Commentary argues for broader frameworks in persistent symptoms

In this commentary, four Norwegian clinicians and researchers respond to a recent appeal by 63 clinicians and researchers that presented predictive processing as a basis for greater hope of recovery in people with persistent symptoms. The authors agree that improvement can be possible, but caution against treating one explanatory model as sufficient. They note that empirical support for predictive processing is still developing.

The authors describe health and illness as involving interacting biological processes, personal experiences, relationships and living conditions. They distinguish functional and behavioral, psychological, and biological levels of explanation, using persistent pain as an example: nervous-system activity, the person’s experience of threat, and changes in activity or social participation may all be relevant. They argue that a patient-informed biopsychosocial case formulation can help connect symptoms with their meaning and context, while identifying factors that may maintain them.

This is an opinion piece, not a clinical study or treatment guideline. It does not assess outcomes or establish the comparative effectiveness of explanatory models. Its central clinical argument is that predictive processing may contribute to a broader formulation but is not sufficient on its own; language focused mainly on brain mechanisms may obscure patients’ own accounts and the influence of their circumstances.