Journal of Psychosomatic Research

Objective: To characterise the symptoms of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Method: 1028 adults with ME/CFS completed The Index of ME Symptoms (TIMES) online. Raw ordinal data were Rasch transformed into interval data so parametric statistics were used. Results: Mean TIMES score was 57.2/100 (sd 5.4) indicating a severe symptom burden affecting multiple body systems. The correlations between symptom burden, age and duration were negligible, and moderate with ME/CFS severity. Women had a greater symptom burden than men. All participants experienced fatigue, neurological symptoms and dysautonomia. The mean Fatigue Scale score was severe (67.7 (sd 19.9)) and moderate for the Neurological Scale (mean 45.11 (sd 9.45)) and Dysautonomia Scale (43.98 (sd 8.42)). Over 90% experienced cognitive, pain, motor-sensory, sleep, cardio-respiratory, cranial nerve and gastro-intestinal symptoms to some degree. They were mild-moderately troublesome overall, except cognitive symptoms which were severe. Conclusions. ME/CFS causes a heavy multi-system symptom burden. Although most individual symptoms were mild-moderately troublesome, the cumulative effect was severe or very severe. Fatigue was the most common and troublesome problem followed by cognitive symptoms, sleep disturbance and pain. Women experienced a greater symptom burden than men, and there was a moderate relationship between symptom burden and disease severity.

Objective: There is a bidirectional relationship between emotional distress and pain. However, this relationship is understudied in people with HIV in low-resource settings. This study sought to describe the temporal relationship between emotional distress and pain in people with HIV. Design: Longitudinal observational study. Methods: Participants with virally suppressed HIV, reporting either no pain or persistent pain at baseline, provided weekly remote ratings of distress, worst pain, and average pain using 0-10 visual analogue scales. Within-individual fluctuations in distress and pain were visualised over time. Group-level correlations were determined using Spearman's correlation tests. Cumulative link mixed models assessed whether distress and pain each predicted the other in the following week. Results: 72 participants provided responses over 49 weeks. The participants had a median (IQR) age of 43 (37-51) years, 63% (n=45) were unemployed and most were females (n=51;71%). Distress and pain fluctuated concurrently within individuals: distress was positively correlated with worst pain ({rho}=0.66, 95% CI= 0.60-0.72, p<0.001) and average pain ({rho}=0.70, 95% CI=0.64-0.75, p<0.001) intensity within the same week. Worst pain (OR=1.42, 95% CI=1.17-1.71, p<0.001) and average pain (OR=1.43, 95% CI=1.20-1.71, p<0.001) intensity both predicted distress in the next week. Distress predicted worst pain intensity (OR=1.25, 95% CI=1.07-1.46, p=0.023) but not average pain intensity (OR=1.19, 95% CI=1.01-1.40, p=0.152) in the next week. Conclusions: The temporal relationship between distress and worst pain intensity was bidirectional, whereas distress did not temporally predict average pain intensity. Both pain and emotional distress should receive attention from HIV research and clinical care in low-resource settings.

Background: Multiple sclerosis (MS) is a chronic, immune-mediated disease of the central nervous system marked by demyelination and neurodegeneration. Beyond physical symptoms, MS is often linked to clinically relevant sleep disturbances. The variability and unpredictability of symptoms and disease progression can also fuel fear of relapse (FoR), undermining well-being and potentially increasing morbidity through inflammatory processes. Understanding biopsychosocial risk factors, including childhood maltreatment (CM) and sleep, in relation to FoR remains an important gap in MS management and research. Methods: Data from N = 48 participants were collected via an online survey. We used the Pittsburgh Sleep Quality Index (PSQI), the Fear-of-Relapse Scale (FoR), and the Childhood Trauma Questionnaire (CTQ) to assess the variables of interest. In addition, time points of exposure to different CM subtypes were assessed. Linear regression analyses were conducted to examine associations within the proposed negative triad. Results: A significant negative association between overall sleep quality and FoR was observed. In the total cohort, the interaction between CM and sleep was not a significant predictor of FoR. However, exploratory analysis revealed a significant interaction between CM and sleep among male participants, whereas the same interaction was not significant among female participants. Conclusion: A history of CM and impaired sleep quality introduce new stressors in managing one's own illness that have received little attention to date. However, the present study found that these factors were at least partly influential on the FoR. The results underscore the translational need for additional support services to enhance prevention and personalized care.

