Cognitive Behavioral Therapy for Foreign Accent Syndrome: A Single-Case Experimental Design

Nicola Birdsey, Josie F. A. Millar

Research output: Contribution to journalArticlepeer-review

3 Citations (SciVal)


Foreign accent syndrome (FAS) has historically been attributed to a neurological etiology. However, recent research has identified psychogenic causes of FAS, where patients present to health care services with medically unexplained FAS symptomology. Due to the rare nature of psychogenic FAS, there is currently no evidence-based psychological treatment for this syndrome. Although patients with psychogenic FAS do not meet the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) or the International Classification of Diseases (ICD)-10 diagnostic criteria for a diagnosis of somatization disorder, there are some similarities in presentation between psychogenic FAS and the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for somatic symptom disorder (SSD). These include the presence of distressing and disruptive symptoms that result in increased health care utilization. Given the emerging evidence for cognitive behavioral therapy (CBT) for SSDs, it is arguable that CBT could help patients with psychogenic FAS to manage the psychological distress they experience. This paper aims to explore the use of CBT in reducing the psychological distress of a patient with no organic explanation for FAS using a single-case (A-B) experimental design. The results suggest that CBT was effective in reducing distress, as measured using the Clinical Outcomes in Routine Evaluation–Outcome Measure (CORE-OM). This paper highlights the value in using an individualized formulation-driven CBT approach for presentations that do not yet have evidence-based guidelines. In this case, cognitive restructuring, activity scheduling, and stress management appear to be key mechanisms of change in reducing psychological distress associated with FAS.

Original languageEnglish
Pages (from-to)321-338
Number of pages18
JournalClinical Case Studies
Issue number5
Early online date3 Jul 2020
Publication statusPublished - 1 Oct 2020

Bibliographical note

Funding Information:
The author thanks Becky (pseudonym) for her consent to the publication of this article. Names used in the report have been changed to maintain confidentiality. The author(s) received no financial support for the research, authorship, and/or publication of this article.

Publisher Copyright:
© The Author(s) 2020.


  • aphonia
  • cognitive behavioral therapy (CBT)
  • Foreign accent syndrome (FAS)
  • psychogenic
  • single-case experimental design (SCED)

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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