{ "version": "0.1", "updated": "2026-09-24", "status": "Working source reconstruction and research model family; no fitted parameters", "sources": [ { "id": "D1", "title": "DNRS: current program", "url": "https://retrainingthebrain.com/the-program", "depth": "Public offer text; paid lessons not inspected", "date": "2026-09-15", "locator": "" }, { "id": "D2", "title": "DNRS: current explanation", "url": "https://retrainingthebrain.com/", "depth": "Public homepage text", "date": "2026-09-15", "locator": "What is DNRS; origin account" }, { "id": "D3", "title": "DNRS: frequently asked questions", "url": "https://retrainingthebrain.com/frequently-asked-questions", "depth": "Public FAQ text", "date": "2026-09-15", "locator": "Mechanism, graduated exercises, visualization and comparison with other treatments" }, { "id": "G1", "title": "Gupta: current offer", "url": "https://guptaprogram.com/", "depth": "Public homepage text; paid lessons not inspected", "date": "2026-09-15", "locator": "" }, { "id": "G2", "title": "Gupta: how the program works", "url": "https://guptaprogram.com/how-the-program-works/", "depth": "Public explanation text", "date": "2026-09-15", "locator": "" }, { "id": "G3", "title": "Gupta: how your condition started", "url": "https://guptaprogram.com/how-your-condition-started/", "depth": "Detailed public causal account", "date": "2026-09-15", "locator": "Seven-stage diagram and practices" }, { "id": "P1", "title": "Primal Trust: curriculum assessment", "url": "/program-audits/primal-trust/", "depth": "Accessible Level 1, Level 2 and selected library synthesis; expanded independent and human safety review pending", "date": "2026-09-14", "locator": "Whole-program synthesis dated 4 September; belief atlas Q01–Q11" }, { "id": "P2", "title": "Primal Trust: practices and protective guidance", "url": "/program-audits/primal-trust/#practices", "depth": "Curriculum-based inventory and source references", "date": "2026-09-14", "locator": "ABC, somatic presencing, breathing, pacing" }, { "id": "P3", "title": "Primal Trust: worldview and nonresponse", "url": "/program-audits/primal-trust/#worldview", "depth": "Selected curriculum passages; not a prevalence estimate", "date": "2026-09-14", "locator": "Belief atlas Q06–Q11; Level 2 protective identity and nonresponse material" }, { "id": "C1", "title": "CFS Health: program information", "url": "https://www.cfshealth.com/programinfo", "depth": "Public offer; paid coaching not inspected", "date": "2026-09-15", "locator": "" }, { "id": "C2", "title": "CFS Health: nervous-system episode", "url": "https://www.cfshealth.com/podcasts/the-chronic-illness-recovery-podcast/episodes/2149206545", "depth": "Previously captured public transcript assessed in 7 September audit; not newly listened to", "date": "2026-09-07", "locator": "Episode 193, 18 May 2026" }, { "id": "C3", "title": "CFS Health: critique of fixed graded exercise", "url": "https://www.cfshealth.com/podcasts/the-chronic-illness-recovery-podcast/episodes/2148184672", "depth": "Previously captured public transcript assessed in 7 September audit", "date": "2026-09-07", "locator": "Episode 59, 2 October 2023" }, { "id": "C4", "title": "CFS Health: identity in recovery", "url": "https://www.cfshealth.com/podcasts/the-chronic-illness-recovery-podcast/episodes/2149241326", "depth": "Previously captured public transcript assessed in 7 September audit", "date": "2026-09-07", "locator": "Episode 204, 9 August 2026" }, { "id": "S1", "title": "Somia: current recovery pathway", "url": "https://somiainternational.com/", "depth": "Public program text; paid lessons not inspected", "date": "2026-09-15", "locator": "Brain retraining was only the beginning; Stabilize, Recondition, Optimize" }, { "id": "S2", "title": "Somia: public cross-condition account", "url": "https://www.instagram.com/p/DbEMcfqmb-O/", "depth": "Previously reviewed public post; current audiovisual access not reverified", "date": "2026-07-21", "locator": "Somia public-account-pattern audit, pinned cross-condition source" }, { "id": "H1", "title": "On the Mend: science explanation", "url": "https://onthemend.uk/science", "depth": "Public mechanism and practice description", "date": "2026-09-15", "locator": "" }, { "id": "H2", "title": "On the Mend: how it works", "url": "https://onthemend.uk/how-it-works", "depth": "Public sequence and delivery description; paid sessions not inspected", "date": "2026-09-15", "locator": "Three phases; month-by-month expectations" }, { "id": "T1", "title": "Supplied video transcript attributed to Taylor", "url": null, "depth": "User-supplied text assessed; original post and audiovisual fidelity unverified", "date": "2026-09-14", "locator": "Short claim-specific excerpts shown for review; full text remains in the private research record", "availability": "supplied-only" }, { "id": "T2", "title": "Taylor: approach and background", "url": "https://starjessetaylor.com/about.html", "depth": "Public page; includes allowing emotion and meditation", "date": "2026-09-14", "locator": "" }, { "id": "T3", "title": "Taylor: coaching", "url": "https://starjessetaylor.com/services.html", "depth": "Public offer; private delivery not inspected", "date": "2026-09-15", "locator": "" }, { "id": "T4", "title": "Taylor: terms", "url": "https://starjessetaylor.com/terms.html", "depth": "Public terms, dated 28 April 2026", "date": "2026-09-15", "locator": "Nonrefundability and commitment framing; licensed-care boundary" }, { "id": "R1", "title": "CFS Recovery: public program", "url": "https://cfsrecovery.com/", "depth": "Public-source audit dated 7 September; source update pending", "date": "2026-09-07", "locator": "" }, { "id": "R2", "title": "CFS Recovery: the recovery system", "url": "https://cfsrecovery.com/how-it-works/our-system/", "depth": "Public source previously captured and assessed in the 7 September audit", "date": "2026-09-07", "locator": "Understand, Recalibrate, Rebuild; public-source audit source CR-SYSTEM" }, { "id": "E1", "title": "Repeated checking and memory confidence: van den Hout & Kindt (2003)", "url": "https://pubmed.ncbi.nlm.nih.gov/12600401/", "depth": "Original abstract and task description; independent task L10", "date": "2026-09-15", "locator": "Healthy volunteers; virtual checking; immediate memory confidence, not illness" }, { "id": "E2", "title": "Active relief learning: Zhang et al. (2018)", "url": "https://elifesciences.org/articles/31949", "depth": "Primary design, results and discussion; independent task L14", "date": "2026-09-15", "locator": "Thermal pain; active escape versus yoked relief; minute-scale analgesia" }, { "id": "E3", "title": "Operant pain sensitization: Hölzl et al. (2005)", "url": "https://pubmed.ncbi.nlm.nih.gov/15836965/", "depth": "Abstract and rationale; full-method review pending; independent task L13", "date": "2026-09-15", "locator": "Experimental contingencies can shape pain sensitivity in either direction" }, { "id": "E4", "title": "Mindfulness acceptance dismantling: Lindsay et al. (2018)", "url": "https://pubmed.ncbi.nlm.nih.gov/29040891/", "depth": "Abstract and author-manuscript results excerpts; independent task L18", "date": "2026-09-15", "locator": "153 stressed adults; 15 lessons; monitor+accept versus monitor-only and coping control" }, { "id": "E5", "title": "Interoceptive exposure versus breathing: Craske et al. (1997)", "url": "https://pubmed.ncbi.nlm.nih.gov/9051281/", "depth": "Original abstract; independent task L06", "date": "2026-09-15", "locator": "38 panic/agoraphobia patients; component comparison within treatment packages" }, { "id": "E7", "title": "ACT versus relaxation for OCD: Twohig et al. (2010)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC2948415/", "depth": "Abstract, intervention and discussion; independent task L09", "date": "2026-09-15", "locator": "79 adults; eight sessions; ACT package, not values alone; three-month follow-up" }, { "id": "E8", "title": "Post-exertional muscle findings: Appelman et al. (2024)", "url": "https://doi.org/10.1038/s41467-023-44432-3", "depth": "Primary pages 1 and 6; independent task L28", "date": "2026-09-15", "locator": "25 long-COVID patients with PEM; exercise challenge and physiological observations; not an individual classifier" }, { "id": "E9", "title": "Back-pain MBSR/CBT trial: Cherkin et al. (2016)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4914381/", "depth": "Abstract, outcomes, harms and limitations; independent task L21", "date": "2026-09-15", "locator": "342 adults; package benefits; temporary adverse experiences did not establish necessary healing" }, { "id": "E10", "title": "Judicious safety behavior during exposure: Blakey et al. (2019)", "url": "https://pubmed.ncbi.nlm.nih.gov/30481681/", "depth": "Original abstract; independent task L05", "date": "2026-09-15", "locator": "60 adults with spider fear; both arms improved, nonsignificance is not equivalence" }, { "id": "E11", "title": "Respiratory and cognitive training in panic: Meuret et al. (2010)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3327286/", "depth": "Abstract, mechanisms and limitations; independent task L08", "date": "2026-09-15", "locator": "41 panic/agoraphobia patients; distinct plausible physiological/cognitive routes" }, { "id": "R3", "title": "CFS Recovery: flare-ups and recovery", "url": "https://cfsrecovery.com/blog/flare-ups-required-for-recovery/", "depth": "Public lesson previously captured and assessed in the 7 September audit", "date": "2026-09-07", "locator": "CR-FLARES: adaptation and expansion claims; not a clinical study" }, { "id": "R4", "title": "CFS Recovery: practitioner-facing measurement methods", "url": "https://cfsrecovery.com/for-practitioners/", "depth": "Public protocol assessed in the 7 September audit", "date": "2026-09-07", "locator": "Uncontrolled design and SF-36/PEM limitations" }, { "id": "G4", "title": "Gupta 2002: amygdalar conditioning hypothesis", "url": "https://pubmed.ncbi.nlm.nih.gov/12445517/", "depth": "Original abstract and publication metadata", "date": "2026-09-15", "locator": "Medical Hypotheses; explicitly proposed for a subset, not a treatment trial" }, { "id": "PR1", "title": "PRT: randomized chronic-back-pain trial", "url": "https://doi.org/10.1001/jamapsychiatry.2021.2669", "depth": "Clinical methods, results, mediation and discussion reviewed", "locator": "151 adults; physician session plus eight individual therapy sessions, four weeks; one-year outcomes", "date": "2026-09-16" }, { "id": "PR2", "title": "PRT: trial treatment supplement", "url": "https://cpb-us-e1.wpmucdn.com/sites.dartmouth.edu/dist/2/2150/files/2021/03/Ashar-2021-PRT-supplementary-materials.pdf", "depth": "Clinical methods/results and treatment appendices read", "locator": "Appendices I–II: assessment, evidence gathering, somatic tracking and exposure; pagination differs from journal version", "date": "2026-09-16" }, { "id": "PR3", "title": "PRT Center: patient and practitioner FAQ", "url": "https://www.painreprocessingtherapy.com/pain-reprocessing-therapy-faqs", "depth": "Complete current public FAQ text reviewed", "locator": "Medical assessment, mixed pain, scope of practice and coaching; paid delivery not observed", "date": "2026-09-16" }, { "id": "PR4", "title": "PRT: same-cohort five-year follow-up", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12311821/", "depth": "Full research letter, table and disclosures read", "locator": "113/151 retained; not independent replication; supplementary analyses not audited", "date": "2026-09-16" }, { "id": "P4", "title": "Primal Trust: pacing and monthly review", "url": "/program-audits/primal-trust/#practice-progression", "depth": "Direct re-reading of authorized August 2026 curriculum captures; concise paraphrase, no course files redistributed", "date": "2026-09-17", "locator": "FAQ 2024 pp. 2–3, 9; Module 1 Lesson 3 chronic-stress checklist p. 3; overview lesson 1036592 captured transcript lines 44–48." }, { "id": "P5", "title": "Primal Trust: practice choice and continuing onward", "url": "/program-audits/primal-trust/#practice-progression", "depth": "Direct re-reading of authorized August 2026 curriculum captures; concise paraphrase, no course files redistributed", "date": "2026-09-17", "locator": "Module 4 workbook p. 30; Module 5 workbook p. 22; Module 7 workbook pp. 9–10, 16–17; lesson 1091271 captured transcript lines 14–27." }, { "id": "P6", "title": "Primal Trust: Level 2 readiness and shared target", "url": "/program-audits/primal-trust/#practice-progression", "depth": "Direct re-reading of authorized August 2026 curriculum captures; concise paraphrase, no course files redistributed", "date": "2026-09-17", "locator": "Module 7 Regulate Quick Start Guide p. 6; Module 6 workbook pp. 20, 24; overview lesson 1036592 captured transcript lines 44–46." }, { "id": "P7", "title": "Primal