Understanding persistent physical symptoms: Conceptual integration of psychological expectation models and predictive processing accounts, 2020, Kube

Andy

Retired committee member
Perhaps we should have a sub-forum for this kind of publication called "Speculative fiction"? ;)
"Highlights"
• This article reviews sustaining mechanisms of persistent physical symptoms (PPS).
• It connects psychological models and neuroscientific work on symptom perception.
• It assumes that PPS are related to abnormal processing of benign bodily sensations.
• Psychologically, PPS are related to difficulties in processing medical reassurance.
• As a result, people are left with the concern that something is wrong with the body.

Abstract
Persistent physical symptoms (PPS) are distressing, difficult to treat, and pose a major challenge to health care providers and systems. In this article, we review two disparate bodies of literature on PPS to provide a novel integrative model of this elusive condition. First, we draw on the clinical-psychological literature on the role of expectations to suggest that people with PPS develop dysfunctional expectations about health and disease that become increasingly immune to disconfirmatory information (such as medical reassurance) through cognitive reappraisal. Second, we invoke neuroscientific predictive processing accounts and propose that the psychological process of ‘cognitive immunization’ against disconfirmatory evidence corresponds, at the neurobiological and computational level, to too much confidence (i.e. precision) afforded to prior predictions. This can lead to an attenuation of disconfirming sensory information so that strong priors override benign bodily signals and make people believe that something serious is wrong with the body. Combining these distinct accounts provides a unifying framework for persistent physical symptoms and shifts the focus away from their causes to the sustaining mechanisms that prevent symptoms from subsiding spontaneously. Based on this integrative model, we derive new avenues for future research and discuss implications for treating people with PPS in clinical practice.
Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0272735820300179
Sci hub, https://sci-hub.se/10.1016/j.cpr.2020.101829
 
First, we draw on the clinical-psychological literature on the role of expectations to suggest that people with PPS develop dysfunctional expectations about health and disease that become increasingly immune to disconfirmatory information

Health psychologists acquire false and dysfunctional beliefs about reality during training and then wreck other people's lives with them and are also quite immune to disconfirmatory information.

It's also amusing to see them struggle to find new ways to say it's all the mind and imaginary while insisting they are saying no such thing.
 
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This reads exactly like satire of psychosomatic ideology. It would truly make great satire if it weren't a serious word salad attempt at sounding smart.

Intelligence without wisdom. Ugh, so mediocre. This field is inventing so many novel models of the same thing you'd think they get a free coffee at every dozen. It would be really great if someone were to make a tally of how exactly how many nearly identical psychosomatic models exist out there. Just the ones that are generally listed as being in use at least amount to a whole dozen. I'm pretty sure we've reached 100 by now, with mostly cosmetic and framing distinctions but otherwise talking round and round about the same things.

Seriously cringeworthy and oh would you like at that Eysenck-type thingy:
A key finding in the field of belief updating is that healthy people exhibit an optimistic bias when integrating new information into their beliefs, as demonstrated for instance by Sharot and colleagues in a well-designed series of experiments
The only disability is a bad attitude. Thanks, I'm cured!
Belief updating in healthy people, on the other hand, seems to be biased towards the integration of information that is consistent with an optimistic view of the future, the self, and core beliefs to make sense of the world
Wow I had no idea all healthy people are optimistic people who positively integrate new information that makes a lot of sense when you look at the comments section on politics news, everyone is so darn positive out there. That makes perfect sense I've never seen an angry/negative person who is healthy in my life no sir not ever.

Frankly this is seriously advanced foolishness, but mostly it's just the same old rehash of "rousing reassurance" is all the worried well need and chronic symptoms are nothing but a refusal to accept this reassurance based on unhelpful illness beliefs. So literally the same tripe that's been integrated into "novel models" dozens, if not hundreds, of times, always novel, always the same.

It's getting frustrating that people are being paid generous salaries to produce this garbage.
 
This reads like a humanities piece written by someone who identifies unironically as a 'post-modern radical neo-Marxist feminist critical cultural theorist' or something.

Just apply some 'theoretical frames' to a problem and pass off the resulting drivel as highly valuable insight. No need to check for grounding in science or even common sense.

