Brain Sciences最新文献

{"title":"Effectiveness of Telepsychotherapy Versus Face-to-Face Psychological Intervention for Perinatal Anxiety and Depressive Symptomatology During COVID-19: The Case of an Italian Perinatal Psychological Care Service.","authors":"Beatrice Allegri, Giacomo Deste, Valeria Brenna, Emanuela Saveria Gritti, Linda Confalonieri, Alessandra Puzzini, Irene Corbani, Andrea Zucchetti, Umberto Mazza, Tamara Rabà, Mauro Percudani, Stefano Barlati, Antonio Vita","doi":"10.3390/brainsci15090963","DOIUrl":"10.3390/brainsci15090963","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 has limited pregnant and postpartum women's access to mental health services, leading to the introduction of online interventions.</p><p><strong>Objectives: </strong>This study aims to compare the effectiveness of telepsychotherapy (i.e., psychotherapy provided through digital technology supporting real-time interactivity in the audio or audiovisual modality) with the one yielded by face-to-face interventions in treating perinatal depression and anxiety and to assess the therapist's perceived alliance in both interventions.</p><p><strong>Methods: </strong>We collected anamnestic information and obstetrical risk factors for 61 women. We evaluated the effectiveness of face-to-face (N = 31) vs. telepsychotherapy (N = 30) interventions on depressive and anxiety symptoms at baseline (T0) and the end of treatment (T1) using the Edinburgh Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI-Y 1 and 2). We assessed the degree of alliance perceived by therapists with the Working Alliance Inventory (WAI-T).</p><p><strong>Results: </strong>Both groups showed significant decreases in depressive (EPDS face-to-face: T0 12.65 ± 5.81, T1 5.77 ± 4.63, <i>p</i> < 0.001; EPDS remote: T0 11.93 ± 5.24, T1 5.70 ± 4.46, <i>p</i> < 0.001; effect size: 0.002) and state anxiety (STAI-Y 1 face-to-face: T0 51.19 ± 13.73, T1 40.23 ± 12.86, <i>p</i> < 0.001; STAI-Y 1 remote: T0 51.10 ± 11.29, T1 38.00 ± 10.90, <i>p</i> < 0.001; effect size: 0.007//STAI-Y 2 face-to-face: T0 43.13 ± 12.11, T1 41.03 ± 13.06, <i>p</i> = 0.302; STAI-Y 2 remote: T0 44.20 ± 8.70, T1 39.30 ± 9.58, <i>p</i> = 0.003; effect size: <0.001) symptoms by the end of treatment. Women treated remotely also experienced a significant reduction in trait anxiety at T1 (<i>p</i> = 0.003). We found no significant differences in either symptomatology (EPDS; STAI-Y) between the two interventions at baseline or in the therapist-perceived alliance.</p><p><strong>Conclusions: </strong>Synchronous telepsychotherapy for perinatal depression and anxiety showed comparable treatment response to face-to-face interventions, with both modalities associated with significant symptom reduction and the establishment of a working alliance. These findings support the potential of telepsychotherapy as a valuable alternative when in-person services are not accessible, especially during emergency contexts.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linkage Among Cognition, Emotion and Behavior: An Interdisciplinary Perspective.","authors":"Carmelo Mario Vicario, Gabriella Martino","doi":"10.3390/brainsci15090962","DOIUrl":"10.3390/brainsci15090962","url":null,"abstract":"<p><p>The Special Issue \"Linkage among Cognition, Emotion and Behavior\" offers a comprehensive exploration of the dynamic relationships between the emotional, cognitive, and behavioral domains [...].</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Probing Neural Compensation in Rehabilitation of Acute Ischemic Stroke with Lesion Network Similarity Using Resting State Functional MRI.","authors":"Shanhua Han, Quan Tao, Boyu Zhang, Yifan Lv, Zhihao Li, Yu Luo","doi":"10.3390/brainsci15090964","DOIUrl":"10.3390/brainsci15090964","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Neural compensation, in which healthy brain regions take over functions lost due to lesions, is a potential biomarker for functional recovery after stroke. However, previous neuroimaging studies often speculated on neural compensation simply based on greater measures in patients (compared to healthy controls) without demonstrating a more direct link between these measures and the functional recovery. Because taking over the function of a lesion region means taking on a similar role as that lesion region in its functional network, the present study attempted to explore neural compensation based on the similarity of