In patients with conversion disorder and healthy volunteers, does a short term stress reduction technique followed by psychotherapy lead to improved processing of stress?

Healthy Volunteers will participate in Phase 1 Only as described below. including being trained in the breathing stress reduction at baseline and reassessment at 1 month. Participants with Conversion Disorder will be participate in Phase I and II receiving treatments as specified below. Phase 1 Both healthy controls and conversion disorder participants complete tasks a) 1 month of use of a Breathing Stress Reduction Technique for 20 minutes a day. b) At the end of the session, where their baseline cognitive, emotional and psychological testing is done, they will be trained for one 30 minute one-on-one information session with a psychiatrist to show them the breathing technique. This involves breathing for 10 minutes twice a day at a rate per minute which is optimal for that participant. This optimal breathing rate is found from measuring the participant's heart rate variations as they breath at different rates. The breathing rate which is associated with the smallest stress response, as determined by the magnitude of these heart rate variations, is then chosen as the optimal breathing rate. During the one-on-one session the participant will be instructed to breath at this optimal rate using a technique that the patient feels comfortable with. These techniques will include using a freely available breathing App for Android or apple mobile phones called MyCalmBeat, which has a picture of two lungs breathing in and out which can be set to breath at the participant's optimal rate for 10 minutes. The participant follows along with the image for 10 minutes. Alternatively, the participant will be trained in how to use a clock or watch with a second timer, by designating how long each breath should take . The chosen method will be practised with the participant in the session until they feel comfortable using the technique alone. c) Participants will be given a calendar/Study Diary sheet to note down over the following month how often and for how long they do the practise. Notes about the process which the participant feels they need to remember the process can be jotted down on this calendar. Phase 2 This proceeds directly after Phase 1. and involves Conversion Disorder Participants only NB. If the time to psychotherapist or neurologist availability is greater than 6 months the participant will repeat initial psychological questionnaires and cognitive testing with WebNeuroTM at the commencement of psychotherapy. They will not repeat the Adult Attachment Interview at this time as this provides stable categories in the absence of psychotherapeutic intervention for at least one to two years, by which time they would have been allocated a therapist. Treatment with a) Up to 2 years of Psychotherapy with Conversational Model i) Conversational Model psychotherapy is a talking therapy which allows the patient to explore their problems for development of a collaborative trusting relationship between therapist and patient. Specific techniques of language usage by the therapist allow the patient to feel more comfortable expressing their emotions and integrating previous life experiences with emotions from present and the past. ii) Therapy involves meeting for 50 minutes once or twice a week for up to 2 years. This therapy may be either Short Term Intensive Psychotherapy in the Conversational Model or long term psychotherapy in the Conversational Model dependent on assessment. iii) The sessions are one-on-one face-to-face. iv) Sessions are run by a therapist training in the Conversational Model at the Westmead Psychotherapy program.. These therapists may be a psychiatrist, nurse, psychologist or social worker or anyone who has been deemed to have met previous training requirements in psychotherapy. The therapist is supervised by a psychotherapist member of the Faculty of Medicine at the University of Sydney. v) The decision on duration of treatment is made collaboratively with the patient, therapist and Supervisor of the therapy, based on the patient’s clinical symptoms. vi) Attendance at sessions is monitored by an Occasions of Service attendance register maintained by individual therapist in collaboration with their Supervisor on the basis of audio transcripts of sessions. b) 1 to 2 years of Neurology Treatment as Usual (including regular Neurology follow-up, assessment and prescription of medication by Psychiatrist and physiotherapy and rehabilitation). Neurology treatment as usual is tailored to the specific needs of the patient as conversion disorder can manifest in many different types of functional neurological symptoms. This generally includes ongoing evaluation of diagnosis through neurophysiological and pathology tests such as blood tests to monitor for small possibility that the patient has a rare or previously not apparent neurological disorder contributing to their presentation. Some patients with conversion disorder may agree to referral to psychiatrist for medication and psychological therapy for anxiety and depressive symptoms. Such a decision is made in collaboration with the patient. This psychiatrist involvement may involve monthly or less frequent visits to the psychiatrist for monitoring of ongoing mental states and may be present prior to their being requested to enter the study. Rehabilitation with physiotherapy +/- Cognitive therapy for goal setting may also be undertaken by the patient as part of the treatment as usual with Neurology. or c) combination of a) and b) or d) no treatment