ReAttach Affect Coach Journal

Blended insights from the ReAttach M.I.S.T. and Emotional Symptom Regulation Model (ESRM).

Steven Painter — 2025-12-30

Objective:Recent extensive digital phenotyping studies in Functional Neurological Disorder (FND) have uncovered seven unique clusters of emotional states, which challenge the conventional binary view of distress and resilience [1]. The current study intends to create a clinical framework driven by theory and aimed at generating hypotheses that connect these emotional state clusters to the transdiagnostic mechanisms of ReAttach therapy and its diagnostic interview, the Mapping the Individual State of Mind (M.I.S.T.) [3,7].

Method:The researchers performed a conceptual integration of data on digital emotional phenotyping in FND [1] with both empirical and theoretical literature regarding ReAttach therapy [3], W.A.R.A. (Wiring Affect with ReAttach) [4–6,16], and the M.I.S.T. framework [7]. This integration concentrated on arousal regulation, sensory integration, affect wiring, modification of cognitive biases, and processing of social rewards. Evidence from pilot studies, small-scale randomized trials, and protocol-based investigations was used to support the proposed clinical linkages [4,5,16].

Results: The study result has been structured as a clinical mapping model that connects the seven emotional state clusters in FND (Distress, Shutdown, Activation, Anger, Social Isolation, Resilience, and Ambivalence) to specific transdiagnostic intervention strategies. Initial findings from pilot studies and small randomized comparisons indicate that ReAttach-based interventions may decrease the intensity and duration of negative affect, enhance emotional regulation, and improve therapeutic engagement in patients who have difficulties with standard top-down approaches [3–6]. Specifically, W.A.R.A. has shown to be more effective in the short term for reducing negative affect compared to distraction techniques in randomized pilot studies, with positive effects seen in both in-person and remote delivery settings [5,16]. Further observational and protocol-based studies suggest enhancements in emotional regulation, perceived control, and resilience across a variety of psychobiosocial conditions [8,9,31].

Conclusions:The study does not assert clinical efficacy but offers a theoretically sound and neurobiologically plausible framework for customizing psychological interventions in FND based on an individual's mental state. The combination of emotional state phenotyping with the M.I.S.T. framework presents a structured hypothesis foundation for upcoming controlled trials and precision-oriented treatment development in FND and other related psychobiosocial conditions [27,29].

Beyond Distress and Resilience: Identification of Seven Distinct Emotional Phenotypes in Functional Neurological Disorder Through Large-Scale Digital Phenotyping

Steven Painter — 2025-11-30

Abstract

Objective: Functional Neurological Disorder (FND) has traditionally been understood through a binary emotional framework, distinguishing distressed from resilient patients. This study aimed to identify more nuanced emotional presentations using large-scale digital phenotyping data from a symptom-tracking application, emphasizing the importance of these insights for advancing clinical understanding.
Method: The researchers analysed 10,556 emotion instances across 3,307 emotional logs from 1,032 FND patients using the NeuroLog mobile application [1]. While digital phenotyping offers real-time insights, limitations include potential selection bias and reliance on self-reporting, which may affect data validity. Co-occurrence clustering, hierarchical pattern analysis, and temporal transition modelling were employed to identify distinct emotional groupings with prevalence greater than 3%.
Results: Seven distinct emotional phenotypes emerged: (1) Distress Cluster (40.2%), characterised by anxious-sad-frustrated presentations; (2) Shutdown Cluster (32.8%), marked by emotional numbing and low arousal; (3) Activation Cluster (33.6%), featuring paradoxical high energy with anxiety; (4) Anger Cluster (16.0%), showing frustration-anger spectrum presentations; (5) Social Isolation Cluster (16.3%), dominated by loneliness and grief; (6) Resilience Cluster (12.8%), representing positive emotional states; and (7) Ambivalent Cluster (9.5%), characterised by simultaneous positive and negative emotions. Critical findings included the Shutdown Cluster's previously unrecognised prevalence, the Anger Cluster's zero intervention utilisation, and differential recovery trajectories across phenotypes.
Conclusions: FND emotional experience is multidimensional rather than bipolar. These findings have significant implications for personalised treatment approaches and suggest that current therapeutic models may inadequately address the heterogeneity of emotional presentations in FND, encouraging clinicians to consider more tailored interventions.