Trust: illness, regulation and ongoing care", "url": "/program-audits/primal-trust/#practice-progression", "depth": "Direct re-reading of authorized August 2026 captures; provider account, not clinical evidence", "date": "2026-09-17", "locator": "Lesson 1036599 captured transcript lines 17–21; FAQ 2024 pp. 6–8. The FAQ’s reported improvements are provider claims, not verified causal effects." }, { "id": "SYS1", "title": "Bartsch 2015: network physiology", "url": "https://doi.org/10.1371/journal.pone.0142143", "locator": "Measured coordination among physiological signals in healthy sleep. This constrains how to describe changing coupling; it identifies neither a unique causal law nor chronic-illness treatment effects.", "depth": "Primary-source reading limits and study scope recorded in the seven-source companion", "date": "2026-09-17" }, { "id": "SYS2", "title": "Dobreva 2021: inflammation, pain and cardiovascular dynamics", "url": "https://pubmed.ncbi.nlm.nih.gov/33450068/", "locator": "Fitted and independently checked acute endotoxin model. Nonlinear couplings are specified model structure; sustained pathological-input and treatment scenarios are simulations.", "depth": "Primary-source reading limits and study scope recorded in the seven-source companion", "date": "2026-09-17" }, { "id": "SYS3", "title": "Relouw 2024: acute and prolonged inflammatory input", "url": "https://doi.org/10.1038/s41540-024-00473-y", "locator": "Validation across endotoxin doses and a three-hour infusion. Infection inputs were selected to produce plausible ranges, not measured clinical infection trajectories.", "depth": "Primary-source reading limits and study scope recorded in the seven-source companion", "date": "2026-09-17" }, { "id": "SYS4", "title": "Queirazza 2024: inflammation and learning-related neural activity", "url": "https://doi.org/10.1016/j.bbi.2024.03.044", "locator": "Randomized acute inflammatory manipulation changed selected task-related neural signatures. Behavioral performance and fitted behavioral parameters did not significantly differ. No inflammation–belief maintenance loop was demonstrated.", "depth": "Primary-source reading limits and study scope recorded in the seven-source companion", "date": "2026-09-17" }, { "id": "SYS5", "title": "Appelman 2024: tissue and post-exertional changes", "url": "https://doi.org/10.1038/s41467-023-44432-3", "locator": "Long-COVID cohort with PEM and muscle/metabolic observations. Keeps tissue constraints and delayed effects visible; it does not estimate a nonlinear coupling law or test retraining.", "depth": "Primary-source reading limits and study scope recorded in the seven-source companion", "date": "2026-09-17" }, { "id": "SYS6", "title": "Pradhan 2007: mindfulness during rheumatoid arthritis", "url": "https://pubmed.ncbi.nlm.nih.gov/17907231/", "locator": "Small randomized package trial with continued usual care. Later psychological benefit without demonstrated disease-activity benefit; not a mechanism or component-effect estimate.", "depth": "Primary-source reading limits and study scope recorded in the seven-source companion", "date": "2026-09-17" }, { "id": "SYS7", "title": "Tesser 2025/2026: implanted vagus stimulation in active RA", "url": "https://doi.org/10.1038/s41591-025-04114-7", "locator": "Sham-controlled device trial with a clinical response difference during active autoimmune illness. Its device exposure is not equivalent to breathing, felt safety or commercial retraining.", "depth": "Primary-source reading limits and study scope recorded in the seven-source companion", "date": "2026-09-17" }, { "id": "P8", "title": "Primal Trust: later retained access and pacing update", "url": "/program-audits/primal-trust/#practice-progression", "depth": "Bounded independent re-reading on 22 September 2026; source version correction, not a live-portal or clinical review", "date": "2026-09-22", "locator": "source:pt:portal:faqs, captured 2026-08-31T05:44:12.932Z (August 30 local), lines 358–389. Immediate access replaces the older weekly release; order and 1–2 weeks per module remain recommended. SHA-256 9a16282645b823da0214f972e875f606c57c46376f5727e73db817abd5d7bf0d." }, { "id": "P9", "title": "Primal Trust: Level 1, Module 3, Lesson 4, Eye Yoga Tools", "url": "https://portal-of-primal-trust.simplerosites.com/courses/69885-level-1-regulate-brain-body-neural/lessons/1036624-lesson-4-vagus-toning-eye-yoga-tools", "depth": "Retained paid-curriculum transcript, captured August 19, 2026; attribution rechecked September 24; course login required", "date": "2026-09-24", "locator": "source:pt:lesson:69885:1036624. The lesson calls these functional neurology-based exercises. It teaches gaze stabilization, smooth pursuit, near–far gaze and panoramic focus/defocus, followed by a Rosenberg gaze-hold exercise. The retained text verifies what is taught, not its proposed mechanisms or clinical effects." }, { "id": "P10", "title": "Primal Trust: Level 1, Module 5, Lesson 5.1, Hanna Somatics Exercises", "url": "https://portal-of-primal-trust.simplerosites.com/courses/69885-level-1-regulate-brain-body-neural/lessons/1076021-lesson-5-1-hanna-somatics-exercises-red", "depth": "Retained paid-curriculum transcript, captured August 19, 2026; attribution rechecked September 24; course login required", "date": "2026-09-24", "locator": "source:pt:lesson:69885:1076021. The lesson names Thomas Hanna and teaches Red Light, Green Light and Dark Vice movements, including pandiculation. This is a named Level 1 lesson, not an attribution inferred from another program or only from a bonus library." } ], "practiceFamilies": [ { "id": "visualization", "name": "Rehearse a different experience", "description": "Imagine a memory, situation or future response; sometimes paired with words or movement.", "domain": "Attention / expectation", "category": "attention" }, { "id": "interrupt", "name": "Interrupt and reframe a symptom loop", "description": "Notice a familiar reaction, use a script or new interpretation, and redirect the next response.", "domain": "Attention / interpretation", "category": "attention" }, { "id": "exposure", "name": "Revisit feared situations or triggers", "description": "Approach selected cues, activities or experiences gradually. A feared cue and a physiological hazard are not interchangeable.", "domain": "Learning / activity", "category": "activity" }, { "id": "body", "name": "Observe or allow bodily sensations", "description": "Attention may be curious, accepting, directed toward emotional processing, or used to monitor threat. The stance and next action matter.", "domain": "Attention / emotion", "category": "attention" }, { "id": "breathing", "name": "Change breathing", "description": "Use a prescribed breathing pattern. Techniques, intensity and contraindications can differ substantially.", "domain": "Bodily input / attention", "category": "body" }, { "id": "meditation", "name": "Meditate or practice mindfulness", "description": "Sustain attention, notice thoughts, or allow experience. Programs give this different purposes and importance.", "domain": "Attention / stance", "category": "attention" }, { "id": "eye-movement", "name": "Practice eye movements and focus", "description": "Keep the eyes on a target while moving the head, track a moving target, or shift between near, far and panoramic focus. Programs may attach different explanations to these actions.", "domain": "Bodily input / attention", "category": "body" }, { "id": "movement", "name": "Use somatic movement", "description": "Use deliberate bodily movements and notice contraction, release or other sensations. The specific movement and its explanation vary by program.", "domain": "Activity / bodily input", "category": "body" }, { "id": "emotion", "name": "Allow or process emotion", "description": "Feel emotion, explore unresolved experience, or work with protective parts. These are different procedures, not one mechanism.", "domain": "Emotion / meaning", "category": "emotion" }, { "id": "pacing", "name": "Rest and establish a baseline", "description": "Organize demand, rest and routine around a repeatable level of activity. Definitions and progression rules differ.", "domain": "Activity / context", "category": "activity" }, { "id": "capacity", "name": "Rebuild activity and participation", "description": "Expand physical, cognitive or social activity, with varying ideas about readiness and setbacks.", "domain": "Activity / function", "category": "activity" }, { "id": "identity", "name": "Rework roles, values and boundaries", "description": "Name what matters, notice people-pleasing or protective roles, and try a different choice. This differs from denying a diagnosis.", "domain": "Identity / relationships", "category": "identity" }, { "id": "coaching", "name": "Receive coaching and community support", "description": "Use guidance, group sessions, peer examples or accountability while applying the practices.", "domain": "Relationship / delivery", "category": "support" }, { "id": "orienting", "name": "Orient to surroundings or use self-touch", "description": "Notice the surrounding environment or use a self-contact exercise. Structured eye-movement and focus exercises have their own entry.", "domain": "Bodily input / attention", "category": "body" }, { "id": "illness-language", "name": "Change illness or recovery language", "description": "Change how you describe illness or recovery, or how much conversation centers on it. Do not assume every course forbids saying you are ill.", "domain": "Identity / meaning", "category": "identity" } ], "checks": { "origin": { "title": "An initiating event does not settle what maintains illness now.", "status": "unresolved", "explanation": "A virus, injury or stressful event can precede persistent illness without proving that the original pathology and its consequences have ended. The mapped materials do not establish the proposed shared cause for an individual.", "alternatives": [ "Ongoing pathology or residual injury", "Environmental or treatment effects", "Learning and physiological constraints operating together" ], "test": "What independent observations would show that this maintaining process is present, and distinguish it from continuing pathology?", "evidence": [], "job": "Separates how an illness began from processes that might now be changeable. This can turn a confusing history into a candidate target for action.", "balance": "A coherent origin story can create hope; treating it as settled can prematurely close investigation of continuing illness.", "fit": "A useful formulation names a specific present process and remains revisable. Persistence alone, a personality description or a clinician’s uncertainty does not identify that process.", "support": "Learning studies show that responses can be acquired and modified. This is a reason to investigate persistence mechanisms, not evidence that the initiating event is over or that this program’s origin story applies.", "supportSources": [ "E3" ] }, "maintenance": { "title": "Nervous-system involvement is not causal sufficiency.", "status": "unresolved", "explanation": "A system can influence symptoms without being their dominant maintainer or the common cause of several diseases. The exact disease-level bridge is not established by this source map; a full condition-specific evidence review remains needed.", "alternatives": [ "Peripheral and central processes can coexist", "Symptoms, function and disease activity can change separately", "A person can benefit without this being the primary mechanism" ], "test": "Which measured outcome changes, in which population, and is the proposed mediator independently measured?", "evidence": [ "E8" ], "job": "Gives practice a target: reducing a proposed maintaining response rather than treating every symptom as an unrelated event.", "balance": "A target may reduce helplessness; a master-cause story may displace care or turn limited agency into responsibility for disease.", "fit": "Ask what the assessment actually establishes in this condition and illness phase. A mixed formulation can retain both physiological treatment and work on symptom responses.", "support": "These sources propose a learned maintaining response as the target of practice. The inspected material does not directly establish that response as the dominant cause of the illnesses claimed. Evidence for a neural influence, a particular treatment benefit or a physiological alternative must be assessed separately.", "supportSources": [], "sourceNotes": [ { "id": "E8", "role": "Rival explanation / transfer boundary", "note": "Physiological findings are relevant to alternatives; they are not affirmative evidence for the program’s proposed learned maintaining mechanism." } ] }, "attention": { "title": "The kind of engagement matters.", "status": "unresolved", "explanation": "Specific