Third Wave Treatments for Functional Somatic Syndromes and Health Anxiety Across the Age Span: A Narrative Review

Abstract

Functional disorders (FD) are present across the age span and are commonly encountered in somatic health care. Psychological therapies have proven effective, but mostly the effects are slight to moderate. The advent of third wave cognitive behavioural therapies launched an opportunity to potentially improve treatments for FD.A narrative review of the literature on the application of mindfulness-based therapies (MBT) and Acceptance & Commitment Therapy (ACT) in children and adult populations with FD.There were very few and mainly preliminary feasibility studies in children and adolescents. For adults there were relatively few trials of moderate to high methodological quality. Ten MBT randomised trials and 15 ACT randomised trials of which 8 were internet-delivered were identified for more detailed descriptive analysis. There was no evidence to suggest higher effects of third wave treatments as compared to CBT. For MBT, there seemed to be minor effects comparable to active control conditions. A few interventions combining second and third wave techniques found larger effects, but differences in outcomes, formats and dosage hamper comparability.Third wave treatments are getting established in treatment delivery and may contribute to existing treatments for FD. Future developments could further integrate second and third wave treatments across the age span. Elements unambiguously targeting specific illness beliefs and exposure should be included. The benefit of actively engaging close relatives in the treatment not only among younger age groups but also in adults, as well as the effect of more multimodal treatment programmes including active rehabilitation, needs to be further explored.The methodological quality of third wave interventions for FD should be improved, especially in younger age groups.The effect of ACT interventions may be comparable to CBT in adults with FD.The evidence for third wave interventions in young people with FD is still very limited.Newer studies combining second and third wave treatments show some promise.Agreement on, and for child populations further development of, core outcomes, could help determine effect across studies.The methodological quality of third wave interventions for FD should be improved, especially in younger age groups.The effect of ACT interventions may be comparable to CBT in adults with FD.The evidence for third wave interventions in young people with FD is still very limited.Newer studies combining second and third wave treatments show some promise.Agreement on, and for child populations further development of, core outcomes, could help determine effect across studies.

Feasibility of group-based acceptance and commitment therapy for adolescents (AHEAD) with multiple functional somatic syndromes: a pilot study

“…Moreover, we found clinically relevant improvements in physical health (primary outcome) as well as significant improvements on most secondary outcomes. The findings are in accordance with the previously reported positive impact of psychological treatment on symptom load and functioning in children and adolescents with FSS [24][25][26]28] and of ACT-based interventions in adults with FSS [29][30][31]. However, it can be questioned whether the positive changes seen in this uncontrolled study can be explained solely by the Mean at different time points as well as change from baseline to follow-up and from group-start to follow up with inclusion of effect sizes Abbreviations alphabetically presented: AFQ-Y8 avoidance and fusion questionnaire, thorough assessment and psychoeducation, as seen in an RCT in youth with CFS [83].…”

“…Recent reviews show that psychological interventions, particularly based on cognitive behavioural therapy (CBT) principles, are effective for FSS in children and adolescents in reducing symptom load, disability and school absence [24,25]. Acceptance and commitment therapy (ACT) is a newer development within CBT that has shown promising results in children and adolescents with chronic pain [26][27][28] and in adults with various FSS [28][29][30][31]. The overall aim of ACT is to change how the individual reacts to unwanted inner experiences by broadening the behavioural repertoire, to facilitate more adaptive strategies.…”

Functional Somatic Syndromes (FSS) in Children and Adolescents

“…Research has primarily focused on specialized treatments for specific syndromes in youth with severe symptoms (Step 3), whereas the general health promoting strategies proposed for mild and moderate symptoms (Steps 1 and 2) are based on clinical experience and consensus on best practice. Currently there is best evidence for psychological interventions (Frostholm & Rask, 2019), where reviews covering the whole spectrum of FSS as well as individual syndromes show effect on symptom-load and disability (Bonvanie, Kallesoe, et al, 2017; Brent, Lobato, & LeLeiko, 2009; Fisher et al, 2018). Specifically effect sizes were found to be moderate on reducing symptom load (Hedge’s g = −0.61), school absenteeism (Hedge’s g = −0.51) and disability (Hedge’s g = −0.42), and which were relatively well maintained at follow-up (Hedge’s g range: −0.31 to −0.38) (Bonvanie, Kallesoe, et al, 2017).…”

Efficacy of internet-delivered acceptance and commitment therapy for severe health anxiety: results from a randomized, controlled trial

“…Fortunately, long-term cost-effective treatments do exist (Axelsson & Hedman-Lagerlof, 2019 ; Thomson & Page, 2007 ); so far, cognitive behavioral therapy (CBT) being the most frequently investigated. However, acceptance and commitment therapy (ACT), has also demonstrated promising results across a wide range of mental health problems (A-Tjak et al, 2015 ; Frostholm & Rask, 2019 ), including health anxiety (Eilenberg, Fink, Jensen, Rief, & Frostholm, 2016 ; Eilenberg, Hoffmann, Jensen, & Frostholm, 2017 ). ACT is considered a ‘third wave’ CBT approach that aims to increase patients' behavioral repertoire, also designated as ‘psychological flexibility’, in two ways: firstly by changing the way patients relate to distressing symptoms by gradually increasing the ability to ‘open up’ and ‘stay present’ to thoughts, feelings, and bodily sensations, and secondly to enhance engagement with value-based activities to create a meaningful life based on long-term goals and values (Hayes, 2016 ).…”