Functional Seizures analyzed by the Symptom Amplification Model of Neurolog: a distinguished group in Functional Neurological Disorders? A pilot study.

Steven Painter — 2025-11-25

Functional Seizures (FS) are non-epileptic seizures, of which the underlying neuropsychopathology remains unclear. FS can be regarded as symptoms of Functional Neurological Disorder and are therefore included in the Symptom Amplification Model (SAM) of Neurology [1]. As in other psychobiosocial conditions, functional seizures are often linked to psychological trauma, problems with sensory integration, and cognitive dysfunction [2,3]. According to Asadi-Pooya and Sperling (2015), FS is one of the most common Functional Neurological Disorders (FND), with a prevalence of 1.4-4.9 per 100.000 and three times as many females as males [4]. NeuroLog is a digital platform that uses the Symptom Amplification Model (SAM) to analyze transdiagnostic factors that affect symptom severity across biopsychosocial conditions [1]. Neurolog examined continuous, anonymized data analysis of patients with FS logs, providing new insights into the transdiagnostic factors and underlying mechanisms of this specific symptomatology.In this pilot study, Neurolog compared ecological log analyses of functional seizures (FS) with those of other FND presentations. The results strongly support FS as a separable, sensory-linked, paroxysmal subtype with distinct emotional and temporal dynamics.

The effectiveness of ReAttach Therapy for Fibromyalgia Patients analyzed by the Symptom Amplification Model of Neurolog: A study protocol.

Sieto Reitsma — 2025-11-25

Fibromyalgia, a chronic widespread musculoskeletal pain condition affecting approximately 2 to 3 percent of adults [1,2], often co-occurs with symptoms like fatigue, cognitive issues, and psychological problems such as anxiety and depression. The ongoing need to assess psychosocial interventions remains critical, given the multifactorial nature of fibromyalgia despite emerging research on non-invasive neuromodulation, virtual reality, and psychedelic therapies. ReAttach, a tailored, multimodal transdiagnostic intervention, might meet the need for a personalized approach in fibromyalgia [3]. This study protocol is part of a series of studies investigating the efficacy of ReAttach in biopsychosocial conditions [4,5,6,7]. The research will utilize the Emotions Symptom Regulation Model and Symptom Amplification Model, created by Painter (2025), which provide innovative tools to detect and analyze changes in symptom networks [4]. This approach aims to deepen understanding of fibromyalgia's complex mechanisms and the potential impact of ReAttach.

Assessment of the effectiveness of the ReAttach Protocol for Oncology Patients with the Symptom Amplification Model? A study protocol.

Sieto Reitsma — 2025-11-25

Oncology is a psychosocial condition that significantly affects both cancer patients and their families. A trans-diagnostic, multimodal approach, such as ReAttach therapy, may play a crucial role in the recovery from this complex condition by targeting underlying mechanisms and influencing the networks associated with persistent symptoms [1]. This is the first study protocol to assess the effectiveness of ReAttach therapy in oncology patients. The protocol outlines a prospective observational cohort study to evaluate the effectiveness of ReAttach therapy in this population, using the Symptom Amplification Model (SAM) and continuous real-world data collection via NeuroLog [2]. This protocol is part of a systematic research program that investigates ReAttach therapy across various psychobiosocial conditions (functional neurological disorder [3], post-concussion syndrome [4], oncology, fibromyalgia and Parkinson’s Disease).