checking can sustain doubt; attention can also support exposure, acceptance or useful monitoring. These narrower findings do not establish this program’s entire symptom-to-alarm loop.", "alternatives": [ "Threat monitoring or ritualized checking", "Curious or equanimous observation", "Scheduled measurement with a defined decision", "Attention to a signal requiring appropriate care" ], "test": "Specify the target, stance, purpose, frequency and action that follows. Does that process predict the outcome beyond prior symptoms?", "evidence": [ "E1", "E4", "E5" ], "job": "Helps someone notice whether a repetitive response is adding fear, doubt or restriction, and try a different relationship to the experience.", "balance": "Less compulsive checking may free attention. A blanket ban on attention may remove useful observation, body trust or communication about care.", "fit": "Distinguish a chosen observation from an urgent ritual. Compare purpose, frequency, stance and the action that follows; track burden and participation separately from sensation intensity.", "support": "Repeated checking reduced memory confidence in a laboratory task; interoceptive exposure and acceptance have bounded evidence in other settings. These findings support distinctions between kinds of attention, not this whole loop.", "supportSources": [ "E1", "E4", "E5" ] }, "practice": { "title": "Changing a response is a testable possibility.", "status": "unresolved", "explanation": "Adjacent learning and psychological studies justify testing specified components. They do not validate the proprietary bundle, its named neural mechanism, or transfer to every advertised condition. Program efficacy and component mechanism need separate assessment.", "alternatives": [ "Specific learning or physiological effects", "Expectancy, relationship and routine", "Natural history, concurrent care or reporting changes" ], "test": "What changes first, compared with an appropriate control, and does that change explain later benefit?", "evidence": [ "E3", "E7", "E11" ], "job": "Offers a repeatable action and an opportunity to learn a different response.", "balance": "Practice may build a skill, routine or sense of agency. Excessive workload or pressure to reproduce a prescribed state may add strain.", "fit": "Specify which skill and outcome are being tried, whether the person wants that goal, and how dose and limits can change. More confidence or better technique alone does not establish a health benefit.", "support": "Learning can alter pain sensitivity experimentally; specific psychological and breathing packages have condition-specific findings. That supports testing components, without identifying a proprietary mechanism or the best bundle.", "supportSources": [ "E3", "E7", "E11" ] }, "recovery": { "title": "Improvement does not prove the whole explanation.", "status": "unresolved", "explanation": "A symptom report, greater participation and a change in disease activity are different outcomes. Even a controlled benefit would not by itself establish every link in the program’s mechanism story. This map does not complete an efficacy review of each program.", "alternatives": [ "Symptom benefit without disease modification", "Function changes despite continued symptoms", "Effects of co-treatment, support or natural history" ], "test": "Separate symptoms, function, objective disease measures, burden and durability; retain nonresponders and adverse outcomes.", "evidence": [ "E9" ], "job": "Connects the daily work to a hoped-for change in life rather than an endless exercise routine.", "balance": "A credible goal can organize effort; a broad recovery promise can make smaller benefits invisible or make nonresponse feel like personal failure.", "fit": "Name the desired change: symptoms, chosen participation, disease activity, burden or durability. Benefits and losses in different outcomes should not cancel each other invisibly.", "support": "Some multicomponent psychological interventions improve selected chronic back-pain outcomes. This map has not completed an efficacy review of each commercial program or established transfer across diseases.", "supportSources": [ "E9" ] }, "relief": { "title": "Relief is not evidence of long-term harm.", "status": "overbroad", "explanation": "Relief can reinforce an action, and experimental contingencies can shape pain sensitivity. The additional inference that any calming teaches the brain to produce more symptoms is unsupported as a general rule. Active relief learning can reduce acute pain; longer-term effects still depend on the contingency and context.", "alternatives": [ "A rigid ritual prevents corrective learning", "Calming makes participation possible", "Effective treatment reduces an ongoing harmful input", "Relief and durable learning coexist" ], "test": "Measure the action–consequence contingency and later symptoms separately. Compare useful coping with compulsive checking rather than grouping all relief together.", "evidence": [ "E2", "E3", "E10", "E11" ], "job": "Questions whether a relief-seeking ritual is making life depend on repeatedly neutralizing a sensation.", "balance": "More freedom from a ritual may help. Rejecting relief itself may remove useful treatment or the support needed to participate.", "fit": "Ask what action relief reinforces and what happens later. Can the person use it flexibly, or does an escalating rule take over? Immediate relief alone cannot decide.", "support": "Operant learning can shape pain sensitivity. Active relief learning also reduced acute experimental pain, and some safety behaviors did not undermine exposure in a bounded study. The relevant contingency must be specified.", "supportSources": [ "E2", "E3", "E10", "E11" ] }, "identity": { "title": "Identity may influence choices without causing the illness.", "status": "unresolved", "explanation": "Examining values or boundaries may be worthwhile. Inferring a hidden wish, conflict or protective identity from persistent illness does not independently establish causation. Illness can also change identity and relationships.", "alternatives": [ "Identity patterns precede illness", "Illness or social responses change identity", "Both directions operate", "The pattern is not relevant to this person" ], "test": "Can the proposed pattern be assessed independently of outcome, and can the person reject the interpretation while retaining support?", "evidence": [], "job": "Invites someone to examine whether an unwanted role, boundary or self-description restricts choices they care about.", "balance": "New boundaries or a broader identity may be valuable. Searching for hidden motives can produce blame or pressure to deny illness and support needs.", "fit": "A concrete pattern that the person independently recognizes and wants to change is a stronger reason to explore than persistent symptoms. No validated personality or illness-stage matching rule is established here.", "support": "Values and role exploration can be chosen for their own practical goals. These records do not establish that a protective identity causes disease or that changing it treats illness.", "supportSources": [] }, "worsening": { "title": "Worsening has more than one explanation.", "status": "overbroad", "explanation": "Challenge-related distress can occur, but worsening is not a specific marker of useful learning or recovery. Excessive dose, an adverse reaction, disease activity and ordinary fluctuation remain alternatives. Long-COVID PEM research supplies a concrete physiological rival, without classifying every case.", "alternatives": [ "Expected, bounded challenge-related distress", "Dose or practice mismatch", "Post-exertional or other physiological worsening", "Unrelated fluctuation or a new condition" ], "test": "Specify duration, severity, function and review limits before practice. What observation requires reassessment instead of more commitment?", "evidence": [ "E8", "E9" ], "job": "May help someone avoid interpreting every difficult moment as permanent failure.", "balance": "Bounded reassurance may support a chosen challenge; automatic reassurance may normalize injury, PEM or an unsuitable intervention.", "fit": "Specify a review plan in advance and retain deterioration as evidence against the plan. Illness phase, physiological load and delayed functional loss matter; this map cannot set clinical thresholds.", "support": "Trials report some temporary adverse experiences, and challenging practice can be uncomfortable. Worsening is not a specific recovery marker; long-COVID PEM research gives a concrete physiological alternative.", "supportSources": [ "E8", "E9" ] }, "nonresponse": { "title": "A missing skill cannot be inferred from failure alone.", "status": "unresolved", "explanation": "Unnoticed checking or an unresolved pattern could matter in an individual formulation. If nonresponse is its only evidence, the explanation becomes circular. Fidelity and the proposed process must be assessed independently.", "alternatives": [ "A relevant but unmeasured behavior", "Insufficient or unsuitable delivery", "The mechanism is absent or not decisive", "The treatment does not help despite accurate practice" ], "test": "What finding would count against the formulation? Can the practitioner be wrong and the participant leave without a fault label?", "evidence": [], "job": "Prompts a check of whether the intended skill or a relevant pattern was actually addressed.", "balance": "A missed obstacle may be worth exploring. If every disappointing result proves a hidden obstacle, the framework becomes immune to correction.", "fit": "Observe the proposed behavior independently; allow accurate practice with no benefit. The person must be able to decline further identity work or checking analysis without losing support.", "support": "A missed skill or unrecognized habit is a possible individual formulation. The available records do not establish either from treatment failure alone.", "supportSources": [] }, "sequence": { "title": "This arrow describes the offered sequence.", "status": "description", "explanation": "The source supports this order of teaching. It does not establish that the sequence is biologically necessary or superior to another sequence.", "alternatives": [ "Another order may be suitable", "Some components may be unnecessary", "The sequence may need individual adaptation" ], "test": "Would a matched comparison or participant-level evaluation support the need for this order?", "evidence": [], "job": "Organizes workload and prepares someone for a potentially more demanding stage.", "balance": "A manageable order may reduce overwhelm. A rigid sequence may require unnecessary work or make a mismatch seem like a failure to complete earlier stages.", "fit": "Ask what readiness means, which components can be omitted, and whether the plan can change. A source describing a sequence is not a comparison showing it is necessary.", "support": "The linked provider source supports the offered order. This is source evidence about teaching, not a trial of the order’s superiority.", "supportSources": [] }, "values": { "title": "Participation need not wait for complete symptom relief.", "status": "unresolved", "explanation": "An ACT package improved OCD outcomes in a trial, but values alone were not isolated. That supports a bounded practical possibility; it neither establishes Taylor’s program efficacy nor makes every activity appropriate for chronic illness.", "alternatives": [ "Values-based participation with medical limits", "Participation supported by symptom relief", "The chosen activity or dose is unsuitable" ], "test": "Does chosen participation improve without unacceptable burden? Measure that separately from symptom elimination.", "evidence": [ "E7" ], "job": "Makes personally meaningful activity a goal even while uncomfortable experience is present.", "balance": "Chosen participation may enlarge life; imposed activity can ignore limits or make rest feel like failure.", "fit": "Ask whether this is the person’s own goal, whether it fits current capacity, and whether support or symptom relief would make it more workable.", "support": "An ACT package improved OCD outcomes in a trial; values alone were not isolated. This supports a bounded practical possibility, not Taylor’s efficacy or transfer to ME/CFS.", "supportSources": [ "E7" ] }, "pandiculation": { "title": "Motor learning does not identify the cause of PEM.", "status": "unresolved", "explanation": "The source links pandiculation to motor-cortex patterns underlying PEM. Demonstrating a change in movement or muscle tension would not establish that this pattern maintains PEM or that altering it improves exertional tolerance. The named bridge requires its own evidence.", "alternatives": [ "A movement practice changes comfort without changing PEM", "Motor