It is a positive development that researchers dealing with conflict-affected populations have become mindful of the complex interplay of contributing factors concerning the development and perpetuation of mental health disorders, and their role in the transmission and perpetuation of violence. For instance, it has become common to integrate multiple contextual, intra-, and inter-individual factors using conceptual frameworks (e.g., adaptations of Bronfenbrenner’s socio-ecological model) and longitudinal research strategies (e.g Amone-P’olak et al., 2013).

It is clinically well known that olfactory intrusions in PTSD can be a disabling phenomena due to the involuntary recall of odor memories. Odorants can trigger involuntary recall of emotional memories as well have the potential to help diminishing emotional arousal as grounding stimuli. Despite major advances in our understanding of the function of olfactory system, the study of the relation of olfaction and emotional memory is still relatively scarce.

Dr Halvorsen quite rightly draws attention to the various definitions of clinically significant change, which all have their advantages and disadvantages. We especially agree with the comment that the threshold for clinically significant change should at least coincide with the threshold for reliable change (18.66 in our sample).

In the Netherlands, every year 500,000 people are confronted with the death of a close relative. Many of these people experience little emotional distress. In some, bereavement precipitates severe grief, distress, and dysphoria.

A small yet significant minority of bereaved individuals develops persistent and debilitating symptoms of persistent complex bereavement disorder (PCBD) (also termed prolonged grief disorder), posttraumatic stress disorder, and depression.

Knowledge about early identification of, and preventive care for complex grief has increased.