Dr. Cope addresses a popular question EMDR therapists ask: “Can I use EMDR therapy with psychogenic non-epileptic seizures (PNES)?” We learned PNES is an outdated term, replaced by functional/dissociative seizures, a potential symptom cluster that falls under functional neurological disorder (FND). We also learned a lot more about FND and EMDR therapy.

Can EMDR Therapy Help Functional Neurological Disorder (FND) or Functional Non-Epileptic Seizures?

Guest Blog Post by Dr. Sarah Cope

Tell us a little bit about you, your experience becoming an EMDR therapist, and your experience working with functional seizures and symptoms.  

Before I started my clinical psychology training at University College London (UCL), I worked in a variety of mental health settings. During my clinical psychology training, I became drawn to the embodied nature of people’s experiences and the links between brain and body. My doctoral thesis was on the connections between the experience of pain, attachment styles, and the perception of empathy from a partner. And one of my chosen training placements was at a specialist pain management service. 

After qualifying as a clinical psychologist in 2012, I worked in a primary care psychological therapy service and a community mental health team (multi-disciplinary service for complex mental health difficulties). One of my patients in the latter service experienced functional seizures, and other difficulties. Working with him was the first time that I knowingly worked with someone diagnosed with FND. I remember reading everything I could, but there was not a lot out there at that time (around 2013). I primarily used a cognitive behavioural therapy (CBT) approach.  

In 2015, I started working in a Neuropsychiatry Service, based at St. George’s Hospital in London. The clinical psychologist post was being funded due to the service needing a therapist trained in CBT, so that they could offer CBT as part of a multi-centre randomized controlled trial examining CBT for functional seizures (the CODES trial; Goldstein et al., 2020). I was the first clinical psychologist in a service that was staffed previously by neuropsychiatrists alone. Most of my caseload was patients diagnosed with FND. We developed a psychological therapy pathway within the service, and in collaboration with neurology colleagues, we developed an FND Education Session. For those with functional seizures, we created a functional seizures group based on CBT principles; and I tried over the years to develop groups for other functional neurological presentations. In my individual work, I increasingly noticed how traumatic experiences were part of a person’s formulation, but mostly not in the form of a PTSD presentation. For example, a person’s FND may have started after a relationship breakdown or stress at work; or someone may have a history of traumatic childhood experiences, but overt PTSD symptoms would not be present. I learned about EMDR and thought that this might be a useful therapy with FND patients. But I admit I was quite skeptical about it before I attended my EMDR training with Sandi Richman, but she (and the practice of EMDR) quite quickly convinced me that there was something powerful about EMDR therapy. 

Through my use of EMDR with FND patients, I found it increasingly beneficial, but I was aware there was no good quality evidence for its use with the FND population. In 2020, with colleagues Professor Mark Edwards, Dr. Jared Smith, and Dr. Sharif El-Leithy, we applied for a National Institute for Health and Care Research grant (Research for Patient Benefit funding stream), and in March 2021, we found out we had been awarded funding to carry out a randomised feasibility study evaluating EMDR for FND. We completed the MODIFI trial this year, and the results have now been published (Cope et al., 2025).  

Can you help us understand the landscape of PNES and functional neurological disorders? We have encountered various terms and acronyms, such as PNES, FNEA, FND, and conversion disorder, and we would appreciate hearing about how this language is evolving. What do these terms refer to, and who might be affected by these issues?  

The differing terms can make it confusing. FND has historically been referred to as hysteria, conversion disorder, or medically unexplained symptoms(MUS). FND (or Functional Neurological Symptom Disorder in the DSM 5) is the currently preferred term as it emphasises that there is a problem with the functioning of the nervous system, without assuming the presence of a psychological stressor. 

In terms of functional or dissociative seizures, they can also be referred to as psychogenic non-epileptic seizures or pseudo-seizures. But the International League Against Epilepsy (ILAE) has proposed that the term Functional/Dissociative Seizures (FDS) be used as the preferred term (Hingray et al., 2025) as it makes it clear that the condition sits within the broader category of FND, and the use of both ‘functional’ and ‘dissociative’ allows clinicians to flexibly use either or both terms dependent on a patient’s individual presentation. ‘Psychogenic’ or ‘Pseudo’ can imply a purely psychological basis, and this does not reflect what we know about FND as a disorder that is associated with a range of biopsychosocial processes and cannot be understood through only one lens.  