and peripheral physiological processes coexist", "The dose exceeds current physiological capacity", "A different intervention component accounts for change" ], "test": "Does the specific practice change the proposed motor process, then improve measured delayed exertional response relative to a suitable comparator, without accumulating harm?", "evidence": [ "E8" ], "job": "Provides a concrete way to explore habitual movement and muscular effort.", "balance": "A movement practice might change comfort or control. It may also exceed capacity; a motor explanation can incorrectly stand in for a cause of PEM.", "fit": "Measure movement effects and delayed exertional outcomes separately. A reduction in tension does not establish safer exertion or a reset of the process maintaining PEM.", "support": "The offer describes a motor-learning rationale. This review has not established a direct trial linking its pandiculation procedure to the proposed PEM mechanism.", "supportSources": [ "E8" ] }, "prt-1": { "title": "Not separately manipulated; pain can reasonably signal pathology.", "status": "unresolved", "explanation": "Not separately manipulated; pain can reasonably signal pathology.", "alternatives": [ "The proposed process contributes alongside other processes", "Relationship, expectancy or another component contributes", "Changes in symptoms alter the interpretation, rather than only the reverse" ], "test": "Repeated measures of appraisal and fear alongside independent clinical assessment.", "evidence": [ "PR1", "PR2" ], "job": "Makes the meaning of pain a possible target for change, so that fear need not govern every movement or activity.", "balance": "A less threatening interpretation may make a chosen action more approachable. Categorical reassurance can also pressure someone to dismiss bodily information or doubt themselves when pain persists.", "fit": "Distinguish the person’s interpretation, their fear, their activity and the pain itself. Medical assessment can consider mixed contributions; fear or symptom variability does not by itself identify pain as noninjurious.", "support": "The supplement explicitly teaches this link. It is a plausible formulation, but the trial did not separately manipulate this step or establish that every pain experience signifies learned fear.", "supportSources": [ "PR2" ] }, "prt-2": { "title": "Reciprocal mediation; not proof fear is necessary or sufficient, or explains all chronic pain.", "status": "unresolved", "explanation": "Reciprocal mediation; not proof fear is necessary or sufficient, or explains all chronic pain.", "alternatives": [ "The proposed process contributes alongside other processes", "Relationship, expectancy or another component contributes", "Changes in symptoms alter the interpretation, rather than only the reverse" ], "test": "Manipulate appraisal while holding contact and exposure comparable.", "evidence": [ "PR1", "PR2" ], "job": "Makes the meaning of pain a possible target for change, so that fear need not govern every movement or activity.", "balance": "A less threatening interpretation may make a chosen action more approachable. Categorical reassurance can also pressure someone to dismiss bodily information or doubt themselves when pain persists.", "fit": "Distinguish the person’s interpretation, their fear, their activity and the pain itself. Medical assessment can consider mixed contributions; fear or symptom variability does not by itself identify pain as noninjurious.", "support": "Exploratory changes in harm beliefs correlated with pain changes. Reverse mediation also appeared; the analysis does not settle which change caused the other.", "supportSources": [ "PR2" ] }, "prt-3": { "title": "Component-specific efficacy untested; not equivalent to ignoring or generic body scanning.", "status": "unresolved", "explanation": "Component-specific efficacy untested; not equivalent to ignoring or generic body scanning.", "alternatives": [ "The proposed process contributes alongside other processes", "Relationship, expectancy or another component contributes", "Changes in symptoms alter the interpretation, rather than only the reverse" ], "test": "Dismantle tracking, reappraisal and positive affect with equal credibility.", "evidence": [ "PR1", "PR2" ], "job": "Offers a repeatable action and an opportunity to learn a different response.", "balance": "Practice may build a skill, routine or sense of agency. Excessive workload or pressure to reproduce a prescribed state may add strain.", "fit": "Specify which skill and outcome are being tried, whether the person wants that goal, and how dose and limits can change. More confidence or better technique alone does not establish a health benefit.", "support": "This component was included in the successful trial package. Its independent contribution, compared with an equally credible treatment without it, was not isolated.", "supportSources": [ "PR2" ] }, "prt-4": { "title": "No universal safe-to-expose classifier; relief does not prove absence of peripheral contribution.", "status": "unresolved", "explanation": "No universal safe-to-expose classifier; relief does not prove absence of peripheral contribution.", "alternatives": [ "The proposed process contributes alongside other processes", "Relationship, expectancy or another component contributes", "Changes in symptoms alter the interpretation, rather than only the reverse" ], "test": "Measure expected harm, actual activity and immediate/delayed consequences prospectively.", "evidence": [ "PR1", "PR2" ], "job": "Offers a repeatable action and an opportunity to learn a different response.", "balance": "Practice may build a skill, routine or sense of agency. Excessive workload or pressure to reproduce a prescribed state may add strain.", "fit": "Specify which skill and outcome are being tried, whether the person wants that goal, and how dose and limits can change. More confidence or better technique alone does not establish a health benefit.", "support": "This component was included in the successful trial package. Its independent contribution, compared with an equally credible treatment without it, was not isolated.", "supportSources": [ "PR2" ] }, "prt-5": { "title": "Belief revision is not independent validation of a structural-versus-central diagnosis.", "status": "unresolved", "explanation": "Belief revision is not independent validation of a structural-versus-central diagnosis.", "alternatives": [ "The proposed process contributes alongside other processes", "Relationship, expectancy or another component contributes", "Changes in symptoms alter the interpretation, rather than only the reverse" ], "test": "Independent diagnostic assessment; retain disconfirming observations.", "evidence": [ "PR1", "PR2" ], "job": "Offers a way to revise a frightening interpretation after a different experience.", "balance": "Recognizing modifiability may reduce fear. Treating a response as proof that pathology is absent can close assessment too soon.", "fit": "Preserve improvement as a meaningful outcome while keeping causal interpretation open. A transient response does not independently validate a central-versus-peripheral diagnosis.", "support": "The manual incorporates symptom changes into the patient’s evidence sheet; reverse mediation is compatible with pain improvement changing beliefs.", "supportSources": [ "PR2" ] }, "prt-6": { "title": "Selected community sample, expert providers, unmatched contact; no component isolation or disease-modification test.", "status": "conditional", "explanation": "This is direct support for the combined treatment in selected adults with primary chronic back pain. Contact time was not matched to another psychotherapy. Components, diagnostic accuracy, inflammatory disease modification and transfer to ME/CFS were not tested.", "alternatives": [ "Several treatment components jointly contribute", "Expectancy, clinician contact and reporting effects contribute", "The package works through a different mechanism than its explanation" ], "test": "Independent active-comparator and ordinary-provider replication; separate pain, function, harms and durability.", "evidence": [ "PR1", "PR4" ], "job": "Offers an evidence-backed treatment possibility for discussion in the studied clinical context.", "balance": "Substantial pain relief and improved disability were observed for some participants. The schedule required a physician visit and eight therapy sessions; ordinary commercial delivery and prices were not evaluated.", "fit": "Check how assessment, clinician expertise and delivery compare with the trial. It reported no PRT adverse events through spontaneous reports, which does not establish zero risk. This trial cannot select a safe responder from personality or symptom variability.", "support": "In the randomized trial, 33/50 assigned to PRT reported pain of 0–1/10 after treatment, compared with 10/51 assigned to open-label placebo and 5/50 to usual care. Group benefits persisted at one year.", "supportSources": [ "PR1", "PR4" ] } }, "models": [ { "id": "primal-trust-coupled", "title": "Primal Trust as a coupled system", "width": 1300, "height": 845, "nodes": [ { "id": "course", "label": "Course stage and available tools", "kind": "course", "summary": "The course changes what a person has learned and which practices are available.", "details": [ "Correction, 22 September 2026: the later retained FAQ gives immediate module access, with a strongly recommended order and self-paced learning. The older 2024 FAQ described weekly releases. Mastery of module tools is distinct from complete mastery of self-regulation.", "The later retained FAQ still encourages 1–2 weeks per module. The older 2024 FAQ suggests at least 2–3 months overall, longer with cognitive challenges. These are provider recommendations, not validated biological time constants.", "Level 2 deepens protective-pattern, attachment and identity work while Level 1 tools remain active. The overview allows some people to bypass this stage.", "The course is part of the evolving system, not a fixed input switched on once." ], "sources": [ "P4", "P5", "P6", "P8" ], "x": 40, "y": 80 }, { "id": "framework", "label": "Explanation, skills and expectations", "kind": "learning", "summary": "Teaching changes how experience is understood and what responses seem possible.", "details": [ "The nervous-system account offers a target for action, coherence and hope; these functions do not establish its causal truth.", "Behavioral gains may be interpreted as evidence of neural change. This can support commitment but can also protect a mistaken explanation from correction." ], "sources": [ "P1", "P5", "P7" ], "x": 365, "y": 80 }, { "id": "choice", "label": "Choose, adapt or progress", "kind": "decision", "summary": "The participant selects practices, adjusts effort and decides how to continue.", "details": [ "Inputs include noticed symptoms, behavior, relationships, needs and the explanation supplied by the course.", "Tool choice is flexible. No validated score-to-tool algorithm or universal symptom-based graduation rule was found.", "A later FAQ suggests committing for at least six months before reassessing when behavioral or emotional changes are occurring. This differs from the monthly worksheet and is not a demonstrated minimum effective dose.", "The depicted decision process joins distributed guidance; it is not an official algorithm or an optimal controller." ], "sources": [ "P4", "P5", "P6" ], "x": 690, "y": 80 }, { "id": "practice", "label": "Selected practices and actual use", "kind": "action", "summary": "Level 1 and Level 2 actions feed back into the same proposed regulation and response processes.", "details": [ "Actual practice differs from enrollment or intended dose. Both adherence and burden can change with illness.", "Level 1 includes interruption/ABC, visualization, breathing, bodily attention, orienting, movement, emotion work and pacing. Level 2 adds deeper work alongside them.", "This block describes what the program offers; this map does not prescribe a routine.", "The named core and library tools are grouped here for readability; the complete proprietary teaching and practice-specific safeguards are not reproduced." ], "sources": [ "P2", "P3", "P5", "P6", "P9", "P10" ], "x": 1015, "y": 80, "practices": [ { "id": "visualization", "note": "Rehearse a desired experience using imagery within the Choose/Create part of ABC; the curriculum offers several visualization options.", "sources": [ "P2" ] }, { "id": "interrupt", "note": "ABC: notice a habitual symptom reaction, interrupt it, shift into bodily/breath attention, then choose or imagine a different response. This is not the only attention strategy taught.", "sources": [ "P2" ] }, { "id": "body", "note": "Somatic tracking/presencing: stay with sensation with curiosity or less