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Online Intensive Short-Term Dynamic Psychotherapy for Treatment-Resistant Somatic Symptom Disorder: An Interrupted

Peter Lilliengren1, Malin Ljungdahl2, Mattias Rööst3

  • 1Department of Psychology, Stockholm University, Stockholm, Sweden, peter.lilliengren@su.se.

Psychotherapy and Psychosomatics
|March 2, 2026
PubMed
Summary

Intensive Short-Term Dynamic Psychotherapy (ISTDP) effectively treated somatic symptom disorder (SSD) in patients resistant to other therapies. This online intervention improved symptoms and was well-tolerated, offering a new treatment option.

Keywords:
Intensive short-term dynamic psychotherapyInterrupted time-seriesOnline psychotherapyPsychodynamic therapySomatic symptom disorderTreatment-resistant presentation

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Area of Science:

  • Psychiatry
  • Psychotherapy
  • Digital Health

Background:

  • Somatic symptom disorder (SSD) presents significant challenges, especially in treatment-resistant cases with chronic symptoms and comorbidities.
  • Existing interventions often fall short for these complex patients, necessitating novel therapeutic approaches.
  • Intensive Short-Term Dynamic Psychotherapy (ISTDP) shows promise as an emotion-focused treatment, but its efficacy in treatment-resistant SSD requires further investigation.

Purpose of the Study:

  • To evaluate the feasibility and effectiveness of online Intensive Short-Term Dynamic Psychotherapy (ISTDP) for patients with somatic symptom disorder (SSD) refractory to standard treatments.
  • To assess the impact of online ISTDP on symptom severity, depression, anxiety, trauma, and emotion regulation.
  • To determine if treatment gains are maintained at follow-up and to examine adverse events and dropout rates.

Main Methods:

  • An interrupted time-series study involving 25 patients with SSD who had not responded to prior online interventions.
  • Patients received up to 16 sessions of online ISTDP, with symptom trajectories analyzed using piecewise multilevel modeling over 60 weeks pre- and 21 weeks post-treatment.
  • Secondary outcomes (depression, anxiety, trauma, emotion regulation) were assessed pre-, post-, and at 12-week follow-up.

Main Results:

  • Symptom severity (PHQ-15) significantly declined post-ISTDP, contrasting with stable or worsening pre-treatment trajectories (slope difference d = 1.08).
  • Among completers, 59% achieved clinically meaningful improvement, with significant reductions in depression (d = 0.68) and anxiety (d = 0.42).
  • Treatment gains were largely maintained at follow-up, with low dropout and rare adverse events, indicating feasibility and tolerability.

Conclusions:

  • Online ISTDP is a feasible and effective treatment for somatic symptom disorder (SSD) patients resistant to lower-intensity interventions.
  • This approach may serve as a valuable next step in stepped-care models for complex and treatment-resistant SSD presentations.
  • The findings support the integration of online ISTDP into mental healthcare pathways for challenging somatic symptom presentations.