ReAttach Therapy for Persistent Post-Concussion Syndrome: An Occupational Therapy Research Protocol (2025)

Sieto Reitsma — 2025-11-16

Persistent post-concussion syndrome (PCS) affects 30–50% of patients following mild traumatic brain injury (mTBI), causing significant functional impairment. Autonomic nervous system dysregulation is increasingly recognized as a key maintaining factor. ReAttach therapy, targeting autonomic regulation through bilateral stimulation and co-regulation, may address this neurophysiological component. This protocol describes a case series study evaluating an occupational therapy intervention combining ReAttach therapy with psychoeducation and activity-focused interventions for persistent post-concussion symptoms. Ten adults with symptoms persisting beyond six weeks post-mTBI will receive four to six individual sessions. Outcome measures include the Rivermead Post-Concussion Symptoms Questionnaire (RPQ-13), Perceived Stress Scale (PSS-10), Canadian Occupational Performance Measure (COPM), and Activity Balance Scale, assessed at baseline, post-treatment, and 4- and 12-week follow-up. The combination of neurophysiological and occupation-focused outcomes demonstrates the value of an occupational therapy perspective in post-concussion rehabilitation. Results will be presented at the Global ReAttach Summit 2026 and published in peer-reviewed journals. In general, the study focusses To describe clinical outcomes of patients with persistent post-concussion syndrome (PPCS) receiving occupational therapy integrated with ReAttach therapy.

Evaluation of ReAttach in FND with the Symptom Amplification Module (SAM) of Neurolog Study Protocol

Steve Painter — 2025-10-16

NeuroLog [1,2] provides a continuous, patient-led data infrastructure to measure the impact of ReAttach objectively [3], facilitated by specifically trained Affect Coach Online Professionals [4]. Neurolog transforms subjective progress into quantifiable change through:
Real-world symptom tracking, Emotional and behavioral analytics, Automated longitudinal comparisons, Integration of qualitative patient voice. Together, these data create a scientifically robust yet human-centered evidence base for the therapeutic value of interventions in Functional Neurological Disorder. This study protocol is the first of several intervention studies using Neurolog to assess changes in symptomatology, beginning with the evaluation of the effectiveness of ReAttach self-regulation techniques [3,4] in FND patients with stress-related disorders.

NeuroLog: Symptom-Pattern Logging and Flare-Prediction in Functional Neurological Disorder: Study Protocol (2025)

Steve Painter — 2025-10-13

NeuroLog is a free, anonymous mobile application developed by individuals with lived experience of Functional Neurological Disorder (FND). The platform provides users with a structured framework to log symptom patterns, emotional states, and potential triggers, facilitating more transparent communication with healthcare professionals and improved clinical decision-making. The application embeds the Symptom Amplification Module (SAM), a measurement framework that quantifies symptom severity, emotional state, trigger exposure, and flare likelihood. This protocol defines the methodology for collecting, anonymising, and analysing user-generated data to detect symptom patterns, cluster and identify flare incidence, and develop predictive models estimating flare risk. In this observational study, no therapeutic interventions are assigned to users. Separate protocols will govern future interventional trials

Forgive and Forget Hood (FFH): Can it help people with Obsessive-Compulsive Disorder?

Paula Zeestraten-Bartholomeus — 2025-10-01

It happens to all of us that we think about something we would rather not think about. Our brain constantly makes billions of neural connections, and some of these may emerge in our consciousness as intrusive thoughts. This is a normal phenomenon for most of us [1], as it allows us to maintain focus on a task or goal in order to accomplish it (such as that of our partner in the early phase of romantic love, a typical example of intrusive, albeit physiological, intrusive thought). However, patients with obsessive-compulsive disorder (OCD) cannot let go of these thoughts that invade their consciousness against their will and generate intense suffering. As a result, they feel increasingly unstable and insecure as they become entangled in a web of doubt and uncertainty [2, 3]. The Forgive and Forget Hood (FFH) is a ReAttach technique that is remarkably patient-friendly, simple, and can be offered remotely [4, 5, 6]. From ReAttach's perspective, it is a first-aid psychological intervention for patients who have a strong need for control. By providing the FFH as a first choice before therapy, we validate the need for self-control. What makes the FFH so promising for patients with OCD is its potential to stop rumination, a key symptom of the disorder. In this article, the authors describe a single case study of a 48-year-old man with OCD and the effect that using the FFH as a self-regulation tool had on his symptoms and self-confidence.