functional connectivity (FC) patterns between a healthy regions and lesion regions. <b>Methods</b>: Seventeen stroke patients (13M4F, 63.2 ± 9.1 y.o.) underwent three resting-state functional MRI (rs-fMRI) sessions during rehabilitation. FC patterns of their lesion regions were derived by lesion network analysis; and these patterns were correlated with healthy FC patterns derived from each brain voxel of 51 healthy subjects (32M19F, 61.0 ± 14.3 y.o.) for the assessment of pattern similarity. <b>Results</b>: We identified five healthy regions showing decreasing FC similarity (29-54%, all corrected <i>p</i> < 0.05, effect size η²: 0.10-0.20) to the lesion network over time. These decreasing similarities were associated with increasing behavioral scores on activities of daily living (ADL, <i>p</i> < 0.001, η² = 0.90), suggesting greater neural compensation at early-stage post-stroke and reduced compensation toward the end of effective rehabilitation. <b>Conclusions</b>: Besides direct FC measures, the present results propose an alternative biomarker of neural compensation in functional recovery from stroke. For sensorimotor recoveries like ADL, this biomarker could be more sensitive than direct measures of lesion connectivity in the motor network.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emotional Skills and Nursing Training: A Study on Italian Students and a TRI-COM-Based Educational Model.","authors":"Giulia Savarese, Giovanna Stornaiuolo, Alessandro Vertullo, Carolina Amato, Luna Carpinelli","doi":"10.3390/brainsci15090961","DOIUrl":"10.3390/brainsci15090961","url":null,"abstract":"<p><strong>Background/objectives: </strong>Emotional competence is a crucial skill in nursing education, yet it remains underdeveloped in academic curricula. This study aims to (1) propose and preliminarily apply the TRI-COM model as a conceptual and educational framework to operationalize the definition of emotions within nursing contexts, and (2) explore the multidimensional structure of emotional competence among nursing students.</p><p><strong>Methods: </strong>A cross-sectional study was conducted with 233 nursing students (M_age = 23.79, SD = 5.19) from various Italian universities, with 82.8% identifying as female. The participants completed an online questionnaire including the Toronto Alexithymia Scale (TAS-20) and the Jefferson Scale of Empathy-Health Profession Student (JSE-HPS) version. Descriptive statistics, t-test, ANOVA, and Pearson's correlation analyses were performed.</p><p><strong>Results: </strong>The overall mean TAS-20 score was 60.36 (SD = 11.22), which is close to the clinical threshold (cut-off = 61). The EOT subscale showed the highest mean (M = 26.48, SD = 3.16), suggesting a tendency toward externally oriented thinking. The mean JSE-HPS total score was 87.05 (SD = 7.88), with higher scores for Perspective Taking (M = 60.95, SD = 7.42) than Compassionate Care (M = 18.92, SD = 6.40). A significant gender difference was found in Perspective Taking (female: M = 61.54, male: M = 58.10; <i>p</i> = 0.007). The ANOVA results showed no significant differences in empathy across academic years, but the DIF subscale of TAS-20 showed a trend near significance (<i>p</i> = 0.053). Significant negative correlations were observed between age and TAS-20 scores (e.g., age-TAS-20 total: r = -0.23, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The findings suggest a general tendency toward rationalization and emotional detachment among students, possibly as a coping strategy in emotionally demanding contexts. The TRI-COM model-an original pedagogical framework inspired by tripartite theories of emotion-was used as a conceptual lens, providing a preliminary framework to interpret emotional competence in nursing education. Further research is needed to validate its educational relevance and explore practical applications within curricula.