Functional Neurological Disorder (FND) is one of the most common yet misunderstood conditions seen in neurological and psychiatric practice.
With prevalence estimates ranging from 170,000 to over 5.5 million people in the United States alone, FND is characterized by neurological symptoms such as seizures, paralysis, tremors, or gait disturbances that are not attributable to structural brain disease. These symptoms are real, disabling, and often chronic—yet no gold-standard, evidence-based treatment currently exists.
FND carries a substantial personal and societal burden: individuals living with FND spend an average of $87,000 annually on medical care and disability-related costs, and the condition imposes more than $1.2 billion in annual costs on the U.S. healthcare system. Additionally, individuals with FND often struggle to maintain involvement in work, school, and social relationships due to the disabling nature of their symptoms. Despite its prevalence and impact, FND remains drastically under-researched and underserved in both clinical and research domains.
Our research program in Functional Neurological Disorders at UAB aims to transform this landscape through cutting-edge, interdisciplinary investigation and intervention development. We integrate neuroscience, psychology, and implementation science to uncover the underlying mechanisms of FND and deliver innovative, evidence-based treatments to those who need them most.
Research Overview
The FND Research Program, housed within the Department of Psychiatry and Behavioral Neurobiology, centers on both foundational and translational research. Led by faculty experts in clinical psychology and behavioral medicine, our lab focuses on developing and validating novel behavioral health interventions, particularly Retraining and Control Therapy (ReACT)—a novel, mechanistically-informed therapy tailored for individuals with FND.
ReACT is designed to directly retrain functional symptoms by addressing catastrophic symptom expectations and enhancing perceived control. It leverages habit reversal techniques, adapted from tic disorder treatments, to help patients retrain involuntary functional symptoms. Initial clinical studies show promising outcomes, and current NIH-funded investigations include:
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A mechanistic study funded by the National Institute of Mental Health (NIMH) evaluating the specific treatment targets through which ReACT reduces FND symptoms.
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A multi-site feasibility trial in collaboration with Yale University and Baylor College of Medicine, funded by the National Center for Complementary and Integrative Health (NCCIH), to prepare for a large-scale efficacy trial.
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A neuroimaging biomarker development study, funded by the National Institute of Neurological Disorders and Stroke (NINDS), aimed at creating objective outcome measures to validate treatment targets for future clinical trials.
The program is also committed to expanding access to treatment through digital health innovations such as the ReACT digital manual, called the Precision Treatment Tool. The Precision Tool is the first therapist-centered digital platform to assist therapists in providing research-supported precision treatment that is standardized and tailored to each individual patient’s needs at each session.
Core Areas of Investigation
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Biomarker Development: Developing objective, neuroimaging-based outcome measures to quantify treatment targets and enhance future clinical trial design.
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Mechanisms of Symptom Change: Investigating cognitive and behavioral mechanisms—such as symptom expectation and perceived control—that influence treatment response, using both laboratory-based and neuroimaging approaches.
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Intervention Development and Testing: Designing and evaluating scalable interventions grounded in clinical neuroscience and cognitive behavioral theory.
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Implementation Science: Exploring strategies to expand equitable access to FND treatment across healthcare systems.
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Digital Health Delivery: Leveraging digital platforms and remote delivery models to disseminate ReACT internationally with fidelity.
Leadership
Aaron D. Fobian, Ph.D.
Program Lead
Professor of Psychiatry and Behavioral Neurobiology
Tate Jordan Thomas Professor in Psychiatric Medicine
afobian@uab.edu