Acceptance and Commitment Therapy for Functional Cognitive Disorder
Research type
Research Study
Full title
Acceptance and Commitment Therapy (ACT) for Functional Cognitive Disorders (FCD) - an NIHR funded feasibility study
IRAS ID
313730
Contact name
Norman Poole
Contact email
Sponsor organisation
South West London & St George's NHS Mental Health Trust
ISRCTN Number
ISRCTN12939037
Duration of Study in the UK
1 years, 7 months, 26 days
Research summary
Summary of Research
Functional Cognitive Disorder (FCD) describes patients who experience real difficulties with their memory yet show no signs of a neurological degeneration, such as dementia. Brain scans and other investigations do not reveal an abnormality that could account for the symptoms. Over the past decade, increased numbers of people have been assessed in Diagnostic Memory Clinics (DMCs), a significant proportion of whom are found to suffer with FCD. Despite the symptoms being disabling and persistent, it is unclear how to help these patients.The cause of these memory symptoms is not well understood. Most researchers believe that low mood and anxiety contribute to their development, but are not the full explanation. It has been proposed that patients with FCD are unusually alert to memory lapses. These lapses in turn amplify fear of memory failure and doubts about the accuracy of recalled memories.
There is some evidence that brief psychological treatments can be beneficial. However, the majority of studies to date have been of low quality. Also, the proposed interventions were lengthy, involving up to 13 one-hour long sessions. Therefore, an effective brief intervention that can be delivered at scale is required.
At St George's Hospital, a centre of excellence for functional neurological disorders, we have developed a five-session group intervention which delivers Acceptance and Commitment Therapy (ACT) adapted for those with FCD. The treatment aims to reduce the threat of the memory failures and improve quality of life despite their presence. It will be delivered online via video call.
We aim to study the feasibility of delivering a Randomised Control Trial (RCT) of the group intervention. We will compare the outcome of those with FCD who receive the intervention with treatment as usual. If predefined criteria of success are met, we plan to seek funding for a definitive RCT.
Summary of Results
: The study evaluated the feasibility of a future randomised controlled trial (RCT) for Acceptance and Commitment Therapy (ACT) tailored for Functional Cognitive Disorder (FCD). Traditionally, FCD management involves reassurance and discharge to primary care, but emerging evidence supports the potential benefits of psychological interventions.
In this study, 44 participants were recruited from cognitive neurology, neuropsychiatry, and memory clinics in London. They were allocated to either the ACT intervention or standard treatment as usual (TAU) only. The five- session online ACT intervention focused on education, mindfulness exercises, and encouraging values-driven behaviour. Outcome measures, including assessments of psychological flexibility, quality of life, memory, anxiety, depression, and healthcare utilisation, were taken at the start and again at two, four, and six months. Additional interviews were conducted to learn about participants’ experiences.
The study found that it was possible to recruitment and engage participants in the study. Participants who had the ACT intervention reported good levels of satisfaction compared to none in the TAU group. Modest improvements were observed in psychological flexibility, quality of life, mood, and memory satisfaction, and there was a trend towards reduced use of outpatient services and psychological counselling in the ACT group. The trial was safe, with no serious adverse events occurring.
Overall, the study demonstrated that a future definitive trial of ACT for FCD is feasible, with high adherence, positive participant feedback, and potential efficacy. Recruitment from memory clinics proved more challenging than expected. Future studies should aim to enhance engagement with clinicians in memory clinics, offer more flexible session schedules, and consider more active control conditions. Additionally, streamlining data collection and selecting a clinically meaningful primary outcome measures will be crucial.REC name
South East Scotland REC 02
REC reference
22/SS/0059
Date of REC Opinion
30 Sep 2022
REC opinion
Further Information Favourable Opinion