(C) PLOS One This story was originally published by PLOS One and is unaltered. . . . . . . . . . . PLOS Mental Health Conversations: When the Problem is Solved but the Pattern Persists [1] ['Plos Mental Health', '.Wp-Block-Co-Authors-Plus-Coauthors.Is-Layout-Flow', 'Class', 'Wp-Block-Co-Authors-Plus', 'Display Inline', 'Sourceurl Https', 'Speakingofmedicine.Plos.Org Wp-Content Plugins Co-Authors-Plus Build Blocks Block-Coauthors Style-Index.Css', '.Wp-Block-Co-Authors-Plus-Avatar', 'Where Img', 'Height Auto Max-Width'] Date: 2026-09-08 In the latest edition of ‘PLOS Mental Health Conversations’, we hear from Tomáš Brabec – a Czech physiotherapist and chronic pain consultant. As a result of his clinical experience, he presents a hypothesis on persistent adaptive patterns in mental and physical health. This blog series was set up in order to provide a space that stimulates theoretical discussion and fosters potential collaboration. If you would like to bring a hypothesis or framework to the field, please reach out to our Executive Editor. The following has been written by Tomáš Brabec… When the problem is solved but the pattern persists People change. That much is well known. But what side effect does change bring? A person who doubted themselves for years, for example, can gain confidence precisely in the area of life where that doubt began. Someone who lived for a long time in helplessness, sadness, uncertainty, or constant struggle can leave those circumstances behind and no longer experience the original problem as unresolved. In my clinical practice, observing how a person’s body and mind function, I noticed a phenomenon that led me to an unusual question: What if the problem really was solved, but the way of functioning the person learned during it persists? I began to observe that a familiar psychological state can start to appear in a different context. Someone who no longer doubts themselves in the original area of life may begin to experience uncertainty elsewhere. Something that previously carried little emotional weight for them can suddenly acquire disproportionate importance. New circumstances can be interpreted in a way that recreates a familiar state of sadness, helplessness, struggle, or self-doubt. And in my work, with chronic pain and persistent physical symptoms, I have observed a further form of the same phenomenon. In certain cases the physical symptom did not appear during the period of greatest psychological strain, but only after the person had moved on from the original problem. These observations led me to formulate the ‘Adaptive Habit Framework’. The framework is not primarily a theory of pain. It is a hypothesis about what can happen to a learned adaptation once the circumstances that created it have changed. From Adaptive Response to Adaptive Habit A person is constantly adapting to the circumstances in which they live. During a difficult period it is useful to stay on guard, to fight, to withdraw, to endure, to rely on others, to suppress one’s own needs, to postpone decisions, or to be cautious about what one allows oneself. Emotional states such as sadness or uncertainty, too, can be an understandable response to the reality a person is living in at the time. I call this way of functioning an adaptive response: a psychological and behavioral reaction that arises in relation to a specific situation and serves a particular function within that situation. An adaptive habit is the continuation of this learned response after the original conditions have changed and its original function is no longer needed. The persistence of learned reactions is not in itself a new idea. Why might learned ways of responding persist? Image credit: Ruslan Sikunov, from Pixabay. The narrower question the framework raises is: What happens to such a pattern once a person has genuinely overcome the original problem, yet the learned way of responding persists? This is where one of the central ideas of the Adaptive Habit Framework matters. The end of the original situation does not, by itself, mean the end of the adaptive habit that arose during it. Quite the opposite: based on my clinical observations, the learned way of responding continues, because in the meantime it has become automatic. When the Pattern Finds a New Context Imagine someone who lived for many years with the feeling that they could not manage something on their own. Gradually their situation changes. Their behavior changes. They repeatedly confirm that they can handle the situation, and no longer perceive the original problem as a problem. Yet self-doubt begins to appear elsewhere. They may begin to doubt something that never used to worry them. They may start to preoccupy themselves, unusually, with an area that was never particularly important to them. New situations may repeatedly be interpreted through the same familiar question: “Can I really handle this?” A similar principle can be observed with sadness, helplessness, struggle, dependence on others, or other learned states. In my clinical practice I have repeatedly observed situations in which the original problem was genuinely overcome, yet a familiar way of experiencing or responding began to appear in a different context. In a new area that had previously had no direct connection to the original problem. An adaptive habit persists even after its original reason has ceased to exist. It does not automatically disappear simply because the person or their life situation has changed. This idea needs to be distinguished from the Freudian concept of “symptom substitution,” according to which removing a symptom without resolving the underlying unconscious conflict causes a substitute symptom to appear – precisely because the problem was never actually resolved. This idea needs to be distinguished from the Freudian concept of “symptom substitution,” according to which removing a symptom without resolving the underlying unconscious conflict causes a substitute symptom to appear – precisely because the problem was never actually resolved. Empirical support for this concept is, moreover, lacking. The Adaptive Habit Framework starts from the opposite premise: the original problem was genuinely resolved, but the learned way of responding itself persists, not a hidden conflict. At the same time, the framework does not assume that a person consciously creates new problems or circumstances for themselves. It points to a different reality: a learned adaptive habit can continue to influence what a person pays attention to, how they interpret new situations, how they make decisions, and what they experience within them. A familiar psychological state can thus reappear in a new context. And this is precisely where recognizing the adaptive habit itself may matter. If a person regards their current reaction merely as an appropriate response to present reality, they may not see that, in that area, they