Background: Placebo responding involves the reduction of symptoms in response to contextual features of an intervention (e.g., verbal suggestions), yet it is characterized by pronounced heterogeneity. Although verbal suggestions are widely recognised as a hallmark method for inducing placebo responses, an open question is whether variability in placebo responding can be partly attributed to individual differences in trait responsiveness to verbal suggestions (REVS). We conducted a pre-registered meta-analysis (PROSPERO registration number CRD420250654692) to quantitatively synthesize available research on the association between trait REVS and placebo responding. Methods: PsycInfo, PubMed, MEDLINE, and Embase were searched up to June 2026 for original clinical or experimental studies involving both the assessment of REVS and symptom measures (self-report, behavioural, and/or physiological) in response to an inactive intervention (placebo). Results: Of 1,512 search results, 24 articles presenting 66 correlations between REVS and placebo responding were analysed (N = 1,137). A multi-level meta-analysis revealed a significant, albeit weak, positive correlation between REVS and placebo responses, r = 0.18 [95% CI: 0.13, 0.24], such that individuals with higher REVS reported greater symptom relief in response to the placebo. Meta-regression analyses did not identify any significant moderators of the correlation between REVS and placebo responding and sensitivity analyses based on Bayesian subgroup estimates indicated that the aggregate correlation was stable across methodological quality indicators and study features. Conclusion: These findings suggest that individual differences in REVS may partly explain variability in symptom reduction in response to placebos, with implications for the sources of variance in placebo effects in experimental and applied contexts.

Introduction: Functional Neurological Disorder (FND) affects women approximately three times more often than men. This disparity has largely been attributed to higher trauma prevalence and diagnostic bias, while the potential contribution of hormonal influences has received little attention. Methods: An online questionnaire was distributed through FND clinics in thirteen countries, assessing self-reported symptom change across five hormonal events: hormonal contraception, pregnancy, the menstrual cycle, menopause, and gender-affirming hormone therapy. Eligible participants were cisgender women with a diagnosis of FND, or gender minority individuals (transgender or non-binary). Perceived symptom change was rated on a five-point scale ranging from large improvement to large worsening. Results: Among 262 respondents (96% female; mean age 39 years), several hormonal contexts were associated with self-reported symptom changes. Overall, hormonal contraception and pregnancy were frequently associated with worsening of motor and cognitive symptoms, and menopause with worsening across all symptom domains. Menstrual cycle analysis revealed a phase-dependent pattern: worsening was most frequently reported during menstruation and the luteal phase, whereas improvement was most frequent during the follicular phase. Reported changes were not uniform, with a substantial proportion of participants describing no change or improvement. Conclusion: Self-reported FND symptom severity appears to vary with hormonal context, with motor and cognitive symptoms most consistently affected. Given the retrospective, self-report design, these findings are hypothesis-generating and support prospective research into the role of hormonal transitions in FND.

