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Background: Cognitive Muscular TherapyTM (CMT) is an integrated behavioural intervention developed for knee osteoarthritis. CMT teaches patients to reconceptualise the condition, integrates muscle biofeedback and aims to reduce muscle overactivity, both in response to pain and during daily activities. This nested qualitative study explored patient and physiotherapist perspectives and experiences of CMT.Methods: Five physiotherapists were trained to follow a well-defined protocol and then delivered CMT to at least two patients with knee osteoarthritis. Each patient received seven individual clinical sessions and was provided with access to online learning materials incorporating animated videos. Semi-structured interviews took place after delivery/completion of the intervention and data were analysed at the patient and physiotherapist level.Results: Five physiotherapists and five patients were interviewed. All described a process of changing beliefs throughout their engagement with CMT. A framework with three phases was developed to organise the data according to how osteoarthritis was conceptualised and how this changed throughout their interactions with CMT. Firstly, was an identification of pain beliefs to be challenged and recognition of how current beliefs can misalign with daily experiences. Secondly was a process of challenging and changing beliefs, validated through new experiences. Finally, there was an embedding of changed beliefs into self-management to continue with activities. Conclusion:This study identified a range of psychological changes which occur during exposure to CMT. These changes enabled patients to reconceptualise their condition, develop a new understanding of their body, understand psychological processes, and make sense of their knee pain.

Transcranial direct current stimulation (tDCS) is becoming an increasingly popular technique for altering eating behaviors. Recent research suggests a possible eating behavior trait-dependent effect of tDCS. However, studies recruit participant populations with heterogeneous trait characteristics, including "healthy" individuals who do not present with eating behavior traits suggesting susceptibility to overconsumption. The present review considers the effects of tDCS across eating-related measures and explores whether a trait-dependent effect is evident across the literature. A literature search identified 28 articles using sham-controlled tDCS to modify eating-related measures. Random effects meta-analyses were performed, with subgroup analyses to identify differences between "healthy" and trait groups. Trivial overall effects (g = À0.12 to 0.09) of active versus sham tDCS were found. Subgroup analyses showed a more consistent effect for trait groups, with small and moderate effect size (g = À1.03 to 0.60), suggesting tDCS is dependent on participants' eating behavior traits. Larger effect sizes were found for those displaying traits associated with study outcomes (e.g., heightened food cravings). "Healthy" individuals appear to be unresponsive to stimulation. Based on this meta data, future work should recruit those with eating behavior trait susceptibilities to overconsumption, focusing on those who present with traits associated with the outcome of interest.

4These authors contributed equally.The human intestinal microbiota is the ecological community of micro-organisms that share our gastrointestinal tract (1) . Increasing evidence suggests a mediating relationship exists between gut microbiota activity and the brain (2) . Recent research has shown that probiotic administration is capable of affecting brain activity in regions controlling central processing of emotion and sensation (3) . Developing on these findings, the aim of the present study was to assess the effect of probiotic administration on emotional memory (EM), anxiety and acute peripheral pain response (PR).A randomised double-blind controlled trial, involving sixty participants aged 18-40 years, was conducted. Participants completed a six-week intervention, consuming either probiotic (Lactobacillus acidophilus CUL60 and CUL21, Bifidobacterium lactis CUL34, Bifidobacterium bifidum CUL20) or placebo (maltodextrin) capsules. Participants attended pre-and post-intervention sessions. Anxiety was assessed using the State-Trait Anxiety Inventory questionnaire at three time-points during each session (baseline, post-EM task, post-PR task), and again at weeks two and four during intervention. EM was assessed once in each session using a Remember, Know, Guess task; involving the presentation and recall of neutral and negative emotionally arousing images. A cold pressor test was used to assess PR; pain threshold, removal of hand and pain tolerance times were measured. A visual analogue scale was used to assess subjective pain. Finally, immune function was measured via salivary IgA, collected at three time-points in each session (baseline, post-EM task, post-PR task).When comparing treatment groups in terms of EM, the probiotic group recalled significantly more negative images compared to placebo (P = 0·022, Figure 1.a). This effect was more pronounced in female participants (P = 0·009, Figure 1.b). For male participants only, pain threshold was significantly reduced at the second assessment under the placebo condition (−3·687 seconds, P = 0·027, Figure 1.c) but not following probiotic administration, potentially indicating a protective effect of probiotic treatment on pain threshold. No further significant results were observed.In conclusion, probiotic administration may have a moderating effect on EM processing. Specifically, augmented recall of highly negative valiant stimuli in the probiotic treatment group may indicate altered activity of brain regions that control central processing of emotion. Furthermore, probiotic treatment may have some potential to stabilise pain threshold in male participants. These initial data warrant further investigation to substantiate these findings.

ObjectiveThis study aimed to consider the effect of differing transcranial direct current stimulation (tDCS) parameters on eating-related measures and how issues with experimental design (e.g., inadequate blinding) or parameters variation may drive equivocal effects.MethodsLiterature searches were conducted across MEDLINE, PsycINFO, Scopus, and Science Direct. Studies using conventional sham-controlled tDCS to modify eating-related measures in adult human participants were included. A total of 1135 articles were identified and screened by two independent authors. Study quality was assessed using the Risk of Bias tool. Random-effects meta-analyses were performed, with subgroup analyses to determine differences between parameter sets.ResultsWe identified 28 eligible studies; 7 showed low risk of bias, with the remaining studies showing bias arising from issues implementing or reporting blinding protocols. Large variation in applied parameters was found, including montage, current intensity and density, participant and researcher blinding, and the use of online or offline tasks. The application of differing parameters seemed to alter the effects of tDCS on eating-related measures, particularly for current density (g = −0.25 to 0.31), and when comparing single-session (g = −0.08 to 0.01) versus multisession protocols (g = −0.34 to −0.29). Some parameters result in null effects.ConclusionsThe absence of tDCS-mediated change in eating-related measures may be driven by variation in applied parameters. Consistent application of parameters that seem to be effective for modulating eating behavior is important for identifying the potential impact of tDCS. Using the findings of this review, we propose a series of parameters that researchers should apply in their work.