[Experiential acceptance in the treatment of complex somatic symptom disorder]. / Ervaringsgerichte acceptatie bij de behandeling van complexe somatisch-symptoomstoornis.

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.

[Patient-tailored approach in tertiary care expert centres using individual dynamic network analysis]. / Maatwerk in hoogspecialistische ggz met individuele dynamische netwerkanalyse.

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.

Negative affectivity predicts decreased pain tolerance during low-grade inflammation in healthy women.

INTRODUCTION: Experimental animal studies provided evidence for a synergistic effect of immunological and psychological stressors on subsequent sickness behaviours. Up to now, little corroborating evidence for such synergy exists for humans, in whom it may provide a mechanism leading to the expression of functional somatic symptoms. The aim of the present study was to determine an interaction between stress(-vulnerability) and an immunological activation on experimental pain sensitivity, i.e., pressure pain threshold and tolerance in healthy humans. METHODS: In healthy female participants (n=25, mean age 22.3 years), negative affectivity (NA) and experienced stress were assessed by questionnaire before receiving a Salmonella typhi vaccine or saline control in a randomized blinded cross-over design. Pressure pain threshold was assessed at the lower back and calves and pain tolerance was assessed at the thumbnail, before and six hours after each injection. RESULTS: Vaccination induced leukocytosis (+100%) and increased serum IL-6 (+670%). NA predicted decreased pain tolerance after vaccination (ß=-.57, p=.007), but not after placebo (ß=.25, p=.26). Post-hoc analyses also demonstrated an association with administration order. DISCUSSION: NA moderated the effects of inflammation on pain tolerance. This finding is consistent with a synergistic model whereby inflammation may lower the threshold for pain reporting in individuals with increased vulnerability for somatic symptom reporting.

[Psychiatric comorbidity in patients in tertiary care suffering from severe somatoform disorders]. / Psychiatrische comorbiditeit bij ernstige somatoforme stoornissen in de derde lijn.

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.

Biological and psychological predictors of visceral pain sensitivity in healthy premenopausal women.

BACKGROUND: Factors that are associated with pain perception remain incompletely understood, especially in the visceral pain field. Therefore, the current study aimed to investigate possible psychological and biological predictors of visceral pain sensitivity in healthy subjects. METHODS: In a sample of 59 healthy premenopausal female subjects on hormonal contraceptives, measures of gastrointestinal (GI) symptoms in daily life, trait and state anxiety, depression, serum cortisol concentrations and serum levels of interleukin-6 (IL-6) were obtained, followed by assessment of rectal distension pain sensitivity measures (i.e., rectal distension sensory threshold, pain threshold and pain ratings for discrete rectal distension stimuli). RESULTS: Regression analyses showed that more GI symptoms in daily life predicted a lower pain threshold. Higher levels of state anxiety predicted a lower pain threshold. Higher cortisol concentrations predicted lower pain ratings. IL-6 was positively related to GI symptoms but was a non-significant predictor of pain threshold in the multiple regression analysis. CONCLUSIONS: Similar to findings in patients with functional GI symptoms, we showed that subclinical GI symptoms predict visceral pain sensitivity. In line with somatic pain findings, state but not trait anxiety was found to predict visceral pain sensitivity. Our finding on serum cortisol as positive predictor of pain sensitivity might be interpreted in light of immunosuppressive effects of cortisol. Our finding on the role of IL-6 in GI symptoms is promising for understanding GI complaints in patients and needs further investigation.

[Questioning the mechanism behind slow breathing and heart coherence training]. / Vraagtekens bij het werkingsmechanisme van slow-breathing en hartcoherentietraining.

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.

Comparison between the Fourier and Wavelet methods of spectral analysis applied to stationary and nonstationary heart period data.

The aim of this study was to assess the error made by violating the assumption of stationarity when using Fourier analysis for spectral decomposition of heart period power. A comparison was made between using Fourier and Wavelet analysis (the latter being a relatively new method without the assumption of stationarity). Both methods were compared separately for stationary and nonstationary segments. An ambulatory device was used to measure the heart period data of 40 young and healthy participants during a psychological stress task and during periods of rest. Surprisingly small differences (<1%) were found between the results of both methods, with differences being slightly larger for the nonstationary segments. It is concluded that both methods perform almost identically for computation of heart period power values. Thus, the Wavelet method is only superior for analyzing heart period data when additional analyses in the time-frequency domain are required.

A repressive coping style and affective, facial and physiological responses to looking at emotional pictures.

Previous studies have demonstrated increased physiological-emotional responses despite relatively low self-reported affect for individuals with a repressive coping style, as compared to control groups. The main question in the current study was whether such group differences could also be demonstrated by using the picture perception methodology of Lang. A second question was whether differences between these groups could be found in the habituation of physiological and emotional responses. Repressors (n=14), 'truly' low anxious participants (n=14), and moderately high anxious participants (n=13) were selected with the Marlowe-Crowne Social Desirability Scale and the Taylor Manifest Anxiety Scale. Two sets of 27 pictures with alternating neutral, threatening and sexual content were presented whilst valence and arousal ratings, skin conductance, heart rate and facial muscle responses were measured. No straightforward group differences were found. However, the results suggest that differential habituation, and not a repressive coping style, may contribute to differential self-reported, facial and physiological-emotional responses.