Pure self-satire.
 
Perhaps we should have a sub-forum for this kind of publication called "Speculative fiction"? ;)

Yes!

First, I draw on the clinical-psychological literature on the role of expectations to suggest that those who promote theories about PPS being due to dysfunctional expectations about health are increasingly immune to disconfirmatory information. Second, I invoke neuroscientific predictive processing accounts and propose that the psychological process of ‘cognitive immunization’ against disconfirmatory evidence corresponds, at the neurobiological and computational level, to too much confidence (i.e. precision) afforded to prior predictions in flawed hypotheses about PPS. This can lead to an attenuation of disconfirming data, so that strong priors about psychosomatic hypotheses override accumulating evidence that there may be other explanations for PPS symptoms.

See what I did there?
 
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This reads exactly like satire of psychosomatic ideology. It would truly make great satire if it weren't a serious word salad attempt at sounding smart.

Intelligence without wisdom. Ugh, so mediocre. This field is inventing so many novel models of the same thing you'd think they get a free coffee at every dozen. It would be really great if someone were to make a tally of how exactly how many nearly identical psychosomatic models exist out there. Just the ones that are generally listed as being in use at least amount to a whole dozen. I'm pretty sure we've reached 100 by now, with mostly cosmetic and framing distinctions but otherwise talking round and round about the same things.

Seriously cringeworthy and oh would you like at that Eysenck-type thingy:

The only disability is a bad attitude. Thanks, I'm cured!

Wow I had no idea all healthy people are optimistic people who positively integrate new information that makes a lot of sense when you look at the comments section on politics news, everyone is so darn positive out there. That makes perfect sense I've never seen an angry/negative person who is healthy in my life no sir not ever.

Frankly this is seriously advanced foolishness, but mostly it's just the same old rehash of "rousing reassurance" is all the worried well need and chronic symptoms are nothing but a refusal to accept this reassurance based on unhelpful illness beliefs. So literally the same tripe that's been integrated into "novel models" dozens, if not hundreds, of times, always novel, always the same.

It's getting frustrating that people are being paid generous salaries to produce this garbage.
My OH could until recently considered healthy. He has gone through life with a " glass half empty" attitude.
Health has nothing to do with how he frames interactions.
Generalised BS
 
The authors seem to reference their own prior theoretical papers to bolster their arguments. The whole thing is based on the premise that people with so-called PPS do not have any organic problems that could be causing their symptoms.
It goes a bit further and argues that the symptoms are irrelevant and have no actual impact, it's only the expectation that they are indicative of worse things that create the impact, catastrophising about having a fatal disease.

It frames the "symptoms" as something as impactful as the color or length of our hair, if we didn't think about them they wouldn't affect us at all, zero, zilch. Which is typical but it's a little more blatant than usual.

From my POV, I never considered that since the damn symptoms are plenty enough of a problem, the same way as even though the common cold or even most bouts of flu or food poisoning are not fatal, people are still very much affected by the symptoms and rarely think about it being more serious because it's already damn serious enough to disable you for many days.

Still that damn belief that chronic symptoms are completely different than acute ones and have nothing whatsoever in common despite our belief that we "have" "symptoms". Despite the fact that beyond a label we have no understanding whatsoever of how most symptoms even manifest themselves, and even those labels are mostly vague and often have different meanings for the same thing.
 
Persistent physical symptoms (PPS) are distressing, difficult to treat, and pose a major challenge to health care providers and systems.
Well, only some persistent physical symptoms are distressing. The freckles on my forearms are a persistent physical symptom of exposure to solar radiation that has never caused me any distress. And, while some persistent physical symptoms are difficult to treat, for many there are reasonable treatments. For example, a hip replacement for persistent hip pain.

But, yes, if you really must define a persistent physical symptom as
'a symptom that is problematic enough to cause a person to consult the medical system but has not yet been fixed by the bit of the imperfect medical system that has dealt with it so far, despite some effort',
then yes, of course, almost by definition, the symptoms will probably be distressing and difficult to treat and present a challenge to health care providers.