A Dual-Action Non-Invasive Treatment Model for Nociplastic Pain and Psychosocial Disorders

Paula Zeestraten-Bartholomeus — 2025-09-21

The complexity of chronic pain with interfering comorbidities negatively affects pain management and necessitates a multimodal biopsychosocial treatment approach, such as ReAttach. This ReAttach protocol for chronic pain, which involves a series of structured sessions focusing on affective and cognitive processes, describes the theoretical background from which ReAttach Affect Coaches might work when dealing with nociceptive pain, nociplastic pain, neuropathic pain, or a combination of these modalities. In acute pain, Wiring Affect with ReAttach (W.A.R.A.) and the Forgive and Forget Hood (FFH) are discussed for their promise in preventing acute pain from becoming chronic by promoting neuroplasticity and reducing hypersensitivity. It is remarkable how fast ReAttach can reduce altered pain transition, pain regulation, and pain perception in nociplastic and neuropathic pain, as described in the examples. Patient narratives and a case study outline how to build tailored ReAttach sessions for different chronic pain manifestations. The importance of using the M.I.S.T. and the New Mind Creation to target complexity is specifically emphasized. While ReAttach techniques are promising, further research is needed to fully explore ReAttach's potential in chronic pain patients and facilitate its broader implementation in healthcare.

The Psychology of ReAttach and Complex Divorce

Paula Zeestraten — 2025-07-13

Romantic relationships are optimal environments for fulfilling our basic needs [1, 2, 3]. It is, therefore, understandable that we attach so much value to romantic relationships [4]. Deciding to divorce or break up a long-term romantic relationship is very stressful due to the loss of love, care, intimacy, appreciation, company, security, and much more that we expect to find in the bond with this partner [3, 5]. Ending a relationship and initiating a divorce are emotionally challenging decisions, only made when a partner no longer feels that the basic needs are being met and has given up hope that this can change for the better. After a process of accumulating negative, stressful experiences and disappointments that have affected one's perception and experience, the realization of loss makes an entrance.

This article outlines the factors that contribute to complex divorces, providing support to ReAttach Specialists and ReAttach Affect Coaches in guiding families before, during, and after divorce. The aim is to identify common pitfalls promptly to prevent them while working tailored and strategically in complex divorce situations with ReAttach.

ReAttach and Neuroplasticity in Parkinson's Disease: A Message to The Control Room

Maud van Dongen — 2025-06-28

This paper delves into the potential of ReAttach as an intervention for Parkinson's Disease, a neurodegenerative disorder characterized by a decrease in brain connectivity and movement disorders [1]. The brain's ability to rewire itself presents promising opportunities for neuro-rehabilitation [2]. Various factors, including age, experience, learning, genetic factors, physical health, exercise, diet, sleep, and age, influence the extent of this rewiring [3]. The role of new learning activities in stimulating neuroplasticity cannot be overstated. These activities trigger complex molecular events associated with long-term potentiation, strengthening synaptic connections between neurons [1,4]. ReAttach is a transdiagnostic intervention for children and adults with psychological or psychosomatic problems, including neurodegenerative disorders. ReAttach focuses on optimizing arousal, stimulus processing, and learning dynamics while also activating secure attachment patterns and fostering a Growth Mindset [5,6,7]. Numerous studies have highlighted the benefits of physical exercise for individuals with Parkinson's Disease [10, 11, 12]. Exercise is undeniably beneficial for patients with PD, combating both motor and non-motor symptoms by affecting various aspects of the disease, from the dopaminergic synapse to central nervous system perfusion. Additionally, physical exercise helps build strength to compensate for age-related frailty and motor decline [10]. Authors assess how ReAttach techniques, in combination with physical exercises, help patients with Parkinson's Disease harness the neuroplasticity of their brain. This single-case study is the first publication on the application of ReAttach in patients with Parkinson's Disease. The results are part of a pilot study that will also be published shortly.