fear; alternate with resources or the environment. Distinct from ABC redirection. Tracking has prerequisite and structural-damage cautions.", "sources": [ "P2" ] }, { "id": "breathing", "note": "Examples include toned exhalation, slow breathing, box breathing and advanced activation/holds. These are physiologically different; advanced practices have specific cautions and exclusions.", "sources": [ "P2" ] }, { "id": "emotion", "note": "Notice a feeling separately from its story; explore it through bodily presencing and, later, parts/protective-pattern work. Feeling an emotion and proving it maintains disease are different claims.", "sources": [ "P3" ] }, { "id": "pacing", "note": "Use rest, smaller activity doses and adjustments. The reviewed menu also includes movement expectations; a PEM-specific prospective progression rule remains unresolved.", "sources": [ "P2" ] }, { "id": "identity", "note": "Later Level 2: explore protective parts, people-pleasing and an Adult Main Personality; practice values and different relational choices. Some teaching interprets persistent illness as an unconscious protective rule.", "sources": [ "P3" ] }, { "id": "coaching", "note": "Practice/community setting.", "sources": [ "P1" ] }, { "id": "meditation", "note": "Guided meditations and somatic-presencing sessions occur in the reviewed curriculum.", "sources": [ "P2" ] }, { "id": "illness-language", "note": "Some reviewed teaching discourages detailed symptom/diagnosis talk and redirects recovery-focused attention. That does not establish a program-wide ban on saying “I am sick.”", "sources": [ "P3" ] }, { "id": "eye-movement", "note": "Level 1, Module 3 teaches gaze stabilization (watch a target while moving the head), smooth pursuit (follow a moving target), near–far gaze and panoramic focus/defocus. The lesson calls these functional neurology-based exercises and also adds a Rosenberg gaze-hold exercise. It gives dose-reduction and stopping guidance while also describing some initial symptoms as expected. These are the course’s instructions and explanations; their inclusion does not establish the proposed health effects.", "sources": [ "P9" ] }, { "id": "movement", "note": "Level 1, Module 5, Lesson 5.1 teaches Hanna Somatics: Red Light, Green Light and Dark Vice movements, including pandiculation. Participants are guided through arching, curling and releasing while noticing contraction and relaxation. This is a specific curriculum lesson; the wider movement menu contains other practices with different cautions.", "sources": [ "P10" ] }, { "id": "orienting", "note": "Environmental orienting, self-touch and grounding appear in the inspected toolkit. The structured eye-movement exercises are listed separately under “Practice eye movements and focus.”", "sources": [ "P2" ] } ] }, { "id": "body", "label": "Bodily illness and function", "kind": "physiology", "summary": "Infection, exposure, injury and impaired bodily function remain visible in the account.", "details": [ "Lesson 1036599 lists infection and exposure among possible contributors and acknowledges uncertainty about whether illness or dysregulation came first.", "It also proposes that dysregulation affects immune and other bodily functions. That is a provider assertion, not an established universal feedback law.", "This grouped block is not a diagnosis or a single biological variable." ], "sources": [ "P7" ], "x": 40, "y": 350 }, { "id": "regulation", "label": "Threat and regulation dynamics", "kind": "proposed process", "summary": "The course’s proposed maintaining response can interact with bodily illness and with behavior.", "details": [ "Both levels are presented as changing this process. Its effects, speed and relative contribution are not measured by the diagram.", "Feeling calmer, learning a skill and changing immune physiology are distinct observations." ], "sources": [ "P1", "P6", "P7" ], "x": 365, "y": 350 }, { "id": "experience", "label": "Symptoms and felt experience", "kind": "experience", "summary": "Symptoms are experienced within the proposed body–regulation–response system.", "details": [ "This block is distinct from what gets checked or reported. Symptoms can exist when someone is not intentionally monitoring them.", "The diagram permits bodily contributions as well as the course’s regulation account." ], "sources": [ "P1", "P7" ], "x": 690, "y": 350 }, { "id": "monitor", "label": "Attend, check or observe", "kind": "observation action", "summary": "Observation is itself an activity that the course can introduce or modify.", "details": [ "The monthly worksheet asks about symptoms and behavior. Other instructions distinguish fearful checking, interruption and curious somatic attention.", "Those are different purposes and stances; the map does not equate every measurement with harmful checking.", "Observation both supplies information and can alter the response to experience. Its effect depends on how it is done." ], "sources": [ "P2", "P4", "P5" ], "x": 1015, "y": 350 }, { "id": "care", "label": "Continuing care and bodily support", "kind": "care", "summary": "The captured FAQ allows ongoing medical treatment and additional bodily support.", "details": [ "The map preserves that context instead of assuming the original pathology has ended.", "The care-to-body connection records acknowledged concurrent care, not a claim that every treatment helps or that the course can determine medical need." ], "sources": [ "P7" ], "x": 40, "y": 620 }, { "id": "daily", "label": "Activity, rest and relationships", "kind": "behavior", "summary": "Practice is intended to change responses throughout daily life.", "details": [ "The course asks about rest, pacing, boundaries, enjoyment, relationships and values, not only time spent on exercises.", "Behavior can influence physiology and participation; symptom changes alone do not identify which pathway changed." ], "sources": [ "P2", "P5", "P7" ], "x": 365, "y": 620 }, { "id": "appraisal", "label": "Appraisal, emotion and response", "kind": "response", "summary": "A sensation can prompt fear, interpretation, emotion and a habitual or chosen response.", "details": [ "The course tries to change this relationship using both redirection and sustained, less fearful attention in different contexts.", "The response is neither identical to the sensation nor proof of what caused it." ], "sources": [ "P2", "P5" ], "x": 690, "y": 620 }, { "id": "record", "label": "Noticed changes and reports", "kind": "information", "summary": "Observed physical symptoms, behavior and daily-life changes become information for later decisions.", "details": [ "Monthly physical and behavioral totals are explicitly taught. Reports are partial observations, not direct measurements of neural rewiring.", "The six-month commitment/reassessment guidance sits alongside monthly review, not in place of it.", "What gets noticed, remembered and reported can change as the person learns new concepts. This reporting distinction is our analytic reconstruction." ], "sources": [ "P4", "P5" ], "x": 1015, "y": 620 } ], "edges": [ { "id": "body-reg", "from": "body", "to": "regulation", "label": "Illness or exposure can disturb regulation", "role": "claim", "detail": "The lesson names infections, toxins and injury as possible contributors to limbic impairment. It leaves causal order uncertain; it does not establish their relative contributions.", "sources": [ "P7" ], "points": [ [ 260, 395 ], [ 365, 395 ] ], "badge": [ 312, 395 ], "check": "origin", "legacyEdgeId": "primal-trust-e1" }, { "id": "reg-body", "from": "regulation", "to": "body", "label": "Dysregulation is said to impair bodily function", "role": "claim", "detail": "The course proposes effects on infection defense, immune regulation, digestion and other functions. This completes its acknowledged two-way account without validating a universal disease mechanism.", "sources": [ "P7" ], "points": [ [ 365, 420 ], [ 310, 420 ], [ 310, 470 ], [ 180, 470 ], [ 180, 440 ] ], "badge": [ 250, 470 ], "check": "maintenance" }, { "id": "reg-symptom", "from": "regulation", "to": "experience", "label": "A continuing response is said to sustain symptoms", "role": "claim", "detail": "The learned-threat account assigns regulation a maintaining role. How much it contributes alongside ongoing pathology remains an empirical question.", "sources": [ "P1", "P7" ], "points": [ [ 585, 395 ], [ 690, 395 ] ], "badge": [ 638, 395 ], "check": "maintenance", "legacyEdgeId": "primal-trust-e2" }, { "id": "symptom-response", "from": "experience", "to": "appraisal", "label": "Experience prompts interpretation and reaction", "role": "acknowledged", "detail": "The course addresses fearful or habitual responses to symptoms. This reconstruction separates the experienced symptom from the response to it.", "sources": [ "P2", "P5" ], "points": [ [ 800, 440 ], [ 800, 620 ] ], "badge": [ 800, 530 ], "check": "attention" }, { "id": "response-reg", "from": "appraisal", "to": "regulation", "label": "Habitual reactions may reinforce threat", "role": "claim", "detail": "Fear and habitual responses are presented as feeding back into dysregulation. This is not a claim that all attention increases illness.", "sources": [ "P1", "P2" ], "points": [ [ 690, 665 ], [ 635, 665 ], [ 635, 495 ], [ 535, 495 ], [ 535, 440 ] ], "badge": [ 635, 550 ], "check": "attention", "legacyEdgeId": "primal-trust-e3" }, { "id": "teaching", "from": "course", "to": "framework", "label": "New material changes the available explanation and skills", "role": "guidance", "detail": "Modules introduce concepts and practices over time. Instruction changes the participant’s repertoire; mastering a module is not itself evidence of disease change.", "sources": [ "P4", "P5", "P6" ], "points": [ [ 260, 125 ], [ 365, 125 ] ], "badge": [ 312, 125 ] }, { "id": "frame-response", "from": "framework", "to": "appraisal", "label": "The explanation changes how symptoms are approached", "role": "guidance", "detail": "ABC, somatic work and deeper pattern work offer different ways of interpreting and responding to experience. Whether those changes improve health is separate from the instructions.", "sources": [ "P2", "P3", "P5" ], "points": [ [ 475, 170 ], [ 475, 255 ], [ 955, 255 ], [ 955, 565 ], [ 845, 565 ], [ 845, 620 ] ], "badge": [ 955, 515 ], "check": "attention" }, { "id": "frame-choice", "from": "framework", "to": "choice", "label": "Understanding guides choices", "role": "guidance", "detail": "The participant uses taught principles to create a workable routine. We reconstruct this dependency from the course’s guidance, not from a recorded decision algorithm.", "sources": [ "P5" ], "points": [ [ 585, 125 ], [ 690, 125 ] ], "badge": [ 638, 125 ] }, { "id": "choice-use", "from": "choice", "to": "practice", "label": "Select tools and adjust use", "role": "guidance", "detail": "The course encourages using tools for current needs and adapting the routine; not every tool is for daily use.", "sources": [ "P5" ], "points": [ [ 910, 125 ], [ 1015, 125 ] ], "badge": [ 962, 125 ] }, { "id": "practice-reg", "from": "practice", "to": "regulation", "label": "Both levels are offered to change regulation", "role": "claim", "detail": "Level 1 tools and Level 2 deeper work both target the proposed response, with the toolkit continuing during Level 2. Specific mechanisms, efficacy and dose-response remain unresolved.", "sources": [ "P2", "P3", "P6" ], "points": [ [ 1125, 170 ], [ 1125, 220 ], [ 610, 220 ], [ 610, 315 ], [ 500, 315 ], [ 500, 350 ] ], "badge": [ 710, 220 ], "check": "practice", "legacyEdgeId": "primal-trust-e4" }, { "id": "frame-daily", "from": "framework", "to": "daily", "label": "Apply the principles throughout life", "role": "guidance", "detail": "The FAQ and later lessons ask about pacing, self-care, boundaries, relationships and enjoyable activity beyond formal exercises.", "sources": [ "P5", "P7" ], "points": [ [ 400, 170 ], [ 400, 200 ], [ 330, 200 ], [ 330, 565 ], [ 445, 565 ], [ 445, 620 ] ], "badge": [ 330, 520 ] }, { "id": "daily-reg", "from": "daily", "to": "regulation", "label": "Daily responses are said to affect regulation", "role": "claim", "detail": "The course argues that how one lives between exercises can support or impede regulation. This broader formulation does not quantify effects or identify the cause of nonresponse.", "sources": [ "P5", "P7" ], "points": [ [ 395, 620 ], [ 395, 440 ] ], "badge": [ 395, 530 ], "check": "practice" }, { "id": "experience-observe", "from": "experience", "to": "monitor", "label": "Experience can become an object of attention", "role": "acknowledged", "detail": "Symptoms are among the experiences noticed or checked. Whether someone attends, avoids, accepts or records them is another process.", "sources": [ "P2", "P4" ], "points": [ [ 910, 395 ], [ 1015, 395 ] ], "badge": [ 962, 395 ] }, { "id": "observe-record", "from": "monitor", "to": "record", "label": "Observation produces reports and reflections", "role": "guidance", "detail": "The monthly checklist and broader reflection create information about physical symptoms and behavior. These are selected observations, not direct access to the entire physiological state.", "sources": [ "P4", "P5" ], "points": [ [ 1125, 440 ], [ 1125, 620 ] ], "badge": [ 1125, 530 ] }, { "id": "record-choice", "from": "record", "to": "choice", "label": "Review informs what to keep, change or pursue", "role": "guidance", "detail": "Progress reflection and tool adaptation are both documented. Their connection here is a synthesis; no validated score-to-action rule was found. Monthly review and later commitment reassessment have different purposes.", "sources": [ "P4", "P5" ], "points": [ [ 1235, 665 ], [ 1270, 665 ], [ 1270, 195 ], [ 840, 195 ], [ 840, 170 ] ], "badge": [ 1270, 465 ] }, { "id": "observe-response", "from": "monitor", "to": "appraisal", "label": "The way of attending can change the response", "role": "claim", "detail": "The course distinguishes fearful checking from bodily presencing and other attention practices. These can change the relationship to experience; the direction, magnitude and disease implications are not established by one general attention rule.", "sources": [ "P2", "P5" ], "points": [ [ 1015, 420 ], [ 985, 420 ], [ 985, 665 ], [ 910, 665 ] ], "badge": [ 985, 555 ], "check": "attention" }, { "id": "course-observe", "from": "course", "to": "monitor", "label": "Teaching introduces observation practices", "role": "guidance", "detail": "The early checklist establishes baseline and monthly review; later attention instructions add or modify how experience is observed. Monitoring is introduced into the participant’s behavior, not installed outside the system.", "sources": [ "P2", "P4" ], "points": [ [ 150, 170 ], [ 150, 280 ], [ 995, 280 ], [ 995, 365 ], [ 1015, 365 ] ], "badge": [ 850, 280 ] }, { "id": "progress", "from": "choice", "to": "course", "label": "Continue, revisit or enter a further stage", "role": "guidance", "detail": "Self-paced module progression, optional deeper work, continued Level 1 practice and participation outside membership are available routes. Familiarity, readiness and choice replace an invented symptom-only gate.", "sources": [ "P4", "P5", "P6" ], "points": [ [ 800, 80 ], [ 800, 35 ], [ 150, 35 ], [ 150, 80 ] ], "badge": [ 475, 35 ], "legacyEdgeId": "primal-trust-e8" }, { "id": "daily-record", "from": "daily", "to": "record", "label": "Notice participation and behavior changes", "role": "guidance", "detail": "Later guidance explicitly considers changes in behavior, relationships and daily life rather than evaluating progress solely through symptoms.", "sources": [ "P5" ], "points": [ [ 550, 710 ], [ 550, 755 ], [ 1090, 755 ], [ 1090, 710 ] ], "badge": [ 820, 755 ] }, { "id": "response-record", "from": "appraisal", "to": "record", "label": "Include thoughts and emotional reactions", "role": "guidance", "detail": "The later FAQ asks whether thoughts, behavior and emotional reactions have changed. Recording them is distinct from proving why they changed.", "sources": [ "P5" ], "points": [ [ 910, 690 ], [ 1015, 690 ] ], "badge": [ 962, 690 ] }, { "id": "care-body", "from": "care", "to": "body", "label": "Bodily treatment can continue", "role": "acknowledged", "detail": "The FAQ says the program does not replace medical treatment and discusses concurrent support. This arrow retains an acknowledged input, not a claim of efficacy for every medical or supplementary treatment.", "sources": [ "P7" ], "points": [ [ 125, 620 ], [ 125, 440 ] ], "badge": [ 125, 530 ] }, { "id": "body-experience", "from": "body", "to": "experience", "label": "Bodily illness remains a possible contribution", "role": "acknowledged", "detail": "The course acknowledges illness and uncertainty about causal order. Keeping a direct bodily contribution open is our explicit reconstruction of that qualification, not a measured path coefficient or an exhaustive provider model.", "sources": [ "P7" ], "points": [ [ 260, 370 ], [ 295, 370 ], [ 295, 310 ], [ 800, 310 ], [ 800, 350 ] ], "badge": [ 670, 310 ], "check": "origin" }, { "id": "record-frame", "from": "record", "to": "framework", "label": "Gains can reinforce the explanation", "role": "claim", "detail": "The later FAQ interprets changes in behavior, thoughts and emotions as neural shifts and encourages continued practice. This closes an interpretation-and-commitment loop; those observations do not independently prove neural rewiring.", "sources": [ "P5" ], "points": [ [ 1190, 710 ], [ 1190, 800 ], [ 605, 800 ], [ 605, 295 ], [ 450, 295 ], [ 450, 170 ] ], "badge": [ 605, 735 ] }, { "id": "practice-response", "from": "practice", "to": "appraisal", "label": "Practice changes the response being rehearsed", "role": "guidance", "detail": "ABC, bodily attention and parts work involve actively practicing a different relationship or response to experience. Performing the activity is distinct from showing a lasting benefit.", "sources": [ "P2", "P3" ], "points": [ [ 1015, 150 ], [ 975, 150 ], [ 975, 590 ], [ 885, 590 ], [ 885, 620 ] ], "badge": [ 975, 205 ] } ], "loops": [ { "id": "adaptation", "label": "Practice and adjustment", "description": "Choices lead to practice, a proposed change in regulation and symptoms, then observation and review feed back into choices. The loop is closed; its gains and decision rule are not known.", "edgeIds": [ "choice-use", "practice-reg", "reg-symptom", "experience-observe", "observe-record", "record-choice" ] }, { "id": "illness", "label": "Illness and regulation", "description": "The course acknowledges both directions. Ongoing bodily contribution remains visible rather than being assumed to have ended.", "edgeIds": [ "body-reg", "reg-body" ] }, { "id": "attention", "label": "Attention and reaction", "description": "Observation can change the response to the experience being observed. Different stances may act differently; this is not an all-checking-is-harmful rule.", "edgeIds": [ "reg-symptom", "experience-observe", "observe-response", "response-reg" ] }, { "id": "progression", "label": "Learning and progression", "description": "Course material changes understanding and skills, which inform choices about practice and further learning. Stages change the repertoire within the larger system.", "edgeIds": [ "teaching", "frame-choice", "progress" ] }, { "id": "interpretation", "label": "Experience and conviction", "description": "Practice produces experiences and reports; interpreting them through the taught explanation can reinforce commitment. This loop needs a way for evidence to change the explanation too.", "edgeIds": [ "frame-choice", "choice-use", "practice-reg", "reg-symptom", "experience-observe", "observe-record", "record-frame" ] }, { "id": "daily", "label": "Daily-life changes", "description": "The proposed change includes activity, rest and relationships. These are both actions in the system and things a person may value or monitor.", "edgeIds": [ "frame-daily", "daily-reg", "reg-symptom", "symptom-response", "response-record", "record-frame" ] } ], "scope": "A reconstruction of captured course statements and guidance. It shows coupled processes, not a validated causal model. Some connections join statements from different lessons; inspect each link for that boundary.", "legacy": { "primal-trust-e1": "body-reg", "primal-trust-e2": "reg-symptom", "primal-trust-e3": "response-reg", "primal-trust-e4": "practice-reg", "primal-trust-e5": "practice-reg", "primal-trust-e6": "practice-reg", "primal-trust-e7": "record-frame", "primal-trust-e8": "progress" }, "legacyNodes": { "n0": "body", "n1": "regulation", "n2": "experience", "n3": "practice", "n4": "practice", "n5": "daily", "changed": "regulation" }, "legacyPractice": { "learn": "course", "practice": "practice", "review": "record", "adapt": "choice", "deeper": "course", "life": "daily", "reassess": "choice" } }, { "id": "research-coupled", "title": "Illness, experience and intervention", "width": 1300, "height": 1120, "nodes": [ { "id": "course", "label": "Protocol stage and available actions", "kind": "course", "summary": "Discrete course or protocol states change what is offered; acquiring skills or accepting an explanation is a separate outcome.", "details": [ "Hybrid means stages change discretely while other states evolve. Module progression is not treated as biological recovery.", "Instantiate one audited program’s actual rules; preserve optionality and missing exit criteria." ], "sources": [ "P4", "P5", "P6" ], "x": 40, "y": 80 }, { "id": "framework", "label": "Explicit beliefs and skills", "kind": "learning", "summary": "Propositional beliefs, expectations and learned practical skills are separate variables within this block.", "details": [ "A coherent explanation may change interpretation, commitment and choices. Those effects should be measured rather than presumed beneficial.", "Skill acquisition, confidence in a theory and disease change are distinct.", "Reports and feedback can change belief; practice may build skills. Instruction, measured competence and explanatory commitment must not be conflated." ], "sources": [ "P5" ], "x": 365, "y": 80 }, { "id": "choice", "label": "Choices within real constraints", "kind": "decision", "summary": "A descriptive decision policy generates intended actions from available observations, goals, support and constraints.", "details": [ "The policy is endogenous: illness and prior outcomes influence practice, care and monitoring.", "It is not an optimal controller, a treatment recommendation or proof that people control disease. Actual action may differ from intention.", "Choices include monitoring, everyday activity and seeking or continuing care. Felt experience and resource constraints can affect choices before any formal report exists." ], "sources": [], "x": 690, "y": 80 }, { "id": "practice", "label": "Actual practices and exposure", "kind": "action", "summary": "Specify action, dose, timing and delivery, including relational and explanatory components.", "details": [ "Breathing, attending, reappraising, movement, support and a device are different interventions. Their pathways cannot be substituted for one another.", "Record actual use, adherence, burden and concurrent care separately from enrollment or instruction.", "The RA papers test assigned packages or devices and their scoped outcomes. Their presence here does not establish this graph’s regulation or learning mediators, nor an actual-dose effect." ], "sources": [ "SYS6", "SYS7" ], "x": 1015, "y": 80 }, { "id": "body", "label": "Pathology and tissue state", "kind": "physiology", "summary": "Condition-specific states may include inflammation, tissue injury, infection burden or metabolic constraint.", "details": [ "This is a vector chosen for a condition, not one hidden pathology score. A pathogen state is included only where specified and measured appropriately.", "Pathology can persist while symptom appraisal changes. Sustained inputs are represented separately below." ], "sources": [ "SYS2", "SYS3", "SYS5" ], "x": 40, "y": 350 }, { "id": "regulation", "label": "Regulatory physiology", "kind": "proposed process", "summary": "Autonomic, cardiovascular, endocrine or immune regulation must be specified as measurable processes.", "details": [ "Do not reduce all regulation to a scalar safety level. Coupling, gain and recovery rates can be distinct parameters.", "Network coordination is evidence about relationships between signals; directional causal couplings require more than correlation." ], "sources": [ "SYS1", "SYS2", "SYS3", "SYS7" ], "x": 365, "y": 350 }, { "id": "experience", "label": "Symptoms and felt experience", "kind": "experience", "summary": "An experienced symptom is generated by bodily, regulatory, learned and contextual processes to be tested.", "details": [ "Experience is distinct from an intentional observation and from a report on a questionnaire.", "A change in unpleasantness, intensity or interpretation need not mean the same biological change." ], "sources": [ "SYS2", "SYS5", "SYS6" ], "x": 690, "y": 350 }, { "id": "monitor", "label": "Observation action and attention", "kind": "observation action", "summary": "What is sampled, when, how often, with which stance and what action follows are part of the intervention.", "details": [ "Monitoring can supply information and may alter attention, reassurance seeking, burden or appraisal. The direction is not assumed.", "The seven-paper set does not directly estimate this reactivity. Program sources identify behaviors; prior attention/checking studies supply narrower leads." ], "sources": [ "P2", "P4", "E1", "E4" ], "x": 1015, "y": 350 }, { "id": "care", "label": "Concurrent care and