What can you tell us about the overlap, if any, with FND symptoms and dissociative symptoms? 

People diagnosed with FND are more likely to have experienced adverse events in both childhood and adulthood (compared to healthy controls), and adverse life events (including injury or illness) are associated with the triggering of FND symptoms. Trauma exposure and tendency to dissociate are, of course, linked. And dissociation itself is thought to be a core mechanism in the symptom production, particularly for those with functional seizures. There are different theories proposed to account for functional seizures, including activation of dissociated traumatic material, a panic response without recognizing the feelings of panic (a dissociative response to anxiety), a physical manifestation of emotional distress, and/or a learned response, but none of these ideas fully explain functional seizures. The Integrative Cognitive model combines these theories into a single explanatory framework (Reuber & Brown, 2017). 

The presence of dissociative symptoms or disorder is associated with more severe FND symptoms and worse quality of life. Dissociative symptoms such as depersonalization/derealization can often co-occur with FND presentations. Patients with functional seizures may describe some dissociation before a functional seizure begins (e.g., zoning out), and this can be a useful warning sign and give them time to utilize grounding strategies.  

How can EMDR therapy help treat FND?  What successes have you seen?  

In my personal clinical experience, EMDR therapy can be extremely helpful for patients with FND. It is essential to include education regarding FND in the early phases of EMDR therapy, such as discussing brain-body communication and how predictive processing and attention play a part in symptom production (Hallett et al., 2022; Edwards & Bhatia, 2012). The more a patient understands their FND, the more the threat associated with the symptoms reduces. Some people find their FND symptoms resolve after therapy, others may only have a reduction in symptoms, but generally, they will still gain greater insight into their symptoms and have a better relationship with them.  

We recently completed the MODIFI trial, a feasibility study examining EMDR for FND (Cope et al., 2023, 2025). We recruited participants from a Neuropsychiatry Service who experienced functional seizures or functional motor symptoms (such as walking difficulties, limb jerking, limb weakness, tremor) or both. They were randomized to EMDR plus usual care or usual care alone. Those randomised to EMDR attended up to 16 FND-focused EMDR sessions (completed within six months), a one-month optional follow-up session (not counted as an EMDR session), and outpatient neuropsychiatric appointments (NPC). The sessions were in-person or virtual sessions (participant choice). The standard EMDR protocol was delivered, but it was adapted for FND presentations. The initial sessions included education on FND, anxiety and dissociation; and formulating collaboratively with each participant regarding their FND symptoms development and maintenance. With the participant, target memories/images were chosen, such as:  

  • Distressing memories associated with the time when symptoms began or FND symptoms generally  
  • Distressing memories from past events that may be relevant to their FND symptoms; FND symptoms themselves, when present in session, or an image of them
  • Distressing images about the future, e.g. image of having FND symptoms in front of others 

MODIFI was a feasibility study, so in essence, it was a randomized controlled trial in a small form, in order to test the trial design and whether the trial is feasible, acceptable to participants, and safe. We recruited 50 participants, and this is not enough to test for significance. We found that MODIFI was feasible, acceptable, and safe. Additionally, we found that participants who received EMDR therapy reported being more satisfied with their treatment and felt their FND symptoms improved to a greater degree compared to those who only received usual care. The data also suggested that the EMDR group saw greater reductions in symptoms like PTSD, depression, anxiety, and general disability, and used less healthcare. Our results suggest that FND-focused EMDR therapy is a promising treatment for FND, but a larger study is needed to establish efficacy. 

Are there cautionary measures you would like to mention regarding the use of EMDR therapy and FND?  