Objectives: To estimate the prevalence of Post-Exertional Malaise (PEM) among adults with prior COVID-19 and associated mental health and disability outcomes. Methods: We conducted a cross-sectional analysis of data from a survey of 9,620 adults with prior COVID-19 in New York City, collected May - June 2024. PEM was measured with the DePaul Symptom Questionnaire - Post Exertional Malaise, categorized by symptom duration (< 14 vs. [&ge;]14 hours). Weighted prevalence estimates were stratified by socio-demographic and clinical characteristics. Modified Poisson regression was used to assess the association of PEM with depression, anxiety, and disability. Results: The prevalence of PEM symptoms was 20.9% overall and 4.0% with symptom duration [&ge;]14 hours, representing over 800,000 New Yorkers affected and over 150,000 who meet a diagnostic criterion for ME/CFS. PEM prevalence was higher among women, transgender and non-binary adults, people of color, and lower educational attainment, chronic comorbidities, or disabilities. PEM was associated with 3 - 4 times higher prevalence of mental health outcomes and 4 - 5 times higher disability scores. Conclusions: PEM symptoms were common and strongly associated with disability and adverse mental health. Screening, pathways to care, and supportive policies are needed to mitigate long-term consequences, particularly among marginalized populations.

Purpose Because simple symptom counts treat all symptoms as equally important and may not adequately capture the HRQoL impact of heterogeneous post-COVID-19 symptoms, we aimed to develop an HRQoL-anchored symptom severity score providing an interpretable measure of post-COVID-19 disease burden. Methods Baseline data from the population-based EPILOC and EPILOC Omicron surveys (adults aged 18-65 years) were used to develop a symptom-based severity score anchored to physical and mental HRQoL assessed with the SF-12. A two-stage modelling approach was applied to identify HRQoL-relevant symptoms and to derive symptom-specific weights for physical and mental component scores, incorporating 30 ordinal symptom severity variables. Symptom-specific weights were extracted to compute physical, mental, and composite severity scores. Score interpretation was examined using external reference measures, including EPILOC case status, self-reported health recovery, and functional consequences. Results A total of 19,004 participants (mean age 44.3 years, 59.6% female) were included. Sixteen symptoms contributed to the physical and eleven to the mental HRQoL score, with a limited subset accounting for most of the HRQoL loss. Severity scores were heavily right-skewed, with 50.6% of participants showing no measurable HRQoL impairment. Higher scores correlated with lower self-reported recovery, and increased probability of rehabilitation use and health-related changes in working time, supporting convergent and criterion-related validity. Conclusions This study introduces a transparent, HRQoL-anchored symptom severity score that measures graded post-COVID-19 burden beyond simple symptom counts. The score may be particularly suited for longitudinal assessment of recovery trajectories.

Chronic pain is highly heterogeneous, with individuals varying substantially in symptoms. pain severity, disability, affective distress, cognitive functioning, and trauma-related symptoms. This study examined whether working memory, post-traumatic stress symptoms (PTSS), trauma exposure, and pain modulation explain distinct or shared dimensions of chronic pain variability. Individuals with chronic pain completed clinical, cognitive, trauma-related, and behavioural pain modulation measures, as well as resting-state functional magnetic resonance imaging. Multivariate regressions were used to determine whether working memory, PTSS, trauma exposure, and pain modulation independently predicted chronic pain outcomes. Principal component analysis was used to identify latent dimensions of chronic pain, and mediation analyses tested whether behavioural pain modulation explained relationships between dlPFC to vlPAG resting-state functional connectivity and clinical pain outcomes. PTSS independently predicted affective outcomes, including depression, state anxiety, and trait anxiety, whereas working memory independently predicted pain severity and pain interference. Trauma exposure was associated with greater PTSS and poorer working memory, but did not independently predict core pain outcomes after accounting for these more proximal factors. Principal component analysis identified partially distinct affective and sensory-disability dimensions, while trauma exposure loaded primarily on a separate component characterized by greater PTSS and poorer working memory. Behavioural pain modulation showed broader relationships across symptom dimensions and was associated with dlPFC to vlPAG connectivity. Exploratory mediation analyses demonstrated that pain modulation mediated relationships between dlPFC to vlPAG connectivity and both pain severity and affective distress. These findings support an integrated model where PTSS and working memory are more proximal predictors of affect and severity respectively, and trauma exposure represents a more distal vulnerability factor that predicts both. Thus, pain modulation represents a shared mechanism linking cortico-brainstem connectivity to chronic pain intensity and affect. These variables need further testing for phenotyping people with chronic pain based on their specific clinical needs.