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychiatric Symptoms in Cerebral Amyloid Angiopathy: A Significant but Overlooked Association.","authors":"Polona Rus Prelog, Matija Zupan, Senta Frol","doi":"10.3390/brainsci15090959","DOIUrl":"10.3390/brainsci15090959","url":null,"abstract":"<p><p>Cerebral amyloid angiopathy (CAA) is an increasingly recognized cause of cognitive decline and lobar intracerebral hemorrhage in older adults. Recent research highlights that neuropsychiatric symptoms (NPSs)-including depression, anxiety, apathy, and irritability-are highly prevalent in CAA, often emerging prior to overt cognitive impairment or major vascular events. Compared to other cerebrovascular diseases, CAA presents a distinctive and multifaceted NPS profile, with symptoms closely linked to disease severity and neuroimaging biomarkers such as white matter hyperintensities and microbleeds. Critically, NPSs in CAA can complicate cognitive assessment and predict worse functional outcomes, yet remain underappreciated in clinical and research contexts. Management is complicated by pharmacologic risks-including heightened bleeding risk associated with SSRIs and novel anti-amyloid therapies-underscoring the need for individualized and multidisciplinary approaches. We highlight the urgent need for standardized NPS assessment, targeted research into mechanisms and treatment, and greater integration of neuropsychiatric evaluation into CAA care. We suggest that recognizing NPSs as core clinical features-not secondary complications-of CAA is essential to improving both patient outcomes and scientific understanding. Future studies should focus on longitudinal analyses, the development of tailored interventions, and robust comparative research to clarify the pathophysiology, clinical trajectory, and optimal management of NPSs in CAA.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12467706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Impact of Multiple Sclerosis on Quality of Life: An Italian Pilot Study.","authors":"Elsa Vitale, Roberto Lupo, Ludovica Panzanaro, Rebecca Visconti, Maria Rosaria Tumolo, Paolo Caldararo, Federico Cucci, Donato Cascio, Giorgio De Nunzio, Stefano Botti, Ivan Rubbi, Luana Conte","doi":"10.3390/brainsci15090960","DOIUrl":"10.3390/brainsci15090960","url":null,"abstract":"<p><strong>Backgorund: </strong>Multiple sclerosis (MS) profoundly affects the lives of patients and their families. The experience of the disease is shaped not only by its progression and specific characteristics but also by the quality of medical and caregiving support received. The diagnosis of MS represents a transformative event that may lead to job loss, the need for continuous care, and a significant reorganization of family roles. In Italy, more than 140,000 people are affected by MS (AISM data, 2024). The impact of the disease is multifaceted and complex, involving various aspects of the patient's life. Dependence on external assistance often becomes an unavoidable necessity, highlighting the importance of exploring the quality of life of people with MS in the Italian context. The main objective is to assess the quality of life of individuals affected by MS, both before diagnosis and during the course of the disease. A secondary aim is to identify related psycho-physical consequences, including care-related needs.</p><p><strong>Methods: </strong>An online survey was conducted through various associations operating across Italy, involving a sample of 99 individuals diagnosed with MS.</p><p><strong>Results: </strong>The results show a predominance of female participants, with a mean age of 41 years. The disease was reported to be at an early stage in 66.7% of cases and advanced in 33.3%, with none of the respondents being in a terminal phase. The most frequent clinical form was relapsing-remitting MS (RRMS), which accounted for 78.8% of the cases. In terms of employment and daily activities, more than half of the participants reported underperforming (59.6%) or limiting specific tasks (51.5%) due to disability caused by the disease. Emotional distress had even more pronounced effects, with 63.6% reporting a decline in performance and 62.6% experiencing concentration difficulties. Quality of life was significantly affected, particularly in the physical and emotional domains. Vitality, physical pain, perceived health, and psychological well-being emerged as compromised dimensions, pointing to the need for a multidimensional care model that integrates therapeutic, rehabilitative, and psychosocial interventions. Individuals in the early stages of MS tended to maintain better work relationships and demonstrated higher levels of professional engagement.</p><p><strong>Conclusions: </strong>The findings underscore the importance of a continuous and personalized care approach, addressing not only clinical treatment but also psychological and social support. These aspects are crucial for monitoring patients' needs, promoting quality of life, facilitating disease acceptance, and mitigating psychological distress.