Hypnosis in the treatment of functional neurological disorder

Michael H. Connors
Centre for Healthy Brain Ageing, University of New South Wales, Sydney, Australia

P. Quinton Deeley
Cultural and Social Neuroscience Research Group, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK

Correspondence: m.connors@unsw.edu.au

Keywords: conversion disorder, functional neurological disorder, hypnosis, hysteria, suggestion

Functional neurological disorder (FND) involves neurological symptoms – such as weakness, sensory loss, and seizures – that are incompatible with recognised neurological disease (Hallett et al., 2022). The condition is thought to arise from altered functioning of the nervous system with contributions from neuropsychiatric mechanisms, such as distorted bodily awareness, sensory-motor expectancies, and dissociation. The condition has also been known as “hysteria” and “conversion disorder.” It is common in neurology clinics and associated with significant morbidity.

Hypnosis and suggestion have long been used to treat FND (Deeley, 2016b). This includes seminal figures, such as Charcot, Freud, Janet, and Babinski (Gauld, 1992). Hypnosis and suggestion have been considered particularly appropriate as treatments given phenotypic similarities between the effects of suggestions and the symptoms of FND, such that common underlying mechanisms are possible (Deeley, 2016a). Consistent with this, people with FND are typically more suggestible than the general population (Wieder et al., 2021). The neural correlates of FND and hypnotically-suggested symptoms also resemble each other in functional neuroimaging (Deeley, 2016a; Halligan et al., 2000; but see Cojan et al., 2009).

Treatments for FND involving hypnosis have employed two general strategies: (i) suggestions designed to treat specific symptoms (symptom-oriented) and (ii) suggestions designed to uncover psychological factors, such as trauma or interpersonal or intrapsychic conflict, that might contribute to the symptoms (insight-oriented; Moene & Roelofs, 2008). Techniques for both strategies vary and include direct, indirect, and post-hypnotic suggestions; self-hypnosis; and, historically, use of sedative drugs coupled with clinical interview. Techniques can be tailored to individuals and adapted to different theoretical paradigms.

More than 35 studies have been conducted using hypnosis and/or suggestion to treat FND over the last century, including five randomised controlled trials (Connors et al., 2024). All studies reported patient improvement and almost all inferred specific contributions of hypnosis and suggestion. Across studies, more than 80% of patients who received either intervention demonstrated clinically significant improvements (Connors et al., 2024). More than 75% had complete or almost complete resolution of symptoms, at least in the short-term.

These findings are in contrast to the usual course of FND, which has much lower remission rates. The outcomes are comparable or superior to more commonly used interventions, such as psychotherapy, physiotherapy, pharmacotherapy, and neurostimulation. Most studies, however, suffered from design limitations that restrict their conclusions. Such limitations are similarly present in studies of other interventions and not unique to hypnosis and suggestion.

The best quality evidence for hypnotic suggestion in the treatment of FND comes from two randomised controlled trials. These trials found that weekly outpatient sessions led to improvements relative to a waitlist control (Moene et al., 2003), but did not provide additional benefits over intensive inpatient physiotherapy (Moene et al., 2002). These findings imply that clinical setting and concurrent interventions may moderate treatment effects. Other factors – such as patient suggestibility, symptom duration, and the suggestions used – could also influence treatment outcomes, though have not been examined in detail.
Altogether, hypnosis and suggestion appear to be promising treatments for FND. Further well-designed clinical trials, however, are needed to more clearly demonstrate efficacy and determine treatment characteristics.

References
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Connors, M. H., Quinto, L., Deeley, Q., Halligan, P. W., Oakley, D. A., & Kanaan, R. A. (2024). Hypnosis and suggestion as interventions for functional neurological disorder: A systematic review. General Hospital Psychiatry, 86, 92-102. https://doi.org/10.1016/j.genhosppsych.2023.12.006

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