ReAttach Forgive and Forget Hood: Clear the mind stop rumination!

Paula Zeestraten-Bartholomeus — 2025-06-24

It is understandable that when we are hurt, even when we try to forgive with our hearts, it is far more complicated to forgive and forget. If we retain sensory information excluded from processing, it remains, as it were, "before our retina," and therefore influences our perception and the behavior associated with it. Research links this disturbed perception inextricably to a broad spectrum of psychological and psychosomatic complaints. The ReAttach Forgive and Forget Hood (FFH) is an accessible tool for clearing the mind, helping us to place sensory information behind our eyes [1]. Recently, we published the first pilot studies examining the effectiveness of Forgive and Forget Hood in decreasing total burden and person-intolerance [2]. This paper presents a second effectiveness study on Forgive and Forget Hood, in which we also investigate the impact of the FFH on neuro-markers to help us understand the underlying mechanisms. In the discussion, we discuss the possibilities that this accessible, affordable self-regulation tool can offer as a first-aid psychological intervention.

ReAttach Protocol for Adverse Childhood Events: Nurturing Resilience and Strength

Paula Zeestraten-Bartholomeus — 2025-06-06

Early childhood trauma is associated with higher risks of mental illness, addiction, suicide attempts, chronic health conditions, and even premature mortality in adulthood (1,2,3,4,5). Due to chronic, toxic stress, the biological stress response systems are repeatedly activated, inducing elevated stress-related hormones and neuromodulators that negatively impact brain development (1,7,8,9). Research suggests that learning, development, and health are at stake due to the dysregulation of various stress response systems, such as the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, which can lead to various health issues. Exposure to any form of early childhood trauma is a transdiagnostic factor in the origin or development of psychological or psychosomatic complaints in adults (10). It is, therefore, of the utmost importance to be trauma-sensitive in the approach and treatment of patients with chronic or complex problems. This ReAttach Protocol for Adverse Childhood Events is a guideline for all ReAttach Specialists and ReAttach Affect Coaches who want to work in a trauma-sensitive manner without shifting the focus to trauma.

ReAttach Protocol for Adoption and Foster CareBuilding Family Cohesion

Paula Zeestraten-Bartholomeus — 2025-06-06

Due to global wars, food shortages, and natural disasters, the number of orphans worldwide is growing (1). These orphans have survived terrible circumstances but have lost their parents. In addition to providing safe shelter and basic needs for survival, providing a safe home to grow up in is essential. Foster families and parents who adopt these children do incredible work. However, at the same time, these newly blended families are dealing with older, traumatized children who are much more vulnerable than babies who are given up for adoption before their first birthday (2, 3, 4). The older children have an increased risk of later emotional problems (5).
ReAttach is a transdiagnostic intervention for children and adults with mental health problems. As a brief, not-trauma-focused family-intervention (6), ReAttach aims to optimize learning conditions and development. This paper describes how ReAttach can promote the mental health of adopted and foster children and increase their resilience, well-being, and personal growth. When used strategically, the applicability of ReAttach and ReAttach Specializations (Wiring Affect with ReAttach (7) and New Mind Creation (8) becomes even more attractive. Combining ReAttach to optimize learning conditions with tailored connecting interventions is an excellent opportunity to promote mental health and personal growth.

