{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T07:18:22Z","timestamp":1787815102577,"version":"build-2784847793"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Chronic psychological suffering may persist despite adequate diagnosis, evidence\u2010based treatment and preserved cognitive insight. In clinical practice, this persistence is often interpreted as treatment resistance, symptom severity or insufficient adherence. However, such explanations may fail to capture the structural organization through which suffering becomes stabilized over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives<\/jats:title>\n                    <jats:p>This theoretical article proposes an alternative conceptualization of psychopathological chronicity as a structural mode of organization sustained by recursive affective\u2010symbolic loops, rather than by the mere persistence of symptoms. It aims to explain the paradox of insight without recovery and to clarify how chronic suffering may acquire a homeostatic function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The article integrates concepts from clinical psychopathology, phenomenology, affective neuroscience and predictive processing. It also draws on converging evidence from clinical domains in which psychological status, perceived health and self\u2010regulatory appraisals modify relationships among symptom reports, objective findings, functional impairment and somatic outcomes. Clinical vignettes are used to illustrate the proposed model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The proposed framework suggests that cognition may become functionally recruited in the stabilization of chronic suffering. Within this organization, chronicity can operate as a form of \u201cpathological health\u201d, protecting the subject from greater psychic fragmentation while simultaneously maintaining distress. The model also highlights how therapeutic interactions may inadvertently reinforce recursive loops when interventions remain confined to cognitive insight, reassurance or premature disruption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Psychopathological chronicity may be better understood as an affective\u2010symbolic architecture that organizes symptoms, self\u2010appraisal, embodiment and relational patterns. Structural change may therefore require embodied and transferential interventions capable of disrupting the recursive core, together with operational markers for distinguishing timely therapeutic destabilization from premature disruption. This model is primarily applicable to adult and older adolescent populations and may contribute to a more nuanced evaluation of chronicity in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70528","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T19:49:01Z","timestamp":1783540141000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Insight Trap: Recursive Affective\u2010Symbolic Loops and the Architecture of Chronicity"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1077-876X","authenticated-orcid":false,"given":"Rafael Tonella","family":"Vezzoli","sequence":"first","affiliation":[{"name":"COPE Cana\u00e3 \u2010 Centro de Oftalmologia e Pediatria Especializado, Cana\u00e3 dos Caraj\u00e1s\u2010PA Independent Researcher  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Cognitive Therapy of Depression","author":"Beck A. T.","year":"1979"},{"key":"e_1_2_13_3_1","first-page":"145","volume-title":"The Standard Edition of the Complete Psychological Works of Sigmund Freud","author":"Freud S.","year":"1958"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/med:psych\/9780198527664.001.0001"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordhb\/9780198803157.001.0001"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780195096736.001.0001"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi.2015.29.5.575"},{"key":"e_1_2_13_8_1","volume-title":"Schema Therapy: A Practitioner's Guide","author":"Young J. E.","year":"2003"},{"issue":"29","key":"e_1_2_13_9_1","first-page":"1","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"Fokkens W. J.","year":"2020","journal-title":"Rhinology"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01136-2019"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001384"},{"key":"e_1_2_13_12_1","volume-title":"The Normal and the Pathological","author":"Canguilhem G.","year":"1991"},{"key":"e_1_2_13_13_1","first-page":"351","volume-title":"Causal Cognition: A Multidisciplinary Debate","author":"Hacking I.","year":"1995"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599820926129"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.846"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2024.0898"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmedr.2022.101721"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.44836"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780199646883.001.0001"},{"key":"e_1_2_13_20_1","volume-title":"The Shadow of the Object: Psychoanalysis of the Unthought Known","author":"Bollas C.","year":"1987"},{"key":"e_1_2_13_21_1","volume-title":"The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma","author":"Kolk B. A.","year":"2014"},{"key":"e_1_2_13_22_1","volume-title":"The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self\u2010Regulation","author":"Porges S. W.","year":"2011"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.01707"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780199826988.001.0001"},{"issue":"12","key":"e_1_2_13_25_1","first-page":"864","article-title":"Is the Self a Higher\u2010Order Cognitive Function? Self\u2010Referential Processing and Resting State Efficiency","volume":"20","author":"Northoff G.","year":"2016","journal-title":"Trends in Cognitive Sciences"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrn2787"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780199682737.001.0001"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.02.026"},{"key":"e_1_2_13_29_1","volume-title":"The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are","author":"Siegel D. J.","year":"1999"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1124\/pr.118.017160"},{"key":"e_1_2_13_31_1","volume-title":"Waking the Tiger: Healing Trauma","author":"Levine P. A.","year":"1997"},{"key":"e_1_2_13_32_1","volume-title":"Trauma and the Body: A Sensorimotor Approach to Psychotherapy","author":"Ogden P.","year":"2006"},{"key":"e_1_2_13_33_1","volume-title":"Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures","author":"Shapiro F.","year":"2018"}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70528","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jep.70528","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70528","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:35:10Z","timestamp":1787812510000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.70528"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":32,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/jep.70528"],"URL":"https:\/\/doi.org\/10.1111\/jep.70528","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"value":"1356-1294","type":"print"},{"value":"1365-2753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"assertion":[{"value":"2026-02-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70528"}}