The Belief Prerequisite: How FND Treatment Echoes Faith Healing

14 May 2026 Christoff Trüter Spousal caregiver

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One of the most striking things you notice when you first start reading the literature on FND is how crucial it is considered for patients to accept and believe in the diagnosis. Without that belief, treatment is often regarded as futile. PM&R KnowledgeNow (AAPM&R): Patients who do not believe their illness is functional... are twice as likely to have poor outcomes Shipston-Sharman et al. (2022): ‘Favourable reaction to diagnosis’ and ‘agreement with diagnosis’ are protective factors; ‘disagreement with psychological attribution’ predicts worse outcome Management of Functional Neurological Disorder (2025): Acceptance of diagnosis linked to better engagement and outcomes; lack of acceptance hinders treatment

This stands in sharp contrast to how medicine is generally practised. Penicillin’s antibacterial effect, for example, works regardless of what I believe about its effectiveness. The same is true for many direct acting treatments, such as insulin for diabetes, antihypertensive medication for high blood pressure, or chemotherapy for cancer. In these cases, the primary mechanism is biochemical or physiological, not dependent on patient belief.

Even the DSM 5 itself briefly notes that agreement with the diagnosis is a positive prognostic factor (an oddly phrased way of putting it). In other words, patients who accept an FND diagnosis tend, on average, to have better outcomes or recovery rates than those who do not. Treatment outcomes in FND (Thomas et al., 2025) and related reviews citing DSM-5 prognostic factors: acceptance of diagnosis Shipston-Sharman et al. (2022): Agreement with diagnosis repeatedly identified as positive prognostic factor (aligns with DSM-5-TR notes)

For this reason, neurologists are trained Jon Stone (MDS presentation): “Show the patients their positive physical signs” as a core part of explaining the diagnosis O’Neal et al. (2021): Clear explanation using positive criteria is a “powerful treatment tool” for patient engagement and acceptance Harvard Medicine: Positive signs “serve as evidence for patients that recovery can be possible” and help understanding to deliver the diagnosis in a way that maximises belief and acceptance, often by emphasising positive clinical signs. The treatment model itself demands this belief, since Cognitive Behavioural Therapy (CBT), the mainstay of FND treatment, FND Hope: CBT is the most commonly used psychological treatment; focuses on thoughts, feelings, behaviours, illness beliefs, and triggers Lin et al. (2021): CBT for FND targets cognitive patterns and symptom-related beliefs is fundamentally built around cognition: beliefs, interpretations, assumptions, expectations, and thought patterns. Some clinicians even incorporate hypnosis Connors et al. (2024 systematic review): Hypnosis and suggestion as interventions for FND; >80% clinically significant improvement in reviewed studies FND Society: Hypnosis Special Interest Group; recognises its role in treatment for this purpose.

So, to put it bluntly: believe, or you will not get better. Hmm. Where have I heard that before?

I grew up in a very religious household. My father was a theologian and prominent minister. My mother was a social worker for the state church at the time. Although I was never a believer myself, I was actively involved in church life, attending camps, Bible studies, and all the usual activities.

In my teenage years, my father became involved in revival ministries and shifted toward faith healing.

In that tradition, belief is seen as an essential prerequisite for healing. The Gospel of Mark (6:5 6) describes Jesus returning to his hometown of Nazareth, where he could not do any mighty work there except for a few healings, because of the people’s lack of faith.

Although CBT is very different in intent from faith healing, I believe they share core mechanical features and similar dangers.

You might immediately think of placebo and nocebo effects, and yes, those are well documented mechanisms. There are also overlapping factors such as expectation effects, attention, interpretation of experience, emotional context, social reinforcement, repetition, and reinforcement through ritual or practice. All of these can influence perceived symptoms and outcomes.

The overlap is not merely metaphorical. There are even explicit forms of "religiously integrated CBT" that combine cognitive restructuring with faith based frameworks, prayer, and spiritual interpretation. From a sceptical perspective, this suggests the similarities between CBT driven FND treatment and faith healing may reflect overlapping underlying mechanisms rather than simple coincidence.

But that said, I am however more interested in discussing the dangers.

One situation that stood out to me as a teenager in my father’s congregation was the case of a lady who arrived in a wheelchair one Sunday. She had a rare bone disease that affected her mobility, and she used medication to manage the degeneration of her legs.

After a very emotional service, my father laid his hands on her. She stood up out of her wheelchair and stopped using her medicine.

Every following Sunday I would see her walk into church without her wheelchair. She was clearly still in a lot of pain, but the narrative was that she was healed. She lived in that belief, and everyone around her reinforced it. After all, nothing was wrong with her, right?

Then one Sunday, we saw her pushed into church in her wheelchair once again. This time she would never get out of it. Due to all the exertion and increased activity, both her legs had to be amputated.

Even through all of that she still believed and blamed herself for not believing hard enough or long enough.

Why am I telling you all of this?

All of this raises a serious red flag.

Patients diagnosed with FND are facing real suffering and in distress. Because neurologists could not find evidence of an organic illness (subsequently diagnosed using positive rule in signs, broader clinical picture, and so on), they are pushed into a treatment narrative where trained clinicians try to reframe and rephrase this suffering into something else.

What makes this narrative especially powerful and risky is that people with FND show significantly elevated suggestibility compared to the general population. A 2021 meta-analysis found they are markedly more responsive to verbal suggestion, expectation, and focused attention.

In such individuals, the very process of diagnosis can inadvertently generate, amplify, or entrench symptoms. The standard rule-in examination techniques for FND (distractibility, entrainment, Hoover's sign, etc.) interact directly with this heightened suggestibility. The examiner's instructions, the focused attention on the symptom, and the implicit expectation created by the test itself can shape how the symptom manifests during the examination. Wieder et al. (2021 meta-analysis): Links heightened suggestibility to symptom induction protocols; notes implications for diagnostic use of suggestion Neurosymptoms.org (Jon Stone): Explains positive signs (Hoover’s, entrainment, distractibility) as rule-in tests; acknowledges attention and expectation play roles in FND symptoms Practical Neurology: Describes entrainment, distractibility, Hoover’s sign etc. as positive rule-in tests; notes suggestibility elements in functional tremor assessment

As a result, the clinical signs may not purely reveal the diagnosis. They can partly create or reinforce the very FND pattern they are meant to identify.

Is all of this reductionism really helping anyone?

Are patients not simply being taught to ignore and brush their symptoms under the carpet while we call that medical treatment? In someone already highly suggestible, the heavy emphasis on belief, acceptance, and cognitive reframing risks becoming a self-reinforcing loop, much like the faith healing story I told earlier.

Just like the lady in my father’s congregation who bought wholeheartedly into the narrative and ended up paying the price with her legs?

If you are going to buy into the narrative, please make sure that you were properly examined, properly investigated for organic causes, and properly monitored over time.

Do not get me wrong, many people do claim to experience genuine relief and improved functioning from CBT and related FND treatments, and the vast majority of clinicians involved are acting in good faith — they are not fraudsters or charlatans.

In equal measure, the same can be said about faith healing. My own father was a sincere minister who genuinely believed he was helping people through prayer and laying on of hands.

In both cases, we see reported successes, emotional testimonials, and believers who credit the approach with transforming their lives. Both follow the same core belief pattern: improvement requires accepting the explanation and committing to the prescribed mindset or practices, while failure is often attributed to insufficient belief, lack of engagement, or not trying hard enough.

I’m not denying that relief can occur. I’m questioning whether this heavy reliance on belief, suggestion, and reframing as the central mechanism is always the safest or most accurate framework for people with severe, unexplained neurological symptoms.