support", "kind": "care", "summary": "Actual medical treatment, support and its access are inputs to the system.", "details": [ "Care can affect bodily processes and the person’s options. Its effects are intervention- and condition-specific.", "Do not infer that better self-regulation makes indicated care unnecessary." ], "sources": [ "SYS6", "SYS7" ], "x": 40, "y": 620 }, { "id": "daily", "label": "Activity, rest and exposure", "kind": "behavior", "summary": "Actual behavior changes inputs to the system. Performed activity is distinct from functional capacity and valued participation.", "details": [ "Specify exertion, rest, sleep and social activity separately, including dose and delayed consequences.", "The separate function node records what someone can do and participate in; more activity alone does not establish more capacity or better health." ], "sources": [ "SYS5", "SYS6" ], "x": 365, "y": 620 }, { "id": "appraisal", "label": "Appraisal, emotion and response", "kind": "response", "summary": "Fast attention, interpretation and affect can influence experience, actions and potentially specified physiological responses.", "details": [ "These variables are not interchangeable with learned dispositions, explicit beliefs or immune memory.", "Distinguish effects on distress and choice from effects on a biological disease measure." ], "sources": [ "SYS4", "SYS6", "E4" ], "x": 690, "y": 620 }, { "id": "record", "label": "Reports, assays and outcomes", "kind": "information", "summary": "Measurement produces separate records of symptoms, function, disease activity and burden.", "details": [ "Each measure has its own observation function, error, timing, missingness and possible reporting shifts.", "A symptom diary is not a direct assay of immune activity; a wearable is not an assay of belief. Joint improvement does not alone identify mediation.", "Readout edges connect the relevant experience or physiological variable to its measurement. Monitoring determines sampling and reporting conditions; it does not supply all measured content.", "Record collection time and result-return time separately. Only information returned to the participant can guide the next choice. Missing observations are not zero symptoms or zero disease." ], "sources": [ "SYS1", "SYS5", "SYS6", "SYS7" ], "x": 1015, "y": 620 }, { "id": "inputs", "label": "Ongoing inputs and context", "kind": "input", "x": 40, "y": 925, "summary": "External exposure, changing context and historical constraints remain explicit.", "details": [ "Examples must be defined by the study: environmental exposure, treatment availability, sleep context or a measured infectious input.", "A triggering event does not automatically disappear after symptom onset. A latent pathogen burden and incoming exposure are different quantities." ], "sources": [ "SYS2", "SYS3", "SYS5" ] }, { "id": "learning", "label": "Learned dispositions", "kind": "slow state", "x": 690, "y": 925, "summary": "Acquired response tendencies can evolve on a different timescale from a momentary reaction.", "details": [ "Specify cue associations, anticipation or response habits with a defined task; sensitization need not be learned and requires its own operational definition.", "Queirazza supplies an acute inflammatory-input-to-neural-task finding, not a detected durable change in behavioral learning parameters or a retraining treatment effect." ], "sources": [ "SYS4", "E3" ] }, { "id": "burden", "x": 365, "y": 925, "label": "Burden and resources", "kind": "burden", "summary": "Time, fatigue, cost, emotional load and available support can change with practice, care and monitoring.", "details": [ "This is a vector, not one total score. A diary or practice may be useful while also requiring effort; direction and magnitude must be measured.", "Burden and resources can change actual participation, missingness and decisions to continue, pause or leave. Do not analyze only completers as if that selection were random." ], "sources": [] }, { "id": "function", "x": 1015, "y": 925, "label": "Capacity and participation", "kind": "outcome", "summary": "What the person can do and participate in is distinct from symptom intensity, activity dose and disease activity.", "details": [ "Measure capacity and valued participation with their opportunity and support context. More activity can coexist with delayed functional loss.", "Function can constrain the dose someone actually performs and the options they consider. It is not a universal graduation threshold." ], "sources": [ "SYS5" ] } ], "edges": [ { "id": "body-reg", "from": "body", "to": "regulation", "label": "Bodily state can affect regulation", "role": "hypothesis", "detail": "Inflammatory challenges constrain selected physiological responses. Extension to a chronic condition needs its own states, inputs, measurements and validation.", "sources": [ "SYS2", "SYS3", "SYS5" ], "points": [ [ 260, 395 ], [ 365, 395 ] ], "badge": [ 296, 395 ] }, { "id": "reg-body", "from": "regulation", "to": "body", "label": "Regulation can affect specified bodily processes", "role": "hypothesis", "detail": "A neural device has a scoped clinical effect in active RA. This does not establish that voluntary calming produces the same immune effect or that the proposed mediator is identified.", "sources": [ "SYS7", "SYS2" ], "points": [ [ 365, 420 ], [ 310, 420 ], [ 310, 470 ], [ 180, 470 ], [ 180, 440 ] ], "badge": [ 254, 470 ] }, { "id": "reg-symptom", "from": "regulation", "to": "experience", "label": "Regulatory state can contribute to experience", "role": "hypothesis", "detail": "Model selected physiological contributions with condition-specific scope. Relative contribution is not known from a symptom report alone.", "sources": [ "SYS2" ], "points": [ [ 585, 395 ], [ 690, 395 ] ], "badge": [ 638, 395 ] }, { "id": "symptom-response", "from": "experience", "to": "appraisal", "label": "Experience can shape appraisal and emotion", "role": "hypothesis", "detail": "Proposed experiential dependency. Distinguish this direction from reverse and common-cause effects. The RA mindfulness trial does not isolate this link.", "sources": [], "points": [ [ 800, 440 ], [ 800, 620 ] ], "badge": [ 800, 521 ] }, { "id": "response-reg", "from": "appraisal", "to": "regulation", "label": "Responses may affect physiology", "role": "hypothesis", "detail": "A candidate coupling to be specified and tested. Not every emotion or attention pattern has the same physiological effect, and none of the seven papers supplies a universal gain.", "sources": [ "E4" ], "points": [ [ 690, 665 ], [ 635, 665 ], [ 635, 495 ], [ 535, 495 ], [ 535, 440 ] ], "badge": [ 574, 495 ] }, { "id": "teaching", "from": "course", "to": "framework", "label": "Instruction may change beliefs and skills", "role": "hypothesis", "detail": "Instructional exposure is documented by course sources; changes in belief and competence are proposed learning outcomes that require their own measurements. Stage progression does not guarantee either outcome.", "sources": [ "P4", "P5" ], "points": [ [ 260, 125 ], [ 365, 125 ] ], "badge": [ 312, 125 ] }, { "id": "frame-response", "from": "framework", "to": "appraisal", "label": "Beliefs and skills influence response", "role": "hypothesis", "detail": "This is a candidate behavioral pathway, not proof that a mechanism story is required for benefit.", "sources": [ "P2", "P5" ], "points": [ [ 475, 170 ], [ 475, 255 ], [ 955, 255 ], [ 955, 565 ], [ 845, 565 ], [ 845, 620 ] ], "badge": [ 955, 515 ] }, { "id": "frame-choice", "from": "framework", "to": "choice", "label": "Understanding informs choices", "role": "hypothesis", "detail": "Measure endorsed explanations separately from practice fidelity and choice. People may use a practice without accepting its full theory.", "sources": [ "P5" ], "points": [ [ 585, 125 ], [ 690, 125 ] ], "badge": [ 638, 125 ] }, { "id": "choice-use", "from": "choice", "to": "practice", "label": "Intended choices shape actual exposure", "role": "hypothesis", "detail": "Operational delivery dependency: intentions are translated into actual exposure under capacity, access, burden and adherence constraints. Assignment and received dose are not equivalent; no optimal policy is assumed.", "sources": [], "points": [ [ 910, 125 ], [ 1015, 125 ] ], "badge": [ 976, 125 ] }, { "id": "practice-reg", "from": "practice", "to": "regulation", "label": "Practice may change specified regulation", "role": "hypothesis", "detail": "Candidate biological input pathway, not a mechanism established by the RA package or device trials. Those trials test scoped assignment-to-outcome effects, not a common regulation mediator or a breathing/retraining coefficient.", "sources": [], "points": [ [ 1125, 170 ], [ 1125, 220 ], [ 610, 220 ], [ 610, 315 ], [ 500, 315 ], [ 500, 350 ] ], "badge": [ 764, 220 ] }, { "id": "frame-daily", "from": "framework", "to": "daily", "label": "Learning can change everyday behavior", "role": "hypothesis", "detail": "Proposed behavioral pathway with the course as an example of instruction. Measure actual change; the seven studies do not establish explanatory framing as the active ingredient.", "sources": [ "P5" ], "points": [ [ 400, 170 ], [ 400, 200 ], [ 330, 200 ], [ 330, 565 ], [ 445, 565 ], [ 445, 620 ] ], "badge": [ 445, 591 ] }, { "id": "daily-reg", "from": "daily", "to": "regulation", "label": "Daily activity and rest affect state", "role": "hypothesis", "detail": "Specify the action and delay. Post-exertional findings justify retaining delayed physiological constraints, not a universal direction for movement.", "sources": [ "SYS5" ], "points": [ [ 395, 620 ], [ 395, 440 ] ], "badge": [ 395, 519 ] }, { "id": "experience-observe", "from": "experience", "to": "monitor", "label": "Experience can influence observation behavior", "role": "hypothesis", "detail": "Endogenous measurement: people may check more when symptoms change. This complicates simple associations between checking and symptoms.", "sources": [ "P2", "P4" ], "points": [ [ 910, 395 ], [ 1015, 395 ] ], "badge": [ 941, 395 ] }, { "id": "observe-record", "from": "monitor", "to": "record", "label": "Sampling and reporting shape the record", "role": "hypothesis", "detail": "Observation operator: the record depends on the sampled state or experience, timing, instrument and reporting conditions. This is not itself a biological intervention effect. Model observation error, result delays and informative missingness.", "sources": [ "P4", "SYS1", "SYS6" ], "points": [ [ 1125, 440 ], [ 1125, 620 ] ], "badge": [ 1125, 481 ] }, { "id": "record-choice", "from": "record", "to": "choice", "label": "Available records inform subsequent choices", "role": "hypothesis", "detail": "Operational information dependency: only temporally prior results returned to the participant can inform a subsequent choice. A participant does not directly observe latent physiology; records need not be accepted or used optimally.", "sources": [ "P5" ], "points": [ [ 1235, 665 ], [ 1270, 665 ], [ 1270, 195 ], [ 840, 195 ], [ 840, 170 ] ], "badge": [ 1270, 465 ] }, { "id": "observe-response", "from": "monitor", "to": "appraisal", "label": "Monitoring may change the observed process", "role": "hypothesis", "detail": "Observation reactivity is a hypothesis requiring a matched comparison of purpose, timing and stance. Laboratory checking/acceptance findings do not estimate chronic disease effects.", "sources": [ "E1", "E4" ], "points": [ [ 1015, 420 ], [ 985, 420 ], [ 985, 665 ], [ 910, 665 ] ], "badge": [ 985, 601 ] }, { "id": "course-observe", "from": "course", "to": "monitor", "label": "Protocol changes the observation policy", "role": "hypothesis", "detail": "Record when monitoring, symptom attention, reporting cadence or interpretation instructions are introduced. They are active components, not neutral metadata.", "sources": [ "P4" ], "points": [ [ 150, 170 ], [ 150, 280 ], [ 995, 280 ], [ 995, 365 ], [ 1015, 365 ] ], "badge": [ 856, 280 ] }, { "id": "progress", "from": "choice", "to": "course", "label": "Decisions change the protocol stage", "role": "hypothesis", "detail": "Operational stage transition: choices can revisit, add, pause or leave content under access and completion rules. Stage changes alter offers, not biology by definition. Symptom reduction is neither the only gate nor an established readiness criterion.", "sources": [ "P4", "P5", "P6" ], "points": [ [ 800, 80 ], [ 800, 35 ], [ 150, 35 ], [ 150, 80 ] ], "badge": [ 475, 35 ] }, { "id": "daily-record", "from": "daily", "to": "record", "label": "Actual activity is recorded", "role": "hypothesis", "detail": "Observation dependency: record activity, rest and exposure doses with timestamps. They are inputs as well as behaviors; the separate capacity/participation and burden nodes have their own readouts.", "sources": [ "SYS5", "SYS6" ], "points": [ [ 550, 710 ], [ 