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating, often infection-triggered illness with no cure and no effective treatment. Marked symptom heterogeneity hampers diagnosis, disease management, and trial design. Using phenotype data from the world's largest ME/CFS cohort, this study aimed to identify groups of patients with similar symptom profiles using cluster analysis, to assess the association between cluster membership and onset type, and to explore genetic associations with cluster membership. Methods: This study included 19,019 DecodeME participants, ages 16 and over, with ME/CFS in the UK, from 2022-2024. We performed a k-modes cluster analysis of individuals based on similar symptoms. Cluster metrics identified the optimal number of clusters, which were characterised and compared. A sex-stratified subgroup analysis explored differences between clusters among males and females. The association between ME/CFS onset type (infectious, non-infectious, or unknown) and cluster membership was assessed with logistic regression models, adjusting for sex, age, deprivation, and ethnicity. Genetic associations with cluster membership were assessed using a genome-wide association study. Results: We identified two clusters in our study population: a high symptom burden cluster (HSBC; 57% of participants) and a lower symptom burden cluster (LSBC; 43%). The HSBC was characterised by higher prevalence of symptoms across all domains, more comorbidities, and greater illness severity. Individuals with infectious and unknown onset had 1.24 times (95% CI: 1.15-1.35) and 1.30 times (95% CI: 1.18-1.43) higher adjusted odds of HSBC membership relative to non-infectious onset, respectively. A similar pattern was observed in the sex-stratified analyses, although it showed an overall higher symptom prevalence for females and a higher proportion of females in the HSBC compared to males. No genetic variant was significantly associated with cluster membership. Conclusions: This large-scale cluster analysis of DecodeME symptom data reinforces that ME/CFS is a heterogeneous condition with clinical subtypes. The identification of symptom-based phenotypes, along with sex-based differences in symptom burden and cluster characteristics, highlights the importance of incorporating symptom burden and sex in future research, clinical decision-making, and public health strategies. Tailoring future interventions to these subgroups could enhance patient management and improve outcomes.

Individuals with NF2-related schwannomatosis (NF2-SWN) experience a complex constellation of physical, emotional, and social symptoms that substantially impact quality of life (QoL). Although disease-specific patient-reported outcome measures are increasingly important for evaluating treatment benefit in clinical trials, existing NF2-SWN QoL measures have limitations in content coverage and sensitivity to change. This study describes the development and initial validation a new disease-specific QoL assessment -- the Quality of Life Evaluation in NF2-related Schwannomatosis Trials (QUEST). Using a three-phase, mixed-methods approach, items were generated through concept elicitation interviews with individuals with NF2-SWN and clinicians, prioritized via patient survey data, and refined through iterative cognitive debriefing procedures. The resulting 21-item QUEST assesses the extent to which NF2-SWN has negatively impacted a persons daily life over the past seven days. Initial psychometric evaluation was conducted in an international sample of 174 individuals with NF2-SWN aged 15 years and older (117 women (67%), 158 White individuals (89%)). Exploratory factor analysis supported a four-factor structure, and the total score demonstrated excellent internal consistency and strong test-retest reliability. Evidence of construct validity was demonstrated through hypothesized associations with disease-specific, generic, and domain-specific QoL measures, as well as known-groups validity based on self-reported disease severity and number of prior surgeries. Incremental validity analyses indicated that QUEST explained unique variance beyond existing measures. Together, findings support the QUEST as a reliable and valid disease-specific QoL measure with strong content validity and feasibility for use as a clinical trial endpoint in NF2-SWN.