As your readers are no doubt aware, EMDR therapy can be a powerful treatment, and as with other disorders, it requires careful application and proper supervision. Used carelessly, it can trigger mental health crises, including a significant increase in dissociation, anxiety, or depression, particularly in patients who are predisposed to dissociation. I am particularly cautious about proceeding with EMDR therapy in the context of any dissociative identity disturbance. Additionally, alongside potential emotional distress during processing, physical symptoms may intensify and remain temporarily heightened following a session. It is important to inform patients of this possibility beforehand to mitigate worry. However, recognizing these temporary increases can also help patients identify connections between their FND and their emotional state, and this can be useful therapeutically. 

Are there any myths you would like to bust about using EMDR therapy and FND?  

I think the most important myth I would like to bust is that EMDR therapy can only be used with patients who have comorbid PTSD alongside their FND. In my experience, EMDR therapy is useful for FND patients presenting with and without PTSD. Additionally, there is a long history of FND patients being poorly treated within healthcare, with their symptoms dismissed as “just psychological” or “due to trauma.” Therapists should be cautious about providing overly simplistic explanations. 

It is not necessary to process “everything” to make a difference. You may be working with someone who has an extensive trauma history, but what they are particularly struggling with is their functional seizures. Processing memories related to their functional seizures alone (e.g., first functional seizure) may be enough to make a difference—it may not be necessary to process earlier traumatic memories. And depending on your clinical formulation, it might be much more tolerable for the patient to focus on the FND-specific memories. A potential risk of going directly to the worst earlier traumatic memory in the first instance is that the patient’s FND symptoms may increase significantly, and they may not be able to tolerate the therapy. 

And finally, functional seizures can look like epileptic seizures, but they are not epileptic—there is no epileptic activity in the brain during a functional seizure. There is guidance available at https://www.rcemlearning.co.uk/foamed/functional-seizures/, which gives good advice regarding what to do if someone is having a functional seizure. It is key to remember that someone having a functional seizure can likely hear during the seizure, so it helps if you stay calm. Also, a person can experience both functional seizures and epileptic seizures—it is vital that a person experiencing seizures (or if new seizures develop) be seen by a neurologist for assessment and diagnosis. 

What multicultural considerations might EMDR therapists need to keep in mind regarding EMDR therapy and FND?  

I think it is helpful for therapists to keep in mind that the FND symptoms may hold a particular meaning for patients, and that this meaning may be influenced by their cultural background. For example, functional seizures may be viewed as “possession” by a jin or devil. Or the symptoms may be viewed as a punishment for a perceived wrongdoing. 

Do you have any favorite free EMDR related resource that you would suggest to EMDR therapists interested in learning more about using EMDR with FND? 

What would you like people outside the EMDR community to know about the use of EMDR therapy and FND?

EMDR therapy can sound like a strange therapy, but in essence, it is a therapy that helps with distressing memories. If someone has distressing memories associated with their FND, then EMDR therapy could be beneficial. 

Anything else you would like to add?  

FND patients are heterogeneous, and the patients that EMDR therapists might see in non-FND specialist services are unlikely to be representative of FND patients generally. For example, the patients seen in non-specialist services or routine private practice will likely be those who are aware of specific psychological stressors related to their FND symptoms (e.g., past traumatic experiences), but those seen in a neurology setting will not necessarily be aware of psychological stressors, nor will psychological aspects necessarily be a focus in their formulation and treatment. Some patients can recover after education and explanation of their symptoms alone, and others can achieve full or partial recovery of their symptoms through FND-specific physiotherapy (Nielsen et al., 2024). 

 

Dr. Sarah Cope is a Consultant Clinical Psychologist, specializing in neuropsychiatry and FND. She is additionally accredited as an EMDR Therapist (EMDR-Europe) and CBT Therapist. She works within the National Health Service and operates a private practice in the United Kingdom. 

