Telehealth provision of Retraining and Control Therapy (ReACT) on cognitive and biopsychosocial functioning in pediatric functional neurological disorder

Caroline Watson; Lindsay Stager; Badhma Valaiyapathi; Burel R Goodin; Jerzy P Szaflarski; Aaron D Fobian

doi:10.1016/j.jpsychores.2025.112112

Telehealth provision of Retraining and Control Therapy (ReACT) on cognitive and biopsychosocial functioning in pediatric functional neurological disorder

J Psychosom Res. 2025 May:192:112112. doi: 10.1016/j.jpsychores.2025.112112. Epub 2025 Mar 25.

Authors

Caroline Watson¹, Lindsay Stager¹, Badhma Valaiyapathi², Burel R Goodin¹, Jerzy P Szaflarski³, Aaron D Fobian⁴

Affiliations

¹ Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.
² Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: afobian@uabmc.edu.

PMID: 40168888
PMCID: PMC12021547 (available on 2026-05-01)
DOI: 10.1016/j.jpsychores.2025.112112

Abstract

Introduction: Retraining and Control Therapy (ReACT) has been shown to improve functional seizure (FS) frequency. This prospective observational study evaluated the effects of ReACT on mixed functional neurological disorder (FND) symptoms and the maintenance of outcomes 6-months post-treatment. We hypothesized that all mixed FND symptoms and other biopsychosocial outcomes would improve following ReACT.

Methods: Adolescents ages 11-18 with FS completed one in-person and 11 telehealth ReACT sessions. Participants self-reported FS frequency for 30-days pre-treatment, 30-days post-treatment, and 30-days at 6-months post-treatment. Cognitive performance was assessed at baseline and 1-week post-treatment. Other biopsychosocial assessments and FND symptoms were self-reported at baseline, 1-week post-treatment, and 6-months post-treatment. Descriptive statistics assessed changes in FND symptoms. Paired-samples t-tests and ANOVAs assessed changes in cognitive and biopsychosocial outcomes.

Results: The final sample included 34 consecutively enrolled adolescents (82.4 % Female sex; 70.6 % White; M_age = 15.4, SD = 1.9) who completed 12 sessions of ReACT and 1-week post-treatment assessments. Twenty-eight adolescents completed 6-months post-treatment assessments. At 30-days and 6-months post-treatment, 94 % and 87 % of adolescents reported ≥50 % reduction in FS, respectively, and 62 % and 61 % reported FS freedom, respectively. At 1-week post-treatment, 60 %, 60 %, and 80 % of adolescents who previously reported positive motor (excluding FS), negative motor, or psychological/cognitive FND symptoms, respectively, reported symptom freedom. By 6-months post-treatment, these percentages were 75 %, 70 %, and 100 %. Biopsychosocial outcomes improved and were maintained or continued to improve at 6-months post-treatment.

Conclusion: At 6-months post-ReACT, adolescents with FND experienced broad functional and biopsychosocial improvements. Telehealth provision demonstrates the potential to expand treatment access.

Keywords: Adolescents; Functional neurological disorder; Functional seizures; Health-related quality of life; Telehealth.

Publication types

Observational Study

MeSH terms

Adolescent
Child
Female
Humans
Male
Nervous System Diseases* / therapy
Prospective Studies
Seizures* / therapy
Telemedicine
Treatment Outcome

Abstract

Publication types

MeSH terms

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