Background. The SRQ-20 screens common mental distress in low- and middle-income countries, yet its equivalence across groups, especially armed-conflict exposure, is rarely tested with methods that separate true invariance from an underpowered null. We evaluated its psychometric properties and measurement equivalence in Colombian adults. Methods. In 10,865 adults from the 2015 Colombian National Mental Health Survey, we assessed dimensionality, fitted a two-parameter logistic (2PL) model, and tested equivalence across armed-conflict exposure, sex, and region using multiple-group models with purified anchoring and freely estimated group means, separating true distress differences from item bias. Item functioning was equivalence-tested against a {+/-} 0.10 band on signed expected-score differences (SIDS), with test-level differential test functioning (DTF) plus severity-graded and design-weighted sensitivity analyses. Criterion validity used design-weighted ROC against 12-month CIDI diagnoses. Results. The scale was essentially unidimensional (one-factor CFI = .945, rising to .971 with four content-redundant item pairs modelled; explained common variance = .71) and fit the 2PL well, with high conditional reliability at the cut-points (.93-.94). Once true distress differences were separated from item bias, the SRQ-20 was equivalent across armed conflict exposure (all |SIDS| < .10, maximum .03; net DTF {approx} 0.1 points) and region, holding even among directly victimised adults; sex was partially invariant (three items; DTF {approx} 0.85 points). Design-weighted AUC was .88 (major depression) and .84 (any disorder). Conclusions. The SRQ-20 measures distress equivalently across armed-conflict exposure (including direct victimisation) and region in Colombian adults, supporting exposed-non-exposed comparisons within this population; raw-total sex comparisons carry a small, quantifiable bias. The 20-item form is recommended.

Objective: The Brief-cope questionnaire explore coping behavior. However, the underlying factor structure remains a subject of ongoing debate. Exploratory factor analyses (EFA) conducted across different populations have identified factor solutions ranging from two to fourteen factors. As of yet, the underlying factor structure of the Brief-cope has not been investigated in patients with seropositive rheumatoid arthritis (RA). Therefore, the aim of this study was to explore the underlying factor structure of the Brief-cope in a German population of seropositive RA. Methods: 216 outpatients with seropositive RA completed the Brief-cope. An EFA with principal axis factoring and Promax rotation was conducted. Results: EFA indicated a five-factor solution. The five-factor solution explained 51.95% of variance. The identified factors were: (1) problem-focused coping (Cronbach's = .851), (2) emotion-focused coping ( = .754), (3) maladaptive coping ( = .747), (4) religious coping ( = .851), and (5) substance-use coping ( = .869). Conclusion: A five-factor solution provided the most appropriate representation of the underlying factor structure of the Brief-cope in patients with seropositive RA. This factor structure may serve as a suitable basis for future analyses of Brief-cope data in comparable RA populations.

C-Reactive Protein (hs-CRP) is a common marker for human inflammation, a response to perceived threat and precipitate to many compromising health conditions. Previous work demonstrated that in addition to other biological features that may be predictive and explanatory of variance in inflammation, psychosocial influences may play a role. The present work uses structural equation modeling to examine pathways including socioeconomic status (SES), psychological capital (PsyCap), and perceived discrimination (Discrim) -insofar as they explain variance in hs-CRP, potentially moderated by neurological lateralization (handedness). Body mass index (BMI), an indicator of body composition, stood as the strongest predictor of the obesity-related inflammatory marker (ORIM). On average, females are predicted to have higher hs- CRP scores than males. The psychosocial constructs were estimated to have little to no effect on inflammation (via hs-CRP) in the analysis sample (ADD Health Study) in either group (left and right-handers) although a small, statistically non-zero indirect path is found in the retained model for right-handed participants (given statistical power for estimation). With this finding, contextual effect estimates are provided with regard to the effect of perceived discrimination on hs-CRP given the range of SES and BMI.

