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Background: Acceptance and Commitment Therapy (ACT) plays an important role in the treatment of patients with refractory Somatic Symptom Disorder and related disorders with complex problems and/or somatic or psychiatric comorbidity (complex SSD)., Aim: To gain insight into the possible role of (experiential) acceptance in improved quality of life during and after treatment., Method: Observational longitudinal study in 41 patients with complex SSD treated at Altrecht Psychosomatic Medicine Eikenboom. They completed online questionnaires around the start and completion of treatment and after six months of follow-up. Assessed were experiential acceptance (AAQ-II-NL) and three aspects of quality of life (RAND-36: mental health, physical functioning, general health perception). The associations between changes in acceptance and quality of life were determined., Results: Acceptance increased significantly from treatment initiation to follow-up. Mental health increased significantly between start and end of treatment, and general health perception increased significantly in the follow-up period. Physical functioning did not change. During treatment, an increase in acceptance was significantly associated with improvement in mental health and general health perception; during follow-up, an increase in acceptance was associated with an improvement in mental health., Conclusion: The current study demonstrates that an increase in experiential acceptance goes hand in hand with an improvement in mental health and general health perception. These results indicate the potential importance of acceptance-based treatment in patients with complex SSD. Experimental research with more frequent measurements is needed to test a temporal relationship between (first) increased acceptance and (then) improved quality of life.

Background: Patients with mental health disorders often have difficulty perceiving associations between multiple symptoms, such as inter-relations between somatic and psychological symptoms. This difficulty may be particularly challenging in patients with complex disorders. Individual dynamic network analysis may provide novel diagnostic and treatment possibilities because it can create a starting point for a personalized approach in complex cases in tertiary mental health care expert centres, where standard protocolized interventions were insufficiently effective., Aim: To explore the possibilities provided by dynamic network technologies in the care of patients in tertiary care expert centres., Method: Overview of these possibilities, with a focus on somatic symptom disorder., Results: Intensive longitudinal data can be obtained using a short and personalized questionnaire that is presented via a patient's smartphone a few times per day during several weeks. These data are then converted to patient-specific dynamic symptom networks using time series analysis. These networks display how variations over time in somatic and mental symptoms and other factors (such as specific situations) mutually influence each other in daily life. They also provide information about cause-effect associations., Conclusion: Dynamic symptom networks provide insight into the associations between symptoms and other factors and can be used to personalize treatment goals and interventions in tertiary care expert centres. Furthermore, these networks create opportunities to examine the (patient-tailored) effects of personalized interventions.

Background: Although it is generally the severity of a patient's symptoms and impairments which determines the amount of care allocated to patients with somatoform disorders, comorbidity appears to be an additional relevant factor. A number of studies in different populations with somatoform disorders have shown that these disorders overlap with mood disorders, anxiety disorders, and personality disorders. So far, however, little is known about comorbidity in patients in tertiary care who are suffering from severe somatoform disorders., Aim: To determine comorbidity of mood, anxiety and personality disorders in patients in tertiary care suffering from severe somatoform disorders., Method: The study was based on a sample of 340 patients with dsm-iv-tr somatoform disorder who were awaiting treatment in a specialised care centre. The sample was examined by means of structured clinical assessment of dsm-iv-tr axis I and axis II disorders., Results: 49.4% of the 340 participants was diagnosed with a mood disorder, 62.1% with an anxiety disorder and 50.6% with a personality disorder., Conclusion: Patients in tertiary care suffering from (severe) somatic disorders show higher comorbidity of mood, anxiety and personality disorder than previously reported for somatoform disorder patients in primary and secondary care.

Background: Slow breathing and heart coherence training are being offered increasingly as treatments for anxiety, depression and stress-related mental and somatic complaints. Both of these interventions are aimed at influencing (i.e. increasing or optimising) heart rate variability and the mechanism involved is described in terms such as heart coherence, resonance breathing and heart-brain communication., Aim: To find out whether treatment effects are indeed based on the optimisation of heart rate variability., Method: Our literature search focused on 1) the assumption that poor mental health is definitely linked to deviant heart rate variability, and 2) the assumption that optimising heart rate variability leads specifically to a reduction of complaints and symptoms., Results: There is insufficient evidence to support these two assumptions., Conclusion: Slow breathing and heart coherence training probably achieve their effects as a result of non-specific psychological mechanisms.