Assessment and exposure treatment for patients with persistent physical symptoms in primary care
A new doctoral thesis from Karolinska Institutet shows that simple questionnaires and targeted online therapy can improve the assessment and treatment of persistent physical symptoms in primary care, offering better support for patients with chronic and distressing health problems.
What is the main focus of your thesis?
”The thesis focuses on a common but often overlooked problem: persistent physical symptoms like chronic pain, fatigue, or recurrent stomach issues. These can be highly disabling and cause substantial suffering for many patients. At the same time, it is a challenge to assess such symptoms in routine primary care, and patients often experience insufficient effects of existing treatments. The aim was to help change that," says Jonna Hybelius, doctoral student at the Department of Neurobiology, Care Sciences and Society, who will defend her thesis on June 5, 2026.
Which are the most important results?
”We found that the self-report questionnaire Patient Health Questionnaire-15 (PHQ-15) and its short version, the Somatic Symptom Scale-8 (SSS-8), are suitable for assessing patients’ overall physical symptoms in research and routine care. Further, the results suggested that symptoms of the same type, such as pain, often occur together, but there is also a general tendency for different types of symptoms, such as pain and stomach issues, to co-occur. We also found that patients with various persistent physical symptoms appear to benefit from one and the same psychological treatment. However, this internet-delivered exposure therapy appears to offer clear advantages compared to the more rudimentary intervention of internet-delivered promotion of healthy lifestyle habits only for patients with pronounced physical symptoms and distress.”
How can this new knowledge contribute to the improvement of people’s health?
”Our results support use of the PHQ-15 and SSS-8, as well as exposure therapy, for the assessment and treatment of persistent physical symptoms, primarily in more severe cases. Such brief self-report questionnaires and flexible psychological treatments that work across different types of symptoms could improve care processes and make treatment more accessible for many patients.”
What’s in the future for you? Will you continue to conduct research?
”Going forward, I will be involved in further research on persistent physical symptoms. I will also be part of another research group evaluating cognitive therapy for post-traumatic stress disorder.”