Objective: To evaluate long-term neurological, mental, and menstrual health outcomes using a mixed-methods approach among women approximately 2 years after concussion compared with non-head-injured controls. Setting: Participants were recruited from [University X] sites, including the Concussion Clinic, Emergency Departments, Student Health Clinic, and [University X] + Me registry (April 2023 to September 2025). Follow-up occurred October to November 2025. Participants: Eligible participants were assigned female at birth, aged 18 to 45 years, not using hormonal birth control, and, for the concussion group, diagnosed within 7 days of injury. Of 45 concussion patients and 29 controls recruited, 11 concussion patients (mean age 30.4 +/- 8.4 years) and 16 controls (31.3 +/- 7.4 years) completed follow-up. Main Measures: Post-concussion symptoms were assessed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), depression using the Patient Health Questionnaire-9 (PHQ-9), and anxiety using the Generalized Anxiety Disorder-7 (GAD-7). Menstrual health was assessed using study-specific measures. Qualitative data captured perceived impacts on daily life, with recurring themes summarized using word clouds. Results: At follow-up, concussion patients reported significantly greater symptom burden (RPQ: 31.6 +/- 13.5 vs 9.4 +/- 9.8; p=0.0002; Hedges g=1.90), depression (PHQ-9: 9.5 +/- 6.5 vs 2.3 +/- 2.2; p=0.0005; g=1.60), and anxiety (GAD-7: 9.8 +/- 6.8 vs 2.8 +/- 3.0; p=0.0057; g=1.42). Qualitative findings highlighted persistent headaches, sleep difficulties, reduced interest, and effects on relationships and daily functioning. Conclusions: This study demonstrates significant long-term differences in symptom burden among women with concussions compared to controls. Findings highlight the importance of understanding real-world impacts to improve long-term care.

Introduction Auto-Induced Cognitive Trance (AICT) is a non-ordinary state of consciousness (NOSC) that can be accessed by will alone once a standardised self-induction procedure has been learnt. The first research publication on AICT dates back only ten years, meaning that research on this phenomenon is still in its infancy. Previous reports concerning the phenomenology and neurophysiology of AICT revealed similarities with more extensively described NOSCs, as well as unusual features, raising questions about the potential benefits of AICT practice for well-being. Objective This study aimed to gather quantitative descriptive data on features associated with well-being in a large comparative sample of AICT practitioners and non-practitioners. Method This research followed a web-based survey study design which enquired AICT-trained and yet-to-be trained participants to self-report through validated standardised questionnaires on vitality, self-esteem, mental well-being, trait anxiety, life satisfaction, happiness, positive and negative affect, nature-relatedness and connectedness. Data on NOSCs practices, life history events that could have led to spontaneous NOSCs, and demographic data were collected for further inclusion as control variables in statistical models. Results The online questionnaire yielded 607 valid responses, (171 yet-to-be trained participants and 436 AICT-trained participants). AICT practice was found to be associated with increased self-esteem (RSE), overall connectedness (WCS) as well as all subdimensions of connectedness (WCS Self, WCS Others, WCS World). AICT practice Duration exhibited significant effects on global connectedness and all subdimensions of connectedness, self-esteem, trait anxiety (STAIT-5), and positive affect (PANAS+). Conclusions AICT seems to benefit to practitioners well-being shortly after training through increases in self-esteem and in the sense of connectedness. Prolonged AICT practice is associated with added decreased trait anxiety and increased positive affect. Further research is needed to confirm these findings with a sample including AICT-uninterested participants, and to clarify the underlying mechanisms of AICT.

