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.