The authors of this paper go further. The suggested mechanisms for the symptom's persistence are an abnormal level of attention to the symptom and/or a lack of attention to disconfirmatory evidence - so that people falsely believe that there is something seriously wrong with their body. So the authors seem to be suggesting that what they define as 'physical persistent symptoms' must also be unrelated to or, at most a greatly exaggerated response to, a real physical cause.

So, the authors leave out great swathes of persistent physical symptoms from their definition of PPS. And then they suggest that a 'fix' that may or may not be useful for a very specific type of persistent physical symptoms should be applied to a much broader range of people with 'persistent physical symptoms'.

The stupidity is breath-taking. And the consequences: the inadequate diagnostic processes, the stigma applied to people who are already suffering, the lack of research to solve real medical problems, and the waste of public funds on research and treatments that won't help, are very sad indeed.
 
Well, only some persistent physical symptoms are distressing. The freckles on my forearms are a persistent physical symptom of exposure to solar radiation that has never caused me any distress. And, while some persistent physical symptoms are difficult to treat, for many there are reasonable treatments. For example, a hip replacement for persistent hip pain.

But, yes, if you really must define a persistent physical symptom as
'a symptom that is problematic enough to cause a person to consult the medical system but has not yet been fixed by the bit of the imperfect medical system that has dealt with it so far, despite some effort',
then yes, of course, almost by definition, the symptoms will probably be distressing and difficult to treat and present a challenge to health care providers.

The authors of this paper go further. The suggested mechanisms for the symptom's persistence are an abnormal level of attention to the symptom and/or a lack of attention to disconfirmatory evidence - so that people falsely believe that there is something seriously wrong with their body. So the authors seem to be suggesting that what they define as 'physical persistent symptoms' must also be unrelated to or, at most a greatly exaggerated response to, a real physical cause.

So, the authors leave out great swathes of persistent physical symptoms from their definition of PPS. And then they suggest that a 'fix' that may or may not be useful for a very specific type of persistent physical symptoms should be applied to a much broader range of people with 'persistent physical symptoms'.

The stupidity is breath-taking. And the consequences: the inadequate diagnostic processes, the stigma applied to people who are already suffering, the lack of research to solve real medical problems, and the waste of public funds on research and treatments that won't help, are very sad indeed.
This,
Thank you @Hutan
 
sci hub says it exist to make knowledge freely available .so why are they giving a platform to this philosophical bs that has and always will be disproved when the necessary research is finally done by people who actually understand biology and the scientific process. shame the loved ones who have lost people due to peptic ulcers cannot sue these tripe mongers .
 
sci hub says it exist to make knowledge freely available .so why are they giving a platform to this philosophical bs that has and always will be disproved when the necessary research is finally done by people who actually understand biology and the scientific process. shame the loved ones who have lost people due to peptic ulcers cannot sue these tripe mongers .
Sci-hub is not a publisher. It's a piracy site for academic and scientific papers.
 
sci hub says it exist to make knowledge freely available .so why are they giving a platform to this philosophical bs

Also, if there is research that exists only behind a paywall it is much better to have it freely available on sci-hub for scrutiny. If you don't know it's there you can't high-light problems and expose it. This is the beauty of sci-hub.

They are not taking a philosophical position, they are about exposing science to scrutiny.
After all other researchers may cite this paper as somehow relevant and meaningful and build on their 'conceptual model'. Best it's out there where we can see it happening.
 
i can't go into this correctly or in depth for
health reasons, but as a clumsy statement of the obvious i'd
like to point out a few observations.

i believe in stating the obvious. i think it keeps
everybody (including myself) on the same page.


to me, most of this type of research, including major
trials, shares three distinctive characteristics. there are
a lot more, but the three that really stand out are as follows.

1) category error
2) attack
3) obscuring

the key observation is (2). if you forget everything else,
please remember (2).


let's do them one at a time.