 

References and Resources

Cope, S. R. (2020). EMDR as an adjunctive psychological therapy for patients with functional neurological disorder: Illustrative case examples. Journal of EMDR Practice and Research, 14(2), 76–89. https://doi.org/10.1891/EMDR-D-20-00008  

Cope, S. R., Smith, J. G., El-Leithy, S., Vanzan, S., Pentland, C., Pick, S., Golder, D., Hogwood, P., Turner, K. J., Billings, J., & Edwards, M. (2023). MODIFI: Protocol for randomised feasibility study of eye movement desensitization and reprocessing therapy (EMDR) for functional neurological disorder (FND). BMJ Open 13(6), e073727. http://dx.doi.org/10.1136/bmjopen-2023-073727   

Cope, S. R., Smith, J. G., El-Leithy, S., Vanzan, S., Hogwood, P., Golder, D., Turner, K. J., Crowley, M., Billings, J., Pick, S., Pentland, C., & Edwards, M. J. (2025). Randomized feasibility study evaluating eye movement desensitisation and reprocessing therapy for functional neurological disorder (MODIFI). Journal of Neurology, 272, 493.  https://doi.org/10.1007/s00415-025-13219-5  

Davies, C. (2022, April 12). Functional seizures. FOAMed – Royal College of Emergency Medicine Learning. https://www.rcemlearning.co.uk/foamed/functional-seizures/

Edwards, M. J., &  Bhatia, K. P. (2012). Functional (psychogenic) movement disorders: Merging mind and brain. The Lancet Neurology, 11(3): 250-260. https://doi.org/10.1016/s1474-4422(11)70310-6  

Functional Neurological Disorder Society. (n.d.). Home. Retrieved November 14, 2025, from https://www.fndsociety.org/

Goldstein, L. H., Robinson, E. J., Mellers, J. D. C., Stone, J., Carson, A., Reuber, M., Medford, N., McCrone, P., Murray, J., Richardson, m. P., Pilecka, I., Eastwood, C., Moore, M., Mosweu, I., Perdue, II., Landau, S., & Chalder, T. (2020). Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre randomised controlled trial. The Lancet Psychiatry 7(6): 491–505. https://doi.org/10.1016/s2215-0366(20)30128-0  

Hallett, M., Aybek, S., Dworetzky, B. A., McWhirter, L., Staab, J. P., & Stone, J. (2022). Functional neurological disorder: new subtypes and shared mechanisms. The Lancet Neurology, 21(6), 537-550. https://doi.org/10.1016/s1474-4422(21)00422-1   

Hingray, C., Popkirov, S., Kozlowska, K., Pretorius, C., Sarudiansky, M., El-Hage, W., Zhou, D., Ertan, D., LaFrance, W. C. Jr, & Reuber, M. on behalf of ILAE Functional/Dissociative Seizures Task Force. (2025). Functional/dissociative seizures: Proposal for a new diagnostic label and definition by the ILAE task force. Epilepsia, Epub ahead of print. https://doi.org/10.1111/epi.18574  

Nielsen, G., Stone, J., Lee, T.C., Goldstein, L. H., Marston, L., Hunter, R. M., Carson, A., Holt, K., Marsden, J., Le Novere, M., Nazareth, I., Noble, H., Reuber, M., Strudwick, A-M., Santana Suarez, B., & Edwards, M. J. on behalf of the Physio4FMD study group. (2024) Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): A pragmatic, multicentre, phase 3 randomised controlled trial. The Lancet Neurology, 23(7), 675–686. https://doi.org/10.1016/ S1474-4422(24)00135-2   

Reuber,  M., & Brown, R. J. (2017). Understanding psychogenic nonepileptic seizures-Phenomenology, semiology and the Integrative Cognitive Model. Seizure European Journal of Epilepsy, 44, 199-205. https://doi.org/10.1016/j.seizure.2016.10.029  

Stone, J. (n.d.). Neurosymptoms.org. https://neurosymptoms.org/en/

 

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Additional Resources

If you are a therapist interested in the EMDR training:

If you are EMDR trained:

If you are an EMDRIA™ Member:

 

Date
November 21, 2025

Contributor(s)
Sarah Cope

Topics
Dissociation, Medical/Somatic, Pain/Chronic Pain, Seizures

Audience
EMDR Therapists

Language
English

Content Type
Blog/Blog Post

Access Type
Open Access

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