Individual Video-Based Case Formulation for Participants With Persistent Physical Symptoms Associated With Indoor Environment or Chronic Fatigue
Open accessAbstract
Persistent physical symptoms (PPS) refer to a wide range of symptoms that cannot be fully explained by traditional medical assessment of bodily pathology or environmental factors. The aim of the current study was to illustrate the application of an online interview and Functional Analytic Clinical Conceptualization to describe psychological and life problems perceived by participants with PPS and to give examples of how a functional analysis approach to case formulation could assist in their treatment. We applied the Functional Analytic Clinical Case Model (FACCM) in the assessment of participants with PPS (n = 50), including three focus groups: those with PPS related to the indoor environment (n = 11), those with PPS related to prolonged fatigue (n = 28), and those with both symptoms (n = 11). Among the 50 participants with PPS, a typical amount of concurrent psychological and life problems was 9. In addition to PPS, the most typical problems reported were symptoms of stress and burnout (74%), low mood (68%), narrowing of daily life (58%), and worrying (52%). The results highlight the complexity of the participants’ life situations. We found that the FACCM was acceptable and useful in identifying potential individual treatment targets.
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On average, participants reported nine additional issues beyond their symptoms, related to daily functioning, such as narrowed daily activity, loneliness and social withdrawal, and increased worrying.
“On average, participants reported nine additional issues beyond their symptoms, related to daily functioning, such as a narrowed daily activity, loneliness and social withdrawal, and increased worrying [35].”
From Work Ability and Functioning Among Individuals with Persistent Indoor Environment-Related Symptoms or Chronic Fatigue: Nine-Month Follow-Up of a Web-Based Randomized Controlled Trial. (2026) · cites this paper as [35]
The Reported Problems section (p. 7) reports an average of 9.10 psychological or other problems per participant. Table 4 (p. 10) includes narrowing of daily life, worrying, and loneliness and social withdrawal, but it also counts persistent physical symptoms among the problems. The source therefore does not establish that the nine issues were all additional to participants’ symptoms. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIndividualized case formulation in a patient-centered manner may further enhance treatment acceptability and effectiveness.
“Self-management and web-based treatments show promise in increasing accessibility [33, 34], and individualized case formulation in a patient-centered manner may further enhance treatment acceptability and effectiveness [1, 35].”
An earlier report on video-based case conceptualization identified psychosocial and life challenges as key treatment targets in the intervention group.
“Effects on daily functioning were also manifested in our earlier report [35] on video-based case conceptualization, which identified psychosocial and life challenges as key treatment targets in the intervention group.”
Both previous and current analyses emphasize the value of comprehensive interviews and case formulation as an acceptable and useful method for identifying individual treatment targets for patients with PPS.
“Both the previous and current analyses emphasize the value of comprehensive interviews and case formulation, shown to be an acceptable and useful method for identifying individual treatment targets for patients with PPS [35].”
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- Authors
- Keinonen, K., Lappalainen, P., Lappalainen, R., Selinheimo, S., Vuokko, A., Liesto, S., Sainio, M., & Paunio, T.
- Affiliations
- University of Jyväskylä (FI)
- Finnish Institute of Occupational Health (FI)
- Helsinki University Hospital (FI)
- University of Helsinki (FI)
- Corresponding author
- Keinonen, Katariina
- ORCID
- Venue
- Cognitive and Behavioral Practice
- Publisher
- Elsevier BV
- Published
- 2025-05
- Volume
- 32
- Issue
- 2
- Pages
- 228-243
- ISSN
- 1077-7229 (ISSN-L)
- OpenAlex
- W4391649922
- Cited by
- 4
- References
- 43
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Cognitive and Behavioral Practice (publishedVersion, cc-by)
- Jyväskylä University Digital Archive (University of Jyväskylä) (submittedVersion, cc-by)
- Työväentutkimus Vuosikirja (submittedVersion)
- Funders
- Kela
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- persistent physical symptoms, case formulation, functional analysis, chronic fatigue, indoor environment, stress and burnout, depressive mood, worry, treatment goals, mental illness
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