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Strategic Symptom Displacement in Therapy of a Motor Conversion Disorder Comorbid with PTSD: Case Presentation

  • Valery Krupnik
  • Mariya V. Cherkasova
Original Paper
  • 10 Downloads

Abstract

There is no psychotherapy of choice for conversion disorders. We present a case of a motor conversion disorder comorbid with posttraumatic stress disorder, where we designed a psychotherapeutic approach based on the Bayesian model of brain functioning, specifically, the Bayesian model of functional neurologic symptoms. The model posits that such symptoms are produced as a result of hyper-precise prior beliefs (priors). Priors can be both conscious and unconscious and exist at different levels from perceptual to cognitive. Decreasing their precision/rigidity may then alleviate the related symptoms. In accord with this rationale, we used cognitive, experiential, and behavioral interventions meant to target and modify the putative priors. Central to this strategy was strategic symptom displacement. Application of this intervention coincided with reduction of the target motor symptom, indicating a possibility of causal relationship. We suggest strategic symptom displacement as an integral part of a universal therapeutic approach targeting priors: strategic modification of priors.

Keywords

Functional symptoms PTSD Integrative psychotherapy Bayesian brain Priors 

Notes

Acknowledgements

This research did not receive funding from agencies in the public, commercial, or not-for-profit sectors. We want to thank our patient, who agreed that his treatment case be made public. MVC joined the project at the stage of conceptualizing and writing the paper and had no part in the clinical work.

