The impact of photovoice on the report of emotions in individuals with persistent physical symptoms: Results of an experimental trial 2025 Weise et al

Highlights

• Photovoice facilitates the report of more positive emotion words.
• Emotion report requires multimodal measures (self-report and observational measures).
• Addressing individuals' concerns is key to improving the acceptability of photovoice.

Abstract

Objective
Identifying and reporting emotions can be challenging for individuals with persistent physical symptoms (PPS), like tinnitus or tension-type headaches. Photovoice (PV) helps people identify and report their emotions by photographing relevant objects or situations. The aim of our study was to examine whether PV facilitates the report of emotions in individuals with PPS.

Methods
We randomly assigned 169 participants with PPS to one of three groups: a PV group, a writing group, or a passive control group. The PV group took daily photographs related to their symptoms and coping, the writing group wrote keywords, and the passive control group had no task. After a week, all participants completed an online writing task about their symptoms and coping, which was analyzed for the number of emotion words used. We also assessed self-reported affect, ability to identify and report emotions, and self-disclosure.

Results
Participants in the PV group used more emotion words in the writing task than the control groups. Specifically, the PV group used significantly more positive emotion words (F(2,166) = 26.86, p < .001) and fewer negative emotion words (F(2,166) = 8.28, p < .001) compared to the writing and control groups. No significant group differences were found for self-reported affect and self-disclosure.

Conclusions
PV promises to facilitate more positive, nuanced, and detailed reporting of emotions and may be therapeutically useful in gathering richer insights from the participant's perspective. Future research should target individuals who respond best to PV and develop tailored treatment to increase treatment effects.

Open access

 

A one-way ANOVA revealed no group effect on participants' ratings of their state affect at post-assessment.

At post-assessment, one-way ANOVAs neither revealed a main effect of the group on the difficulties in identifying feelings (TAS-DIF), nor on the difficulties in describing feelings (TAS-DDF), and nor on the fear of self-disclosure (STA-R) (all p-values >.007).​

Post-hoc cell comparisons showed that participants in the PVG tended to report more difficulties in describing feelings compared to participants in the CG and WRG (see Table 2).
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PVG used more positive words, but they also had a harder time describing feelings. Maybe they used more positive words due to the lack of ability to accurately describe the negative emotions?

It seems like the authors believe that it’s beneficial to simply move your focus away from the symptoms and onto ‘positive’ things.

Given the observed tendency of people with PPS to shift their focus away from emotional stimuli [10,44,72,73], it is reasonable to conclude that their attention was focused on coping strategies for their symptoms rather than on the emotions themselves. This assumption is supported by our exploratory qualitative analysis of participants' photographs, which revealed that a significant number of photographs depicted positive activities, coping strategies, and elements of nature (e.g., forests, skies, and landscapes). It could be speculated that PV effectively aids people with PPS by shifting their attention and fostering a resource-oriented perspective on their symptoms [74], rather than a problem-oriented view of their symptoms. Generally, the finding that PV has reduced the use of negative emotion words is highly relevant, given that negative emotions are known risk factors for an increase in physical symptom reporting [75], whereas being able to defocus from symptom-related negative emotions is associated with better coping [76].
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However, this shift in use of positive and negative emotion words that occured in the PVG wasn’t followed by a shift in their affect state. The affect state was measured by asking the participants to what degree they had felt a given way during the last week.

If I understand this correctly, this disproves their theory. Because focusing more on positive things did not affect how the participants actually felt.

 

Really stretching the "this is a joke, right? this can't be serious, they have to just be fucking with us here" vibe. Why don't they just spend their days drinking beer and playing video games instead? It would genuinely be more productive since it's much less expensive and limits their nonsense to the room they spend their time in.

It would be hard to get an LLM to produce something this vapid and useless. You'd have to prompt it explicitly to achieve it, iterate a lot to find the right combination of priming, and still it would be hard. And would become harder with time, as they become smarter.

It's annoying how austerity is all the rage these days, and yet this is the easiest downsizing you could possibly find. Fire all those fools, every last one of them, and it's all upside with zero downside. Not only zero net contribution, not even the smallest blip of a gross contribution. Only gross.

 

I hate to tell you this @rvallee but I promoted ChatGPT and it came up with this at number 7. (You are a health psychologist. Propose ten different interventions to stimulate patient creativity which could be tested in a study of how greater creative expression may lead to patients with persistent physical symptoms reporting more positive emotions.)

Which isn’t surprising because this vapid nonsense is so common.

If the goal of these researchers is to improve people’s feelings about their symptoms, rather than improve their health, have they considered how much emotional improvement would come from taking all the money this study cost and dividing it up among the participants? That is an interesting test of any intervention - are you doing more good than handing out the cash and letting people spend it themselves would accomplish. And yet that’s never a control group option.

 

The differences I’ve observed between those who can afford to be sick and those who can’t, are staggering. I’ve followed many LC patients that got sick around the same time as me, and financial worries are very high on their lists of things that make their life worse. It also makes it more difficult to adapt - money can solve a lot of practical issues.

In Norway, there has been some acknowledgement of the link between financial troubles and mental health troubles, and some of the GPs have actually started asking patients about their finances.

 

Uh. Although it seems mostly a function of the prompt you use, I can definitely see that level of bias being asked by clinicians and therapists. It's an actionable question that may seem reasonable, to someone who understands absolutely nothing about experiencing chronic illness. And there's probably recency bias baked in the responses, going with the latest studies/search results being assumed to be 1) correct and 2) more relevant than older studies. This is how the field gets constantly renewed, and a few months from now the same prompt would yield sligthly different but equally useless answers.

Really shows how questions are so much more important than answers. Someone who wants to find specific answers can always ask questions just the 'right' way to get them. Not much different from "God, if you're listening to me, give me a sign", then whatever happens next, a dog barking, a honk, whatever, is interpreted as divine permission. An internal process that has been granted external validation.

Science is really about questions: asking the right questions the right way and remaining skeptical of whatever answers they give. But evidence-based medicine, aka "Imagine a world"-based medicine, is all about answers, without any concern for the questions. Especially so in the generic psychobehavioral ideology, where they proudly boast of not being interested in the questions/nature of the problem. It's easy to see how most of those academics would behave in a pre-science times, firmly on the side of religion/traditional approaches, definitely not the intellectual mavericks they sometimes assume themselves to be.

 

This is very similar to how to handle homelessness and destitution. Many studies have objectively proven that simply giving them the means to not be destitute, usually a home and a bit of financial support to allow them to rebuild their lives, is not only better but cheaper overall than every other combination of measures. It literally saves money. For better results. It's win-win-win.

But the vast majority of societies, in fact almost all of them, prefer punitive approaches. Even though they are more expensive and yield the worst results. Because it isn't really the results that count, but how people feel about them. If the results are better, but it feels like being cheated out of giving money to 'freeloaders', most people would rather pay more money, indirectly, unseen, unknown to them, for worse results because it feels less like being cheated. Even though everyone loses more in the end.

We can probably apply the same for physicians in dealing with chronic illness. They don't believe in chronic illness, perceive it as a choice, a behavioral failure. Therefore genuinely helping us feels like they are being cheated, taken for suckers. So they'd rather indefinitely continue failing, because even though it produces far worse results, at least it doesn't feel like being cheated. Even though, technically, they are the ones doing the cheating.

Ah, humans are so freaking weird.