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.

持久性身体症状（PPS）令人痛苦，难以治疗，并且对卫生保健提供者和系统构成了重大挑战。在本文中，我们回顾了有关PPS的两个不同的文献，以提供这种难以捉摸的情况的新颖整合模型。首先，我们利用有关期望作用的临床心理学文献来表明，PPS患者对健康和疾病的预期功能失调，这些期望通过认知性重新评估变得越来越容易受到对不确定信息（例如医疗保证）的免疫。第二，我们引用神经科学的预测处理方法，并提出针对神经学证据的“认知免疫”的心理过程在神经生物学和计算水平上对应于过分的自信（即 精度）提供给先前的预测。这可能会导致无法确定的感官信息减弱，从而使先验先验超越身体的良性信号，并使人们相信严重的身体问题。组合这些不同的说明可为持续的身体症状提供统一的框架，并将重点从其病因转移到防止症状自发消退的维持机制。基于此集成模型，我们为将来的研究提供了新途径，并讨论了在临床实践中治疗PPS患者的意义。组合这些不同的说明可为持续的身体症状提供统一的框架，并将重点从其病因转移到防止症状自发消退的维持机制。基于此集成模型，我们为将来的研究提供了新途径，并讨论了在临床实践中治疗PPS患者的意义。组合这些不同的说明可为持续的身体症状提供统一的框架，并将重点从其病因转移到防止症状自发消退的维持机制。基于此集成模型，我们为将来的研究提供了新途径，并讨论了在临床实践中治疗PPS患者的意义。