Compliance with Ethical Standards

Conflict of interest

Valery Krupnik and Mariya V. Cherkasova declare that they have no conflict of interest.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.CrossRefGoogle Scholar
  2. Azrin, N. H., & Nunn, R. G. (1973). Habit-reversal: A method of eliminating nervous habits and tics. Behaviour Research and Therapy, 11, 619–628.  https://doi.org/10.1016/0005-7967(73)90119-8.CrossRefPubMedGoogle Scholar
  3. Badcock, P. B., Davey, C. G., Whittle, S., Allen, N. B., & Friston, K. J. (2017). The depressed brain: An evolutionary systems theory. Trends in Cognitive Sciences, 21, 182–194.CrossRefGoogle Scholar
  4. Boyd, B., Rodgers, C., Aupperle, R., & Jak, A. (2016). Case report on the effects of cognitive processing therapy on psychological, neuropsychological, and speech symptoms in comorbid PTSD and TBI. Cognitive and Behavioral Practice, 23, 173–183.CrossRefGoogle Scholar
  5. Brooks, J. L., Goodfellow, L., Bodde, N. M. G., Aldenkamp, A., & Baker, G. A. (2007). Nondrug treatments for psychogenic nonepileptic seizures: What’s the evidence? Epilepsy & Behavior, 11, 367–377.  https://doi.org/10.1016/j.yebeh.2007.05.007.CrossRefGoogle Scholar
  6. Clark, A. (2013). Whatever next? Predictive brains, situated agents, and the future of cognitive science. Behavioral and Brain Sciences, 36, 181–204.CrossRefGoogle Scholar
  7. Edwards, M. J., Adams, R. A., Brown, H., Pareés, I., & Friston, K. J. (2012). A Bayesian account of ‘hysteria’. Brain, 135, 3495–3512.  https://doi.org/10.1093/brain/aws129.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Friston, K. (2010). The free-energy principle: A unified brain theory? Nature Reviews Neuroscience, 11, 127–138.  https://doi.org/10.1038/nrn2787.CrossRefPubMedGoogle Scholar
  9. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16, 606–613.  https://doi.org/10.1046/j.1525-1497.2001.016009606.x.CrossRefPubMedPubMedCentralGoogle Scholar
  10. LaFrance, W. C., Miller, I. W., Ryan, C. E., Blum, A. S., Solomon, D. A., Kelley, J. E., & Keitner, G. I. (2009). Cognitive behavioral therapy for psychogenic nonepileptic seizures. Epilepsy & Behavior, 14, 591–596.  https://doi.org/10.1016/j.yebeh.2009.02.016.CrossRefGoogle Scholar
  11. Moutoussis, M., Fearon, P., El-Deredy, W., Dolan, R. J., & Friston, K. J. (2014). Bayesian inferences about the self (and others): A review. Consciousness and Cognition, 25, 67–76.CrossRefGoogle Scholar
  12. Neer, S. M., Trachik, B., Munyan, B. G., & Beidel, D. C. (2016). Comprehensive treatment. Clinical Case Studies, 15, 343–359.  https://doi.org/10.1177/1534650116643401.CrossRefGoogle Scholar
  13. Ness, D. (2007). Physical therapy management for conversion disorder: Case series. Journal of Neurologic Physical Therapy, 31, 30–39.  https://doi.org/10.1097/01.NPT.0000260571.77487.14.CrossRefPubMedGoogle Scholar
  14. Nielsen, G., Stone, J., & Edwards, M. J. (2013). Physiotherapy for functional (psychogenic) motor symptoms: A systematic review. Journal of Psychosomatic Research, 75, 93–102.CrossRefGoogle Scholar
  15. Pellicano, E., & Burr, D. (2012). When the world becomes ‘too real’: A Bayesian explanation of autistic perception. Trends in Cognitive Sciences, 16, 504–510.CrossRefGoogle Scholar
  16. Powers, A., Mathys, C., & Corlett, P. (2017). Pavlovian conditioning-induced hallucinations result from overweighting of perceptual priors. Science, 357, 596–600.CrossRefGoogle Scholar
  17. Resick, P. A., & Schnicke, M. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park: Sage.Google Scholar
  18. Robbins, J. M., & Kirmayer, L. J. (1991). Cognitive and social factors in somatization. In J. M. Robbins & L. J. Kirmayer (Eds.), Current concepts of somatization: Research and clinical perspectives (Vol (31, pp. 107–141). Arlington, VA: American Psychiatric Association.Google Scholar
  19. Rusch, M. D., Morris, G. L., Allen, L., & Lathrop, L. (2001). Psychological treatment of nonepileptic events. Epilepsy & Behavior, 2, 277–283.  https://doi.org/10.1006/ebeh.2001.0180.CrossRefGoogle Scholar
  20. Schönfeldt-Lecuona, C., Connemann, B. J., Viviani, R., Spitzer, M., & Herwig, U. (2006). Transcranial magnetic stimulation in motor conversion disorder: A short case series. Journal of Clinical Neurophysiology, 23, 473–476.CrossRefGoogle Scholar
  21. Shapiro, A. P., & Teasell, R. W. (2004). Behavioural interventions in the rehabilitation of acute chronic non-organic (conversion/factitious) motor disorders. The British Journal of Psychiatry, 185, 140–146.  https://doi.org/10.1192/bjp.185.2.140.CrossRefPubMedGoogle Scholar
  22. Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd ed.). New York: Guilford Press.Google Scholar
  23. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.CrossRefGoogle Scholar
  24. Stone, J., Carson, A., Aditya, H., Prescott, R., Zaubi, M., Warlow, C., & Sharpe, M. (2009). The role of physical injury in motor and sensory conversion symptoms: A systematic and narrative review. Journal of Psychosomatic Research, 66, 383–390.  https://doi.org/10.1016/j.jpsychores.2008.07.010.CrossRefPubMedGoogle Scholar
  25. Stone, J., & Edwards, M. J. (2011). How “psychogenic” are psychogenic movement disorders? Movement Disorders, 26, 1787–1788.  https://doi.org/10.1002/mds.23882.CrossRefPubMedGoogle Scholar
  26. Voon, V., & Lang, A. E. (2005). Antidepressant treatment outcomes of psychogenic movement disorder. The Journal of Clinical Psychiatry, 66, 1529–1534.  https://doi.org/10.4088/JCP.v66n1206.CrossRefPubMedGoogle Scholar
  27. Wortmann, J. H., Jordan, A. H., Weathers, F. W., Resick, P. A., Dondanville, K. A., Hall-Clark, B.,… Hembree, E. A. (2016). Psychometric analysis of the PTSD Checklist-5 (PCL-5) among treatment-seeking military service members. Psychological Assessment, 28, 1392–1403.  https://doi.org/10.1037/pas0000260.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Mental Health DepartmentNaval Hospital Camp PendletonCamp PendletonUSA
  2. 2.University of British ColumbiaVancouverCanada

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