Persistent physical symptoms as perceptual dysregulation: A neuropsychobehavioral model and its clinical implications.

P. Henningsen, H. Gündel, W.J. Kop, B. Löwe, A. Martin, W. Rief, J.G.M. Rosmalen, A. Schröder, C.M. van der Feltz-Cornelis, O. Van den Bergh

Research output: Contribution to journalReview articleScientificpeer-review

Abstract

Objective 

The mechanisms underlying the perception and experience of persistent physical symptoms are not well understood, and in the models, the specific relevance of peripheral input versus central processing, or of neurobiological versus psychosocial factors in general, is not clear. In this article, we proposed a model for this clinical phenomenon that is designed to be coherent with an underlying, relatively new model of the normal brain functions involved in the experience of bodily signals.

Methods 

Based on a review of recent literature, we describe central elements of this model and its clinical implications.

Results 

In the model, the brain is seen as an active predictive processing or inferential device rather than one that is passively waiting for sensory input. A central aspect of the model is the attempt of the brain to minimize prediction errors that result from constant comparisons of predictions and sensory input. Two possibilities exist: adaptation of the generative model underlying the predictions or alteration of the sensory input via autonomic nervous activation (in the case of interoception). Following this model, persistent physical symptoms can be described as failures of inference and clinically well-known factors such as expectation are assigned a role, not only in the later amplification of bodily signals but also in the very basis of symptom perception.

Conclusions 

We discuss therapeutic implications of such a model including new interpretations for established treatments as well as new options such as virtual reality techniques combining exteroceptive and interoceptive information.

Original languageEnglish
Pages (from-to)422-431
JournalPsychosomatic Medicine
Volume80
Issue number5
DOIs
Publication statusPublished - 2018

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Equipment and Supplies
Interoception

Keywords

  • BODILY DISTRESS
  • BODY
  • BRAIN
  • FIBROMYALGIA
  • FUNCTIONAL SOMATIC SYNDROMES
  • INTEROCEPTION
  • MEDICALLY UNEXPLAINED SYMPTOMS
  • NEUROBIOLOGY
  • PAIN
  • SOMATOFORM DISORDERS
  • perception
  • persistent physical symptoms
  • predictive coding
  • predictive processing model
  • somatic symptom disorder

Cite this

Henningsen, P. ; Gündel, H. ; Kop, W.J. ; Löwe, B. ; Martin, A. ; Rief, W. ; Rosmalen, J.G.M. ; Schröder, A. ; van der Feltz-Cornelis, C.M. ; Van den Bergh, O. / Persistent physical symptoms as perceptual dysregulation : A neuropsychobehavioral model and its clinical implications. In: Psychosomatic Medicine. 2018 ; Vol. 80, No. 5. pp. 422-431.
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Persistent physical symptoms as perceptual dysregulation : A neuropsychobehavioral model and its clinical implications. / Henningsen, P.; Gündel, H.; Kop, W.J.; Löwe, B.; Martin, A.; Rief, W.; Rosmalen, J.G.M.; Schröder, A.; van der Feltz-Cornelis, C.M.; Van den Bergh, O.

In: Psychosomatic Medicine, Vol. 80, No. 5, 2018, p. 422-431.

Research output: Contribution to journalReview articleScientificpeer-review

TY - JOUR

T1 - Persistent physical symptoms as perceptual dysregulation

T2 - A neuropsychobehavioral model and its clinical implications.

AU - Henningsen, P.

AU - Gündel, H.

AU - Kop, W.J.

AU - Löwe, B.

AU - Martin, A.

AU - Rief, W.

AU - Rosmalen, J.G.M.

AU - Schröder, A.

AU - van der Feltz-Cornelis, C.M.

AU - Van den Bergh, O.

PY - 2018

Y1 - 2018

N2 - Objective The mechanisms underlying the perception and experience of persistent physical symptoms are not well understood, and in the models, the specific relevance of peripheral input versus central processing, or of neurobiological versus psychosocial factors in general, is not clear. In this article, we proposed a model for this clinical phenomenon that is designed to be coherent with an underlying, relatively new model of the normal brain functions involved in the experience of bodily signals.Methods Based on a review of recent literature, we describe central elements of this model and its clinical implications.Results In the model, the brain is seen as an active predictive processing or inferential device rather than one that is passively waiting for sensory input. A central aspect of the model is the attempt of the brain to minimize prediction errors that result from constant comparisons of predictions and sensory input. Two possibilities exist: adaptation of the generative model underlying the predictions or alteration of the sensory input via autonomic nervous activation (in the case of interoception). Following this model, persistent physical symptoms can be described as failures of inference and clinically well-known factors such as expectation are assigned a role, not only in the later amplification of bodily signals but also in the very basis of symptom perception.Conclusions We discuss therapeutic implications of such a model including new interpretations for established treatments as well as new options such as virtual reality techniques combining exteroceptive and interoceptive information.

AB - Objective The mechanisms underlying the perception and experience of persistent physical symptoms are not well understood, and in the models, the specific relevance of peripheral input versus central processing, or of neurobiological versus psychosocial factors in general, is not clear. In this article, we proposed a model for this clinical phenomenon that is designed to be coherent with an underlying, relatively new model of the normal brain functions involved in the experience of bodily signals.Methods Based on a review of recent literature, we describe central elements of this model and its clinical implications.Results In the model, the brain is seen as an active predictive processing or inferential device rather than one that is passively waiting for sensory input. A central aspect of the model is the attempt of the brain to minimize prediction errors that result from constant comparisons of predictions and sensory input. Two possibilities exist: adaptation of the generative model underlying the predictions or alteration of the sensory input via autonomic nervous activation (in the case of interoception). Following this model, persistent physical symptoms can be described as failures of inference and clinically well-known factors such as expectation are assigned a role, not only in the later amplification of bodily signals but also in the very basis of symptom perception.Conclusions We discuss therapeutic implications of such a model including new interpretations for established treatments as well as new options such as virtual reality techniques combining exteroceptive and interoceptive information.

KW - BODILY DISTRESS

KW - BODY

KW - BRAIN

KW - FIBROMYALGIA

KW - FUNCTIONAL SOMATIC SYNDROMES

KW - INTEROCEPTION

KW - MEDICALLY UNEXPLAINED SYMPTOMS

KW - NEUROBIOLOGY

KW - PAIN

KW - SOMATOFORM DISORDERS

KW - perception

KW - persistent physical symptoms

KW - predictive coding

KW - predictive processing model

KW - somatic symptom disorder

U2 - 10.1097/PSY.0000000000000588

DO - 10.1097/PSY.0000000000000588

M3 - Review article

VL - 80

SP - 422

EP - 431

JO - Psychosomatic Medicine

JF - Psychosomatic Medicine

SN - 0033-3174

IS - 5

ER -