ReAttach Protocol for Autism Spectrum Disorders: Activating the Growth Mindset in ASD

Paula Zeestraten-Bartholomeus — 2025-06-06

Autism Spectrum Disorders (ASD) are characterized by a typical way of being resulting from a pervasive developmental disorder affecting all domains of development: speech, language, social communication, social cognitive functioning, behavior, executive functioning, and physical functioning (1). Zeidan et al. (2) conducted a systematic review of the global prevalence of autism and estimated it at approximately 1%, with four times more diagnosed men than women. Realizing that ASD impacts the mental health of direct family members, the global impact of ASD is massive (3). ReAttach is a trans-diagnostic intervention for adults and children with mental health problems (4) that can be tailored for individuals with autism spectrum disorders as a systemic approach. Practice-driven research studies into the results of ReAttach for autism in targeting core symptomatology were promising in a broad range of developmental domains (5,4). In this paper, the authors describe the ReAttach Protocol for ASD for ReAttach Specialists and Affect Coaches. The authors want to state that for complex problems such as ASD, the basic ReAttach skills alone are insufficient, and extra tools for mapping complexity and inter relational dynamics, as well as additional ReAttach techniques (W.A.R.A. and New Mind Creation), are necessary. Nevertheless, describing this protocol will increase insight into applying ReAttach to individuals with autism.

Increasing Resilience in Somatic Symptom Disorder with ReAttach: A Single Case Study in Occupational Therapy

Carolien McCall — 2025-06-06

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Somatic Symptom Disorder (SSD) is a presentation of physical symptoms that accompany excessive thoughts, emotions, or symptom-related behavior, causing significant dysfunction or distress (1, 2). A medical condition does not always explain the symptomatology. According to Kurlansik and Maffei (1), patients with Somatic Symptom Disorder first experience a heightened awareness of bodily sensations. Furthermore, these patients tend to interpret these bodily sensations as indicating that they must have a medical illness (2). Besides the fact that this causes much concern for patients, research shows that there is comorbidity with personality problems. Based on scientific research, the prognosis for patients with these complex complaints is unfavorable. According to Rief and Rojas (3), up to 90% of SSD patients have a disease course that lasts longer than 5 years. Previous studies only yielded small to moderate effect sizes in treatment outcomes for this patient group (4). The current study focused on a 28-year-old young woman as a case with an unspecified SSD and cluster C personality traits.
In general, the authors of this study hope to shed a different light on SSD and the use of ReAttach to improve the resilience and self-reliance of this patient group. Authors also argue that the ReAttach intervention should be applied within Occupational Therapy (OT) as a supportive tool. Most importantly, they want to share the story of a young patient whose quality of life improved dramatically after ReAttach while on the waiting list for outpatient SSD treatment.

ReAttach Protocol for Eating Disorders: A Trans-diagnostic Systemic and Strategic Approach

Mohadeseh Bita — 2025-06-06

Eating disorders are complex psychosomatic conditions that have a massive impact on the personal lives of mostly relatively young individuals. Since eating disorders show overlap in symptomatology, a network approach to treat underlying trans-diagnostic factors would be appropriate. ReAttach is a trans-diagnostic intervention for adults and children that can be tailored for patients with eating disorders as a multi-family approach.

In this article, the authors describe the ReAttach Protocol for patients with eating disorders. The authors publish this protocol for ReAttach Specialists and Affect Coaches trained in the ReAttach specializations. Besides basic skills, this protocol requires a thorough knowledge of the C.A.T. (Computer Adaptive Tool to tailor sessions), the W.A.R.A. (Wiring Affect with ReAttach), the M.I.S.T. (Mapping the Individual State of Mind) and the New Mind Creation.

In the ReAttach Protocol, validation of the need for self-control gets special attention. It is also striking that ReAttach uses the hypothesis that loss of connectivity due to adverse affect is the cause of alienation from the body. Working with this hypothesis, the authors recommend identifying with the body during social cognitive training so that the body becomes part of the self-concept again. The authors use cognitive bias modification to train adaptive skills, necessary for further recovery. Eating disorders are life-threatening and are associated with patterns of insecure attachment. Therefore, the New Mind Creation is indispensable as a learning requirement in the ReAttach Protocol for eating disorders.

Welcome to the first issue of the ReAttach Affect Coach Journal!

Paula Zeestraten-Bartholomeus — 2025-06-06

Editorial