are repeating a way of functioning learned under entirely different circumstances. An adaptive habit continues precisely because it is not recognized as a learned response that no longer matches present reality. A Different Question for Mental Health Past experience, trauma, and emotion are of fundamental importance for mental health. The Adaptive Habit Framework does not call their significance into question – but it opens up a different possibility: if a familiar state of sadness, fear, helplessness, uncertainty, or struggle reappears, this does not automatically mean the original problem is still unresolved. In my clinical practice I have observed cases in which a person’s behavior, functioning, and relationship to the original situation had all changed, and the person themselves experienced the earlier problem as genuinely overcome. Yet the same way of experiencing or responding began to appear elsewhere. The Adaptive Habit Framework distinguishes here between the original problem, which can end, and the adaptive habit that arose during it and can continue. Instead of the question “What is still unresolved?” it therefore offers another: “What is already resolved, yet what way of responding from that period still continues?” This distinction may also matter for how a person understands themselves. The return of sadness need not mean that the original reason for sadness still exists. New uncertainty does not prove that a person has not actually gained self-confidence. A new feeling of helplessness does not mean that a previous experience of helplessness was never overcome – it may be the continuation of a familiar way of responding within a new reality. A new feeling of helplessness does not mean that a previous experience of helplessness was never overcome – it may be the continuation of a familiar way of responding within a new reality. From Psychological Patterns to Physical Symptoms I arrived at this question through nearly twenty years of clinical work in physiotherapy, particularly with people experiencing chronic pain and persistent physical symptoms. I repeatedly encountered a seemingly paradoxical timeline. In certain cases, symptoms did not begin during the period of greatest stress, conflict, or psychological strain. They appeared only after a significant life or internal change, at a point when the person described the original problem as overcome. These observations were one of the reasons I began to think of the adaptive habit as a broader phenomenon. If a certain way of functioning can reappear in a different psychological area after the original problem has been resolved, could a similar principle also apply to bodily experience? In my original clinical language I described this process as a “shift” or “somatization” of the adaptive habit into the body. This formulation, however, should be understood as a metaphor, not as a claim about a known neurophysiological mechanism. The broader idea is what matters: based on my clinical observations, the same adaptive habit may continue across different areas of human functioning. It can show up in psychological experience, in behavior, in the way present reality is interpreted, and also in connection with physical symptoms. The physical symptom is therefore not the essence of the Adaptive Habit Framework. It is one of the areas in which I began to observe the persistence of these patterns. At present the framework does not specify a neurophysiological mechanism by which an adaptive habit might influence bodily experience. Possible processes include interoceptive prediction, autonomic regulation, selective attention to bodily signals, threat appraisal, or amplification of bodily sensation. These possibilities may overlap with one another. Interoceptive predictive models of pain and the fear-avoidance model well established in physiotherapy both show how a learned response to threat can persist even after the tissue damage that originally triggered it has resolved – a principle close to what I describe here as the adaptive habit. This is not, then, a claim that a psychological problem is literally converted into a physical symptom. The question is broader: Can a single learned adaptive habit persist beyond a change in its original context and subsequently influence different areas of human functioning? Recognizing the Adaptive Habit If an adaptive habit persists even after its original function has ended, a further question arises: what allows it to stop? My clinical observation points to an important distinction between solving the present problem and recognizing a recurring way of responding. If a person always looks for the explanation only in the current situation, they may arrive at a different story each time – once the reason for uncertainty is work, another time a relationship, another time health; once the reason for sadness is one event, later another. Circumstances change, but the way of responding remains similar. Recognizing this similarity is one of the central ideas of the Adaptive Habit Framework. This is not a denial of present reality. It is a distinction between what genuinely corresponds to what is happening today and what is a continuation of a way of functioning learned in the past. Based on my clinical observation, an adaptive habit does not end simply because the original problem has been removed. For it to be let go, it must first be recognized as a habit – a response that was once appropriate but no longer matches the present. What If There’s Nothing Left to Solve? I do not present the Adaptive Habit Framework as a proven mechanism, a new diagnosis, or a universal explanation of psychological or physical difficulties. It grows out of long-term clinical observation, and this hypothesis will need to be tested through research. Even so, it opens a question that may matter for how we think about mental health, psychological change, and the relationship between psychological and physical experience. What if a person has genuinely solved their problem, but the way of responding they learned during it continues? If we do not allow for this possibility, the return of a familiar state can keep leading us back to searching for another unresolved problem. If we do allow for it, a different perspective opens up. We do not have to ask only what a person has not yet resolved. We can also ask what they have already resolved, yet to which their learned way of responding still answers as though nothing had changed. And it is precisely in this distinction that the essence of the adaptive About the Author [END] --- [1] Url: https://speakingofmedicine.plos.org/2026/09/08/plos-mental-health-conversations-when-the-problem-is-solved-but-the-pattern-persists/ Published and (C) by PLOS One Content appears here under this condition or license: Creative Commons - Attribution BY 4.0. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/plosone/