly assigned either to an experimental group receiving 20 weeks of DBT-FND (individual + group skills training with adaptations based on Urdu/Islamic culture) or to a waitlist/treatment-as-usual control group. All assessments were completed using valid and reliable Urdu language instruments at baseline, mid-point, post-treatment, and follow-up at three months after completion of treatment. The assessments included emotion regulation assessed with the DERS, PMDRS and SOMS-7 to determine the level of severity of symptoms, PHQ-9, GAD-7, and PCL-5 to assess distress, WHODAS and WHOQOL-BREF to assess level of functioning and quality of life. Intention-to-treat analysis using mixed models yielded large effect sizes for DBT-FND including improved emotion regulation (d = 1.42, p < 0.001), decreased PMDRS (d = 1.28) and SOMS-7 (d = 1.09) severity of symptoms (both p < 0.001) as well as secondarily improved feelings of depression, anxiety, and PTSD (d = 1.11-1.36), functioning, and quality of life. There were statistically significant numbers of DBT-FND participants demonstrating reliable change (71.7%) compared to only 8.7% of the participants in the control group. Emotion regulation was found to be fully mediated the reduction of symptoms for DBT-FND participants (indirect effect = −14.01, 95% CI [–18.64, –9.58]). Results demonstrated that the greater the degree of prior trauma/shame a participant experienced, the stronger their response to therapy was. DBT-FND is feasible (6.5% attrition), acceptable and superior to treatment as usual in a low- and middle-income (LMIC) country context(s).