1) category error

if i were to eliminate one of my three observations, it
would be this one. the other two to me are not
seriously challengeable.

this one is worth pointing out because it is
so, almost literally unbelievably, imbecilic.


when you follow the logic as if it were intended to
seek or convey truth, and get past the fact that it is
not, in fact, logic, to what seem to be the claims, the
claims consistently boil down to one or both of the
following:

- there is no disease. for example, nobody dies from
the disease whose population is being attacked.

at most it is ordinary bodily sensations like
passing wind, which are then magnified in your mind.

for example, you think you have hiv/aids, and that is
the problem. it is not that you HAVE an
hiv/aids-like disease. that is not the problem.
- the belief THAT you have the disease, or any serious
disease, IS, or CAUSES, the disease.

the first claim says that you are mistaken about
PRIMARY FACTS AND EXPERIENCES. they choose
experiences, which they deny using burden of proof
reversal. usually.

if that fails, they need to defend fact claims. but
they still have burden of proof reversal, so it isn't
so much defense as unchallenged ipsedixitism. it is
still at the level of child's play for them.

(in a truth-seeking environment, none of these claims
would exist in the first place. we have to conclude
that academia and medicine are significantly NOT
truth-seeking environments.)

FACT claims are demolished by existence proof (she
died), which drags you into a distracting back and
forth about who has the disease and so on, with you
having it if it suits their claims and you not having
it if not.

but after the long back and forth, which is almost
never followable to completion because there is no good mechanism
in academic discourse in practice in this
case to hold them in place for questioning, whenever the fact claims are demolished, the remaining
option is the second.

(courts of law, perhaps surprisingly?, probably do
significantly better than academia at this.)

so the second claim is really the claim being made in
this subset of this type of research....

... and the second claim -- that the COGNITIONS account
for the disease -- is the category error. so i have
finally got round to my point. apologies for it taking
so long.

this too is subject to diversion rhetoric, but if it
ever poked its head out too directly, even the
self-absorbed academic rabble might start to object.
it makes ALL of academia look bad. THEN they start to
care.

academics really don't care whether populations get
attacked as long as careers are preserved. 1900s
history demonstrates this.

so i think the second claim needs to, for those who
make it, not be revealed too blatantly in the wrong
forums.

so to get down to brass tacks: the category error can
be slipperified, but even if it is turned into a
non-category error, it turns into something like this:

- you can, directly by having beliefs, change multiple
body systems (this is like my hysterical edema post)

if challenged, the response turns to authority
(and spammed) "evidence based" assertions, photographs
of changed brains, excited and wide-eyed magazine
articles, and so on.

but the claim is not challenged on fundamental
scientific grounds. it is NOT a category error, but it
is not like 2 + 2 = 7 either. it is more like 2 + 2 =
avogadro's number. darwinian natural selection cannot
possibly make it make sense as a serious claim. and
that's enough to demolish the claim.

so what remains? a claim that is more like 2 + 2 =
milk. that is the category error.

to me, the thing that is most extraordinary about it is
the degree of imbecility. a young child knows that milk is not a number. yet such researchers defended a dissertation and were granted a doctoral degree.

it is an "i don't even".

2) attack

i can dispose of this one quickly. almost everything
in or connected with this type of research implicitly
or explicitly says one or more of the following:

- that you are illegitimate.
- that you are a burden to society.
- that you are not fully human or normal.

this, combined with the extensive supporting infrastructure, constitutes an attack on the population.

3) always the "right" amount of layering of obscuring
stuff to make (1) and (2) poke their heads out only
briefly.

they are logically entailed, or stated explicitly, or
implied, in every case, but they only make themselves
obvious to the casual reader infrequently, despite
always being there when you grasp the nettle.

by "obscuring stuff" i mean slipperiness, equivocation, ambiguity, vagueness, innuendo,
conflation, confusion, and in general a large
assortment of logical fallacies and eristic and
rhetorical tricks.

the forums in which the claims are made are NEVER
suited for sufficiently, if you were to take the claims
seriously, asking "what precisely do you mean by
that?"


the rest of the attack is implemented by an extensive
infrastructure that includes whoever makes boots on the
ground policy, propaganda including well-timed columnist
columns, press releases, and so on.

the moral inversion is just taken as normal. it seems actually
jarring and outside the ken of the typical observer, to have
any of this pointed out. the degree of effectiveness is
extraordinary.

it is resilient to changes in
politics, science, and academia in general. i am not alleging intent for any of the three observations. i am only saying they hold consistently.

the first only holds for a subset but it is curiously imbecilic.
 
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