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Action Video Gaming Enhances Brain Structure: Increased Cortical Thickness and White Matter Integrity in Occipital and Parietal Regions.","authors":"Chandrama Mukherjee, Kyle Cahill, Mukesh Dhamala","doi":"10.3390/brainsci15090956","DOIUrl":"10.3390/brainsci15090956","url":null,"abstract":"<p><strong>Background: </strong>Action video games-particularly first-person-shooter (FPS), real-time-strategy (RTS), multiplayer-online-battle-arena (MOBA), and battle-royale (BR) titles-have been linked to enhanced visuospatial skills, yet their impact on brain structure remains unclear.</p><p><strong>Purpose: </strong>To examine, using a cross-sectional design, whether long-term exposure to high-speed genres is associated with variations in cortical thickness and white matter microstructure.</p><p><strong>Methods: </strong>Structural and diffusion MRI were acquired from 27 video-game players (VGPs) and 19 non-video-game players (NVGPs). FreeSurfer-derived cortical thickness and DSI-Studio quantitative anisotropy (QA) were compared between groups, co-varying for intracranial volume. All <i>p</i>-values were Holm-Bonferroni- and FDR-corrected; bootstrap 95% CIs are reported.</p><p><strong>Results: </strong>VGPs showed greater cortical thickness in right inferior and superior parietal, supramarginal, and precuneus cortices (η<i>_p</i>² = 0.12-0.21) and higher QA along right SOG-SPL and left SOG-IPL tracts.</p><p><strong>Conclusions: </strong>Frequent action gaming is associated with greater cortical thickness in the dorsal stream and enhanced occipito-parietal connectivity. However, causal inference is precluded; longitudinal work is warranted.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gamma and Psychological Resilience: Where to Now?","authors":"Damian L Rocks, Christopher F Sharpley, Vicki Bitsika, Kirstan A Vessey, G Lorenzo Odierna, Christopher B Watson","doi":"10.3390/brainsci15090957","DOIUrl":"10.3390/brainsci15090957","url":null,"abstract":"<p><p>Because of their potential to enhance pathways for diagnosis and treatment, a great deal of research has been conducted to identify brain biomarkers of mental illnesses such as depression and anxiety. Similarly, the investigation of the biomarkers of those protective factors that help individuals resist, or recover from, these mental illnesses is also directly relevant to clinical practice. One such protective factor is Psychological Resilience (PR) but relatively little is known about its neurobiological underpinnings. A literature search was conducted of electroencephalographic data and PR, revealing seven studies that reported brain electrical activity categorised into bands of specified frequencies. Several studies reported significant associations between PR and alpha band activity, and somewhat less on beta band activity, principally via their roles in emotion regulation and problem solving. However, despite having a major role in many aspects of cognition and brain function, and being implicated in depression, only two studies examined gamma band activity specifically, and their results were equivocal. Several possible reasons for these apparently null results of the association between gamma band activity and PR are discussed, leading to a brief description of gamma, and suggestions for future research into its association with PR.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multidisciplinary Occupational Medicine-Based Intervention Protocol for Conflict Prevention and Crisis Management in High-Stress Professional Environments.","authors":"Martina Corsi, Dorotea Stefanini, Isabella Biagioni, Chiara Bertini, Matteo Accardo, Mirko Bottari, Claudia Antunes, Laura Lazzarini, Ilaria Pertici, Chiara Ciarfella, Giovanni Tritto, Salvio Perretta, Poupak Fallahi, Rudy Foddis","doi":"10.3390/brainsci15090958","DOIUrl":"10.3390/brainsci15090958","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Workplace conflict and aggression pose significant psychosocial risks across diverse professional sectors. This protocol outlines a novel, university-based educational intervention. Developed by a multidisciplinary team from the University Hospital of Pisa, Italy, including occupational physicians and a psychiatrist specializing in work and organizational psychology, its primary