Functional Neurological Disorder Therapy Across Ontario

Brainstem and midbrain level

Most therapies start where the story starts. DBR starts a half-second earlier.

Developed by Dr. Frank Corrigan, Deep Brain Reorienting follows the shock sequence in the order the brainstem actually runs it: the orienting tension in the neck and head, then the shock, then the emotion. For people living with FND this matters, because many of the body’s stuck patterns are held in those pre-emotional midbrain circuits, below the reach of insight or reasoning. DBR is slow, quiet, and unusually gentle, and there is no requirement to narrate anything in detail. A Canadian randomised trial delivered DBR entirely by videoconference, which is part of why we are comfortable offering it online (Kearney et al., 2023, European Journal of Psychotraumatology, doi:10.1080/20008066.2023.2240691).

Reprocessing stuck experience

EMDR helps the brain finish processing experiences that got frozen mid-file.

For clients with functional neurological symptoms, that often includes the medical experiences themselves: the collapse in the grocery store, the emergency room visit where nobody believed you, the appointment where your body was described as a mystery. We adapt EMDR carefully for sensitized nervous systems, working in short, titrated sets and staying well inside your window of tolerance. EMDR and DBR for FND are frequently used alongside each other rather than instead of each other. EMDR now has its first FND-specific randomised study: MODIFI allocated 50 adults with FND (80% motor symptoms, 64% functional seizures, 32% cognitive) to an FND-focused EMDR protocol alongside standard neuropsychiatric care, or that care alone. Adherence ran at 88%, and the EMDR arm reported greater satisfaction and greater improvement, with larger reductions in PTSD, depression, anxiety, dissociation and disability (Cope et al., 2025, Journal of Neurology, doi:10.1007/s00415-025-13219-5). It was designed to test feasibility rather than prove efficacy, and the authors are clear a full-scale trial is the next step.

Working with the body directly

Somatic therapy for FND treats the body as a participant, not a problem to be managed.

Together we build the skills your system is missing: noticing early activation before it escalates, releasing bracing patterns, orienting to the room, and relearning that stillness is survivable. Over time, many clients report that symptoms arrive less often, pass more quickly, or feel less frightening when they do arrive, because the underlying alarm is turning down. This is slow work by design, and it is paced to what your nervous system can actually absorb.

The cycle around the symptom

CBT works on the loop that builds up around your symptoms, not only on the symptoms themselves.

With functional neurological symptoms, a second problem usually forms on top of the first one. You start scanning for early signs. You avoid stairs, driving, crowds, or being alone. You brace before the thing that might happen. Each of those responses is completely reasonable, and each one quietly feeds the alarm that produces the symptoms. Cognitive Behavioural Therapy for FND maps that cycle with you, then works on it deliberately: identifying triggers and early warning signs, loosening avoidance and hypervigilance, testing the predictions your nervous system keeps making, and rebuilding activity in graded steps that do not overshoot. It pairs well with the body-based work, and it is often the piece that makes daily life navigable again while the deeper processing continues.

On the evidence: the CODES trial, the largest randomised trial of CBT for dissociative seizures (368 adults across 27 UK neurology services), found no significant difference in monthly seizure frequency at 12 months compared with standardised medical care alone. However, nine of sixteen secondary outcomes favoured the group who received CBT, including longer seizure-free periods, better psychosocial functioning, and greater self-rated and clinician-rated improvement (Goldstein et al., 2021, Health Technology Assessment, doi:10.3310/hta25430). We share this openly rather than overstating it: CBT is a useful part of FND care, and it is not a cure on its own.

Emotion, not just cognition

Some symptoms are held in feelings that were never safe to have.

Emotional Awareness and Expression Therapy works with avoided emotion, anger, grief, guilt, fear, rather than with thoughts about the symptom. For FND this matters when symptoms track with conflict, suppressed anger or unexpressed loss, which is common. In a randomised trial of 126 older adults with chronic musculoskeletal pain, EAET outperformed CBT: 63% achieved at least a 30% reduction in pain severity compared with 17% for CBT (Yarns et al., 2024, JAMA Network Open, doi:10.1001/jamanetworkopen.2024.15842). That was a chronic pain trial rather than an FND trial, and we would rather say so than imply otherwise.

Focused attention, not stage tricks

Clinical hypnosis uses focused attention to change how the brain routes a signal.

There is nothing here about losing control or being made to do anything. It is structured suggestion and imagery, used to influence movement, sensation and gut signalling at the level where those signals are generated. Hypnosis beat a waiting list on motor symptoms and disability in 44 outpatients with motor FND, and the gains held at six months (Moene et al., 2003, doi:10.1076/iceh.51.1.29.14067). We treat it as a useful component, not a standalone cure.

Rebuilding self-trust

A good portion of FND recovery is learning to read your own signals again.

You learn to pace without punishing yourself. You learn which early cues predict a flare and what actually helps in the first ninety seconds. You learn to stop treating your body as an unreliable narrator. That shift, from fighting your nervous system to working with it, is often where movement starts. It also tends to reduce the fear-symptom loop, where anticipating an episode makes an episode more likely.