Background Multimorbidity is increasingly prevalent, and associated with worse clinical and psychosocial burdens. Interoception, the brain's ability to sense and interpret internal bodily signals, may contribute to multimorbidity, through its link with health behaviors, stress regulation, and mental health. This study examines whether self-reported interoceptive accuracy and attention is associated with multimorbidity, by identifying multimorbid subgroups and their interoceptive profiles. Methods Morbidity classes were identified through latent class analyses in two Dutch survey datasets, focusing on depression and alexithymia (DA-dataset; N = 671) and lifestyle factors (L-dataset; N = 1022). Linear regression analyses were used to assess interoceptive accuracy and attention (by the Interoceptive Accuracy Scale and Interoceptive Attention Scale respectively) among different subgroups. Results Multimorbid subgroups were characterized by older age, low socioeconomic position, and elevated physical, psychological, and behavioral problems. Multimorbid classes exhibited lower interoceptive accuracy (DA-dataset: B = -1.14, 95% CI = [-2.89, 0.62]; L-dataset: B = -2.36, 95% CI = [-3.83, -0.89]) and higher attention (DA-dataset: B = 3.62, 95% CI = [0.97, 6.27]; L-dataset: B = 1.07, 95% CI = [-1.42, 3.56]) compared to healthier classes. Conclusion Multimorbid populations demonstrated lower interoceptive accuracy and higher interoceptive attention. This highlights the psychosocial complexity of multimorbid populations which may impact their self-management and health behavior. These findings underscore the need to expand treatments to include psychosocial domains for multimorbid patients.

Accumulating evidence suggests alterations in neurocognitive, affective, interoceptive and autonomic processing in functional neurological disorder (FND), yet interventions targeting these processes remain underexplored. This study investigated the possible immediate and longer-term effects of a somatic yoga intervention on cognitive control, emotion regulation, state dissociation and affect, autonomic arousal, and interoceptive processing in FND. Twenty-three adults with FND completed six weeks of somatic yoga (N=12) or six weeks of a music-based relaxation control (N=11). At baseline, post-single session, and post-six weeks, participants completed laboratory measures of sustained attention, response inhibition, interoception, emotion regulation, and state dissociation and affect. Electrocardiography and galvanic skin conductance were recorded throughout. Linear mixed effects models assessed potential change on day one, immediately pre/post a single session, and from day 1 to the end of the six-week programme. After one session, stop signal reaction time, negative affect, and heartrate decreased in both groups ({Delta}=.69-.75). After one session and at six weeks, improved sustained attention, elevated positive affect, and reduced dissociation were seen in both groups, with a larger magnitude of change in yoga ({Delta}=.50-1.10). The yoga group exhibited fewer direction errors on the response inhibition task and shorter response times on the sustained attention task, with the opposite seen in the music group ({Delta}=.50-1.17). Both in the short- and longer-term, somatic yoga might lead to adaptive changes in attention and executive functioning, arousal, state affect and dissociation.

Background: Population aging and the rising burden of non-communicable diseases have increased the prevalence of cardiometabolic multimorbidity (CM-MM) among older adults. Patient-reported experience measures (PREMs) are recognized as essential components of healthcare quality assessment, yet evidence on primary care experiences among individuals with CM-MM remains scarce. Objective: To analyze primary care experiences according to the presence of cardiometabolic multimorbidity among Brazilians aged 50 years and older. Methods: Cross-sectional study using data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021; n = 9,949). CM-MM was defined as the self-reported coexistence of two or more of the following conditions: hypertension, diabetes mellitus, dyslipidemia, acute myocardial infarction, and stroke. Primary care experiences were assessed using a validated 12-item instrument organized into four domains: first-contact access, longitudinality, communication, and care coordination. Associations were estimated using Poisson regression adjusted for sociodemographic, health conditions, and healthcare utilization variables, with stratified analysis by Family Health Strategy (FHS) coverage. Results: CM-MM prevalence was 25.5%, with a progressive increase by age and an inverse gradient by education. Individuals with CM-MM reported significantly more positive experiences in longitudinality (mean index 2.53 vs. 2.34; adjusted PR = 1.22; 95%CI 1.12-1.33; p < 0.001) and, to a lesser extent, in communication (mean index 2.68 vs. 2.58; adjusted PR = 1.10; 95%CI 1.00-1.20; p = 0.041). No statistically significant differences were found in first-contact access or care coordination. After stratified by FHS coverage, the observed differences in longitudinality and communication were no longer statistically significant. Conclusions: CM-MM was associated with more positive primary care experiences in longitudinality and communication. The absence of differentiated experiences in first-contact access and coordination highlights structural gaps in primary care responsiveness to individuals with greater clinical complexity. Keywords: Multimorbidity; Cardiometabolic diseases; Primary Care; Patient-reported experience measures; Older adults; ELSI-Brazil.

