Breaking the Cycle: Unhelpful Thinking, Functional Neurological Disorder (FND), and the Role of Cognitive Behavioural Therapy (CBT)

Understandably, FND can be a confusing and scary time. When we consider the impact on physical symptoms, it can be overwhelming and filled with uncertainty about the future. At times like these, we tend to forget our strengths and our ability to cope as things can appear out of control. This can lead us to worry daily and feel like our worries are taking over!

Worry in Functional Neurological Disorder

How do you respond when you notice worrying thoughts about your symptoms? Many may respond saying they try not to think about it and may even try to push those unsettling thoughts away. We can end up putting a lot of mental time and effort into trying to not think about worrying thoughts. However, trying not to think about something does not always work. Essentially, we end up putting a lot of emphasis onto these unwanted thoughts, so it becomes easy for them to pop up uninvitingly and to get stuck in a web of worries. In essence, telling your brain to not think about something will only prompt your brain to think about it more. The brain does not realise you are wanting to dismiss these worrying thoughts; it just recognises the emphasis you are putting on them therefore thinking ‘these must be important, so I’ll hold onto them!’ We then become more distressed by the frequency of these thoughts, and they become harder to dismiss. A vicious cycle!     

You’re not alone!

Understanding Unhelpful Thinking Patterns

Negative information is stored and held onto more than positive information, which basically means we are genetically predisposed to think more negatively; not always helpful! However, it is one of the reasons why we are such a successful species in survival; we’re experts at risk assessing! Therefore, we can often catastrophise and jump to worst case predictions, have a plan a, b, c and perhaps d and e (some more than others). If I was to ask you of three positive thoughts you had today, you may struggle to recall three or take some time to consider these. However, if I ask you to remember three negative thoughts you had today, you’d probably be able to get the ball rolling by thinking of at least one within 10 seconds. Negative information is held onto in case it is required for survival. Today, most of us live in environments where physical threats are greatly reduced, but our brains haven’t entirely caught up and those survival mechanisms are still activated. They can sometimes feel out of place or excessive in modern life such as anxiety and stress over work commitments, instead of predators. Now, take a moment to consider how these thoughts and emotional responses are influenced by the physical symptoms of FND. When your body is triggered into a heightened state of anxiety or fight-or-flight mode, it becomes much harder to hold onto positive thoughts. This often leads to increased catastrophising, which can significantly affect daily life. As a result, managing FND symptoms becomes even more challenging.

Have you noticed how unhelpful thinking and worries causes unhelpful mood changes and behaviours? Are you feeling more stressed, anxious or low? Are you doing things differently? Are you avoiding things? Take a moment to question what has changed and what the long-term benefits versus repercussions are of these changes.  

How Unhelpful Thinking Affects FND

Firstly, ask yourself, how do you know when you are stressed? What do you feel physically? Perhaps, tension in your shoulders, a stiff neck, headache, uncomfortable or dodgy stomach, unable to relax, and so forth. Essentially, the stress is influencing these well-known symptoms. However, if we explore this a little closer, we may notice that it is our thinking about the stressful event/situation which is maintaining the stress and consequently the activation of these physical symptoms. For example, being in a hospital (the event/situation) may trigger a thought such as ‘what if I receive some bad news?’ and this can influence the emotional and physical responses accordingly. We can start to draw links between our thinking and the way we feel emotionally (i.e., stressed) and physically. In the same way, this is apparent for when we feel low or anxious and those physical symptoms are present, though they might present in slightly different ways. This mind-body link is notable in everyone and is important to consider with FND. In FND, this interplay is even more pronounced because the brain’s processing of bodily sensations can be altered, making physical symptoms more noticeable or distressing depending on our emotional state. Thus, it is worth considering how our thinking can influence FND symptoms. In FND the brain’s functioning is disrupted, not due to structural damage but due to problems in how signals are processed. Unhelpful thinking patterns, including worrying, can influence this misfiring.  

Types of unhelpful thinking may include “this will never get better,” “if I am not 100%, I am letting everyone down,” and “what if this gets worse?” These thoughts can often increase the physical symptoms.

It is worth noting that the symptoms in FND are real and debilitating, but the way the brain interprets stress, fear and body signals can amplify or maintain them.    

CBT Strategies for Worry and Cognitive Distortions (unhelpful thinking)

The cognitive element in CBT teaches strategies to manage thoughts in a different way. Reviewing these unhelpful thoughts and worries allows us to consider more balanced and realistic perspectives.

What is more, providing helpful strategies to manage daily worries. For instance, work on shifting attention and worry management. Facilitating more flexible thinking and a more balanced outlook in life.  

CBT also explores the rules we may put in place which may have become quite rigid. These can include unrealistic expectations we put on ourselves, ‘we ought to get better’ and ‘we should be doing more,’ or even, ‘we should stop doing things.’ Sometimes rules can work well in the short-term and can serve a helpful purpose, but sometimes they can make us feel worse. For example, if we push ourselves too hard, we can end up feeling worse. Conversely, not doing enough can lead to deconditioning or to lose a sense of our identity, pleasure in activities and a lack of accomplishment. Reviewing and updating our rules can allow us to gain a sense of fulfilment.

CBT also addresses those activities and routines we might be avoiding due to fear or anxiety. By setting meaningful goals and reflecting on what truly matters to us, we can gradually reconnect with activities and routines that we’ve been hesitant to engage in.

We are aware that an improvement in our mental health has a direct positive correlation with our physical health so targeting those symptoms of depression, anxiety and stress is important.

Therapy overall provides an opportunity to learn a range of different strategies including stress management techniques, calming our nervous system, progressive muscle relaxation, reducing hyperfocus on symptoms and mindfulness. All of which encourage reinforcement in meaningful activities and normal functioning.

From Worry to Wellness: CBT Tools for Unhelpful Thinking in FND

If you’ve been struggling with managing FND symptoms, you’re not alone. Living with FND can be challenging, but support and effective strategies are available.

Perhaps my blog has resonated with you – if so, I encourage you to take the next step toward better managing your symptoms and improving your quality of life.

Reach out today, and let’s start your journey towards wellbeing.