# Basic emotions reported by individuals with persistent physical symptoms receiving exposure therapy versus healthy lifestyle promotion in primary care

## TL;DR

People with persistent physical symptoms experience more negative emotions than healthy individuals, and these emotions decrease with treatment.

## Contribution

The study identifies a range of basic emotions associated with persistent physical symptoms and their response to treatment.

## Key findings

- PPS participants reported higher levels of anger, disgust, fear, sadness, and shame compared to healthy volunteers.
- Negatively valenced emotions decreased significantly in both treatment groups, with no significant differences between them.
- Joy increased significantly in participants receiving exposure therapy.

## Abstract

The importance of fear has been emphasized in research and treatment focusing on persistent physical symptoms (PPS). Recognizing a broader range of emotions may inform theory and personalized care. This study aimed to examine what basic emotions individuals with PPS experience related to their physical symptoms, the correlations between such emotions and overall somatic symptom burden and disability, and whether emotions change with treatment. Analyses drew on data from a randomized controlled trial that compared internet-delivered exposure therapy with healthy lifestyle promotion for patients with PPS (n = 159), supplemented by data from age- and gender-matched healthy volunteers (n = 160). Participants self-reported emotions related to their physical symptoms. Mean differences were evaluated within a linear regression modeling framework. Compared with the healthy volunteers, PPS participants scored significantly higher on anger, disgust, fear, sadness, and shame, and lower on joy. Disgust, fear, sadness, and shame correlated significantly with somatic symptom burden; anger, fear, sadness, and shame with disability. All negatively valenced emotions reduced significantly in both interventions, without significant between-group effects. Joy increased significantly in exposure. These results highlight the potential relevance of diverse emotions in PPS. To facilitate personalized care, future work could evaluate the unique contribution of specific emotions to clinical outcomes.

The online version contains supplementary material available at 10.1038/s41598-026-39962-x.