Living at risk of a neurodegenerative condition such as inherited prion disease (IPD) is associated with substantial psychological burden, yet evidence-based supportive interventions are lacking. This unmet need is likely to grow as advances in biomarkers and predictive testing lead to increasing identification of individuals in pre-symptomatic stages of neurodegenerative disease. Acceptance and Commitment Therapy (ACT), a transdiagnostic intervention targeting psychological flexibility, has shown promise in chronic health contexts but has not been evaluated in individuals at genetic risk. We conducted a feasibility and acceptability study of a brief, group-based ACT intervention in adults at risk of IPD recruited through the UK National Prion Clinic. The intervention comprised a single 5-hour, face-to-face workshop followed by an individual booster session. Prespecified feasibility and acceptability criteria were assessed alongside secondary psychological outcomes at baseline, 1 month, and 3 months post-intervention, complemented by semi-structured qualitative interviews. Twenty-three participants completed the intervention. All predefined feasibility criteria were met, including recruitment (58%), intervention completion (80%), retention at 3 months (79%), and low missing data (10%). Acceptability was high, with all participants reporting the intervention as useful and appropriate. Quantitative analyses demonstrated improvements in psychological quality of life and behavioural awareness at 3 months, with larger effects observed in participants with elevated baseline depressive symptoms. Qualitative findings highlighted the importance of peer connection, experiential learning, and practical strategies for managing uncertainty. These findings demonstrate that a brief, hybrid ACT intervention is feasible and acceptable for individuals living at risk of IPD and provide preliminary evidence for improving psychological well-being. As the population of individuals identified as at risk for neurodegenerative disease continues to expand, scalable psychological interventions that address cost and time barriers may represent an important component of future clinical care.

Background: Force production reflects neuromuscular capacity, central regulation, and sensory feedback, making performance-based testing vulnerable when disease-related limitations could be interpreted as reduced effort. Repeated handgrip strength (HGS) testing may quantify neuromuscular fatigability in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), but interpretation of within-subject variability as an effort-validity marker remains controversial. We tested whether the coefficient of variation (CV) distinguishes ME/CFS-related impairment from deliberate submaximal performance and compared it with the sum of residuals (SR), a trajectory-aware metric. Methods: We analyzed three cohorts using the same repeated-HGS protocol: two 10-trial sessions separated by one hour. We included 211 ME/CFS participants and 170 controls, including 28 instructed to perform at 50% perceived maximum force. CV and SR were determined as HGS variability measures and compared by probability-density overlap and receiver operating characteristic analyses. The primary comparison was ME/CFS versus deliberately submaximal controls. Results: CV distributions showed substantial overlap between groups. SR improved group-level separation, increasing non-overlapping fractions from 0.217 to 0.326 in the Jaekel cohort and from 0.180 to 0.361 in the MIRACLE cohort. In ROC analyses, SR consistently yielded higher discrimination than CV across cohorts, sessions, and sex strata. A commonly used 15% CV cutoff classified 42-48% of ME/CFS participants as submaximal, while correctly identifying only 57-64% of deliberately submaximal controls. Conclusions: CV may conflate ME/CFS-related fatigability with irregular force modulation and should not be used as stand-alone evidence of submaximal effort. Trajectory-aware SR partly reduced this bias and indicated that ME/CFS-related force impairment is distinguishable from deliberate submaximal force production at the group level. However, neither metric should be used alone to diagnose ME/CFS or evaluate sincerity of effort.