I remember having similar feelings about transitioning from trainee to consultant psychiatrist but I ended up loving the work, leading treatment teams, teaching medical students and supervising registrars. I suppose this will be similar.
I’m currently working with several hospitals and universities and I’m nervous about giving up the freedom I have by being employed by a single university but I look forward to supervising PhD students so suppose I will bite the bullet soon.
I’m excited to keep on researching FND, formulation and psychotherapy, and also to help others to study things they are passionate about.
Having now completed my PhD a few months ago, I’m so grateful to have had the opportunity to study an interesting subject (FND) in so much detail and have 29 people give me over a year of their time to do so. A PhD is such a privilege.
I owe a lot to 29 people with FND who gave their time to this research. Now to see how it generalises to other clinical and research populations.
Mixed methods analysis of formulations in FND is now published open access in the European Journal of Psychiatry. This was the final paper in my thesis. Link, and summary follows.
Mixed-methods analysis of formulations in functional neurological disorder": www.sciencedirect.com/science/arti...
The shared formulation and method used captured patterns outside of awareness, but only if the patient agreed, increasing validity. This approach is harder to replicate and is likely to include post-hoc speculations retrofitted to the outcome.
Formulation-based clustering has the advantage of emphasising relevant mechanisms and context, yielding clinically relevant insights that could be of value for personalising treatment of adults with FND.
An interesting finding was that adverse exposures that were not experienced as traumatic, such as restricted expression, childhood illness and lack of containment, may contribute to emotional dysregulation in FND as they are often not asked about during assessment.
Synthesis with exit interview data suggests overvigilance may make relationship focused work challenging, while other directedness makes time to focus on their own needs more helpful. Schemas may mediate the mechanism of action of shared formulation.
We used framework analysis, hierarchical clustering and statistical comparison of co-written formulations. Two groups were characterised by overvigilance and body focus (n = 10), and dissociation and other directedness (n = 14).
Mixed methods analysis of formulations in FND is now published open access in the European Journal of Psychiatry. This was the final paper in my thesis. Link, and summary follows.
thelancet.com/journals/laneur/article/PIIS1474-4422(25)00351-5/fulltext
A challenge to the supremacy of the EQ-5D in the NICE guidelines for dementia
It’s really a way of combining shared formulation with brief psychotherapy so it could be tried in many areas - particularly where acceptance and understanding of causal mechanisms has therapeutic value - but there’s no evidence for it outside of FND. Did you have something in particular in mind?
Ok thanks- I may be thinking a step too far. We developing methods for realist evaluation to better incorporate the views & experiences of people with cognitive impairment. Dementia is our ‘case example’ but we hope this work will be more broadly applicable. @drhannahwheat.bsky.social
I think it’s interesting for our team to think about formulation - maybe it could shed light on diverse experiences and needs
We used various qualitative approaches with the 29 adults with FND who donated their time to these studies. I do recommend patient-verified formulation as part of constructing a context-mechanism-outcome theory for realist evaluation. It’s always a theory but can be refined iteratively.
You could even use SIFT! Happy to collaborate if you think that might work for your population.
We used various qualitative approaches with the 29 adults with FND who donated their time to these studies. I do recommend patient-verified formulation as part of constructing a context-mechanism-outcome theory for realist evaluation. It’s always a theory but can be refined iteratively.
All but one of these is open access and I can provide an authors copy of the SIFT pilot. I hope the fourth will be published soon! Personally, I think a qualitative measure is needed in FND which is a disorder of meaning / interpretation as well as of function. Formulation may fill this role.
There are several published clustering analyses showing a group with FND reporting high levels of psychological distress and another with low levels. This seems to suggest different coping strategies / schemas and this paper (submitted) supports that, using patient-validated formulations.
I’m not a cognitive expert and these results are from FND. I think formulation can contextualise various health problems, and I suspect schemas mediate many therapy outcomes,
especially where beliefs and relationships are involved, but I can’t use this data to make claims about that population.
We’re recruiting for a University of Melbourne study on Functional Neurological Disorder (FND).
Women aged 18–60 with a confirmed FND diagnosis can take part. Help us improve understanding and future care. #FND
📧 stress-fnd@unimelb.edu.au
HREC 2025‑32802‑68820‑3
(See image for details & QR code)
I'm about to complete my Phd at @UniMelb on Shared Individual Formulation Therapy for Functional Neurological Disorder. Formulation has therapeutic potential and identifies processes driving FND. Mechanisms of action and mediators were identified to guide realist evaluation. 1/5
This research is limited to people with FND, which may present with tremor. I think formulation can identify the factors contributing to many health problems but I haven’t collected data for other diagnoses.
Analysis of 24 co-written formulations identified exposures, schemas, activations, and mechanisms. Two groups suggested different pathophysiology but did not predict outcome: over-vigilance and body focus (n=10), and other-directedness and dissociation (n=14). 5/5 (submitted)
Analysing 22 exit interviews, SIFT helped participants to explore and make sense of experiences leading to ongoing recovery and growth. Some were ambivalent and those who found it challenging were less likely to recommend but no less likely to benefit. 4/5 doi.org/10.1002/capr...