purpose is to enhance conflict prevention and crisis management skills. While initially developed and tested within the veterinary sector due to its identified vulnerabilities, the intervention is inherently generalizable to any high-stress professional environment characterized by intense client, customer, or public interactions. <b>Methods:</b> The intervention integrates didactic instruction with active, immersive learning through tailored role-playing scenarios simulating real-world challenging encounters. This study protocol details the structured methodology for evaluating the immediate effectiveness of this training. We are using a specifically developed efficacy scale to assess outcomes. <b>Results:</b> The results demonstrate a significant improvement in all assessed skills from the pre-training to the post-training evaluation. For every item on the scale, the median scores increased, indicating a positive shift in overall group performance. The <i>p</i>-value for each item was <0.001, confirming that the observed improvements were statistically significant. These results demonstrate enhanced conflict resolution skills, improved communication, and an increased sense of self-efficacy among participants. <b>Conclusions</b>: This protocol offers a comprehensive and generalizable approach to addressing workplace psychosocial risks through an innovative educational intervention. A key future goal involves advancing this training methodology by integrating virtual reality (VR) environments with AI-driven avatars for role-playing, aiming to achieve a more realistic and impactful learning experience and sustained behavioral change.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The High-Risk Model of Threat Perception Modulates Learning of Placebo and Nocebo Effects and Functional Somatic Disorders.","authors":"Ian Wickramasekera","doi":"10.3390/brainsci15090955","DOIUrl":"10.3390/brainsci15090955","url":null,"abstract":"<p><p>Threat activation or deactivation in the brain-body is associated with <b>learned</b> nocebo or placebo <b>somatic effects</b> induced by <b>fake invasive</b> medical-surgical procedures. Some <b>functional somatic disorders (FSDs)</b> originate as <b>acute</b> nocebo <b>somatic effects</b> and can become 30-50% of <b>chronic somatic</b> presentations to primary care physicians. Patients with FSD <b>overutilize</b> medical-surgical services, despite the <b>lack of identified pathophysiology,</b> and are at risk for <b>morbidity</b> from <b>unintentional iatrogenic injury</b>. The Conditioned Response Model (<b>CRM</b>) of <b>learning</b> postulates three <b>innate</b> mechanisms, <b>modulated</b> by <b>trait hypnotizability</b>, which drive placebo and nocebo <b>somatic effects</b> and FSD. The High Risk Model of Threat Perception <b>(HRMTP)</b> postulates <b>10 psychosocial risk factors</b> that <b><i>modulate threat perception</i></b>, driving <i>placebo and nocebo</i><b>somatic <i>effects</i></b><i>and</i><b>biologically embedded FSD</b>. <b>Psychosocial factors</b> and the <b>trait</b> of <b>high and low hypnotizability modulate threat</b> and are postulated to <b>reduce</b><i><b>heart rate variability</b></i><b>(<i>HRV</i>)</b>, <i><b>inducing autonomic nervous system</b></i><b>(<i>ANS</i>)</b><i><b>dysregulation</b></i>. <i><b>Reduced HRV was found in</b></i> a large (N = 6,891) sample of patients with <b>FSD</b>. A total of 50% of patients with <b>FSD</b> with chronic pain (n = 224) <b>without identified pathophysiology</b> had a <b>Paradoxical Increase in hand Temperature (PTI</b>) during experimental <b>threat</b> induction. The HRMTP predicts that PTI associated with <b>ANS dysregulation</b> is associated with the <b>risk factor Adverse Childhood Experiences (ACEs)</b>. This <b>ACE</b> prediction was <b>independently</b> confirmed. Learning predicts that <b>threat</b> activation by <b>unconscious neutral stimuli (CS)</b> can <b>amplify</b> nocebo and FSD and can <b>negate</b> placebo effects in clinician-patient relationships. Identifying <b>psychosocial risk factors</b> that <b>modulate threat perception</b> enables the diagnosis of FSD by <b>inclusion</b> and not simply by <b>excluding pathophysiology</b>.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"15 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12468038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145173576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}