550, 755 ], [ 1090, 755 ], [ 1090, 710 ] ], "badge": [ 820, 755 ] }, { "id": "response-record", "from": "appraisal", "to": "record", "label": "Emotion and responses can be reported", "role": "hypothesis", "detail": "Self-report can measure experience without identifying a neural or immune mechanism.", "sources": [ "P5", "SYS6" ], "points": [ [ 910, 690 ], [ 1015, 690 ] ], "badge": [ 971, 690 ] }, { "id": "care-body", "from": "care", "to": "body", "label": "Condition-specific care can affect pathology", "role": "hypothesis", "detail": "Candidate condition-specific treatment pathway. The two RA trials retained usual care, which motivates recording this input but does not randomize or estimate the effect of every concurrent treatment. Specify treatment, target, dose and comparator.", "sources": [ "SYS6", "SYS7" ], "points": [ [ 125, 620 ], [ 125, 440 ] ], "badge": [ 125, 530 ] }, { "id": "body-experience", "from": "body", "to": "experience", "label": "Pathology can directly contribute to symptoms", "role": "hypothesis", "detail": "Keep a bodily route even when learning or appraisal is modeled. Direct means not mediated by the other displayed block, not absence of biological transduction.", "sources": [ "SYS2", "SYS5" ], "points": [ [ 260, 370 ], [ 295, 370 ], [ 295, 310 ], [ 800, 310 ], [ 800, 350 ] ], "badge": [ 670, 310 ] }, { "id": "record-frame", "from": "record", "to": "framework", "label": "Outcomes can update or entrench a model", "role": "hypothesis", "detail": "Study whether adverse or null outcomes change the explanation or are assimilated as hidden resistance. The revised model allows either direction; it does not assume rational updating.", "sources": [ "P5" ], "points": [ [ 1190, 710 ], [ 1190, 800 ], [ 605, 800 ], [ 605, 295 ], [ 450, 295 ], [ 450, 170 ] ], "badge": [ 694, 800 ] }, { "id": "practice-response", "from": "practice", "to": "appraisal", "label": "Practice may change attention or response", "role": "hypothesis", "detail": "Instructional characterization supplies what is rehearsed; actual change and durability require measurement. The course source does not establish efficacy, and a multicomponent trial does not isolate this mediator.", "sources": [ "P2" ], "points": [ [ 1015, 150 ], [ 975, 150 ], [ 975, 590 ], [ 885, 590 ], [ 885, 620 ] ], "badge": [ 975, 176 ] }, { "id": "input-body", "from": "inputs", "to": "body", "label": "Inputs can remain active", "role": "hypothesis", "detail": "A sustained exposure or pathological input is not assumed absent. Chronic infection scenarios in the modeled sources remain extrapolations.", "sources": [ "SYS2", "SYS3" ], "points": [ [ 80, 925 ], [ 80, 880 ], [ 15, 880 ], [ 15, 395 ], [ 40, 395 ] ], "badge": [ 44, 880 ] }, { "id": "activity-body", "from": "daily", "to": "body", "label": "Behavior may have delayed bodily effects", "role": "hypothesis", "detail": "Specify exertion and physiological consequences condition by condition. Retain delay and possible harm rather than assuming an immediate symptom-free response implies safety.", "sources": [ "SYS5" ], "points": [ [ 365, 690 ], [ 300, 690 ], [ 300, 515 ], [ 235, 515 ], [ 235, 440 ] ], "badge": [ 300, 575 ] }, { "id": "practice-learning", "from": "practice", "to": "learning", "label": "Repeated experience can alter dispositions", "role": "hypothesis", "detail": "Candidate learning pathway. Experimental pain contingencies provide a bounded lead; the seven-source set supplies no retraining gain or timescale. Queirazza did not test practice-induced learning and is not used as support for this direction.", "sources": [ "E3" ], "points": [ [ 1210, 170 ], [ 1210, 245 ], [ 1250, 245 ], [ 1250, 1040 ], [ 845, 1040 ], [ 845, 1015 ] ], "badge": [ 1224, 1040 ] }, { "id": "learning-response", "from": "learning", "to": "appraisal", "label": "History shapes current response", "role": "hypothesis", "detail": "Candidate effect of a learned disposition on a current response; measure its contribution and reversibility. Experimental pain learning is a bounded lead, not a broad chronic-illness estimate.", "sources": [ "E3" ], "points": [ [ 765, 925 ], [ 765, 710 ] ], "badge": [ 765, 779 ] }, { "id": "response-learning", "from": "appraisal", "to": "learning", "label": "Responses and consequences may update learning", "role": "hypothesis", "detail": "Candidate learning update from temporally prior responses and consequences. This is not endorsing an explanation or altering immune memory, and the inflammatory-challenge paper did not test this reverse direction.", "sources": [ "E3" ], "points": [ [ 875, 710 ], [ 875, 925 ] ], "badge": [ 875, 776 ] }, { "id": "learning-experience", "from": "learning", "to": "experience", "label": "Learned dispositions may affect symptoms", "role": "hypothesis", "detail": "A candidate symptom-generation route, with experimental pain leads but no validated broad chronic-illness contribution.", "sources": [ "E3" ], "points": [ [ 690, 970 ], [ 650, 970 ], [ 650, 835 ], [ 930, 835 ], [ 930, 335 ], [ 850, 335 ], [ 850, 350 ] ], "badge": [ 650, 905 ] }, { "id": "body-record", "from": "body", "to": "record", "label": "Assays sample specified bodily variables", "role": "hypothesis", "detail": "Readout dependency, not an intervention effect. An assay or clinical examination measures a defined quantity with error; it does not reveal the entire latent pathology vector.", "sources": [ "SYS3", "SYS5", "SYS7" ], "points": [ [ 260, 415 ], [ 285, 415 ], [ 285, 555 ], [ 1055, 555 ], [ 1055, 620 ] ], "badge": [ 616, 555 ] }, { "id": "reg-record", "from": "regulation", "to": "record", "label": "Physiological signals enter the record", "role": "hypothesis", "detail": "Readout dependency. Sensors measure specified signals, with sampling conditions and error; cross-signal coordination does not identify directional causation or a scalar safety state.", "sources": [ "SYS1", "SYS2", "SYS3" ], "points": [ [ 585, 420 ], [ 625, 420 ], [ 625, 575 ], [ 1090, 575 ], [ 1090, 620 ] ], "badge": [ 776, 575 ] }, { "id": "experience-record", "from": "experience", "to": "record", "label": "Experience contributes to symptom reports", "role": "hypothesis", "detail": "Readout dependency. A report depends on experienced symptoms as well as wording, recall and response conventions. Reports can convey meaningful benefit or harm without identifying disease mechanisms.", "sources": [ "SYS5", "SYS6" ], "points": [ [ 870, 440 ], [ 870, 505 ], [ 1140, 505 ], [ 1140, 620 ] ], "badge": [ 1030, 505 ] }, { "id": "frame-record", "from": "framework", "to": "record", "label": "Concepts may alter reporting conventions", "role": "hypothesis", "detail": "Candidate observation-model dependency: learned language, confidence and interpretation may change how an experience is described. This is analytically distinct from changing the experience; the seven papers do not isolate this reporting effect.", "sources": [], "points": [ [ 565, 170 ], [ 565, 265 ], [ 965, 265 ], [ 965, 585 ], [ 1185, 585 ], [ 1185, 620 ] ], "badge": [ 965, 326 ] }, { "id": "choice-monitor", "from": "choice", "to": "monitor", "label": "Choose whether and how to monitor", "role": "hypothesis", "detail": "Operational observation policy. Purpose, timing, modality and feedback can be selected endogenously or scheduled by a protocol. Monitoring is one of the actions, not an instrument outside the system.", "sources": [], "points": [ [ 910, 140 ], [ 960, 140 ], [ 960, 315 ], [ 1060, 315 ], [ 1060, 350 ] ], "badge": [ 1021, 315 ] }, { "id": "choice-care", "from": "choice", "to": "care", "label": "Seek, continue or change care", "role": "hypothesis", "detail": "Operational care-choice dependency under clinical advice, access and resources. This graph does not authorize treatment changes or imply that all care decisions are voluntary.", "sources": [], "points": [ [ 740, 170 ], [ 740, 245 ], [ 20, 245 ], [ 20, 665 ], [ 40, 665 ] ], "badge": [ 197.5, 245 ] }, { "id": "choice-daily", "from": "choice", "to": "daily", "label": "Choose activity, rest and exposure", "role": "hypothesis", "detail": "Operational action policy constrained by illness, opportunity and support. Record what was actually done; choosing an activity does not establish that its dose is safe.", "sources": [], "points": [ [ 710, 170 ], [ 710, 225 ], [ 600, 225 ], [ 600, 580 ], [ 525, 580 ], [ 525, 620 ] ], "badge": [ 574, 580 ] }, { "id": "experience-choice", "from": "experience", "to": "choice", "label": "Felt symptoms can guide choices", "role": "hypothesis", "detail": "Operational dependence on internal experience. A person can act on sensations without first creating a formal record; neither the person nor the analyst thereby knows their complete cause.", "sources": [], "points": [ [ 820, 350 ], [ 820, 170 ] ], "badge": [ 820, 304 ] }, { "id": "input-choice", "from": "inputs", "to": "choice", "label": "Context constrains available choices", "role": "hypothesis", "detail": "Operational context dependency: support, care access, environment and other constraints affect options. Do not treat action-dependent contexts as exogenous merely for modeling convenience.", "sources": [], "points": [ [ 260, 950 ], [ 275, 950 ], [ 275, 210 ], [ 755, 210 ], [ 755, 170 ] ], "badge": [ 275, 324 ] }, { "id": "course-repertoire", "from": "course", "to": "practice", "label": "Stage changes the offered repertoire", "role": "hypothesis", "detail": "Instructional availability dependency, not an efficacy arrow. Stage determines what is offered; choice, ability and delivery determine what is done. Earlier tools can remain available after progression or membership exit.", "sources": [ "P4", "P5", "P6" ], "points": [ [ 170, 80 ], [ 170, 55 ], [ 1125, 55 ], [ 1125, 80 ] ], "badge": [ 646, 55 ] }, { "id": "practice-skills", "from": "practice", "to": "framework", "label": "Practice may develop usable skills", "role": "hypothesis", "detail": "Candidate skill-acquisition dependency. Measure competence separately from attendance, belief in the explanation, or health improvement; do not assume every exposure creates skill.", "sources": [], "points": [ [ 1060, 170 ], [ 1060, 205 ], [ 550, 205 ], [ 550, 170 ] ], "badge": [ 805, 205 ] }, { "id": "practice-burden", "from": "practice", "to": "burden", "label": "Participation changes costs and resources", "role": "hypothesis", "detail": "Candidate burden pathway: time, fatigue, cost, support and emotional consequences can change with participation. Benefit and burden may coexist; neither sign nor magnitude is preset.", "sources": [], "points": [ [ 1235, 150 ], [ 1275, 150 ], [ 1275, 865 ], [ 525, 865 ], [ 525, 925 ] ], "badge": [ 1229, 865 ] }, { "id": "monitor-burden", "from": "monitor", "to": "burden", "label": "Monitoring has effort and other consequences", "role": "hypothesis", "detail": "Candidate measurement-reactivity pathway. Track effort, attention, anxiety or reassurance and data usefulness separately. No assumption that more monitoring always harms or helps.", "sources": [], "points": [ [ 1235, 420 ], [ 1245, 420 ], [ 1245, 825 ], [ 485, 825 ], [ 485, 925 ] ], "badge": [ 1154, 825 ] }, { "id": "daily-burden", "from": "daily", "to": "burden", "label": "Daily load can change burden", "role": "hypothesis", "detail": "Candidate consequence of actual activity, rest and exposure. Specify delayed fatigue, recovery, participation costs and support rather than infer them from immediate symptoms.", "sources": [ "SYS5" ], "points": [ [ 450, 710 ], [ 450, 925 ] ], "badge": [ 450, 817.5 ] }, { "id": "care-burden", "from": "care", "to": "burden", "label": "Care has costs, access needs and support", "role": "hypothesis", "detail": "Candidate care-burden dependency. Record treatment burden and support separately from efficacy. The mere existence of a treatment or trial does not set their direction.", "sources": [], "points": [ [ 260, 690 ], [ 285, 690 ], [ 285, 890 ], [ 405, 890 ], [ 405, 925 ] ], "badge": [ 366, 890 ] }, { "id": "burden-record", "from": "burden", "to": "record", "label": "Burden is measured separately", "role": "hypothesis", "detail": "Readout dependency. Keep time, fatigue, financial cost, emotional load and displaced care distinguishable; adverse burden is not inferred only from symptom scores.", "sources": [], "points": [ [ 585, 950 ], [ 620, 950 ], [ 620, 880 ], [ 1180, 880 ], [ 1180, 710 ] ], "badge": [ 901, 880 ] }, { "id": "burden-choice", "from": "burden", "to": "choice", "label": "Resources and burden affect continuation", "role": "hypothesis", "detail": "Operational feedback: capacity, access and burden influence participation, monitoring and pausing or leaving. Missingness and completion can therefore select participants on treatment and illness consequences.", "sources": [], "points": [ [ 365, 950 ], [ 320, 950 ], [ 320, 260 ], [ 785, 260 ], [ 785, 170 ] ], "badge": [ 320, 350 ] }, { "id": "body-function", "from": "body", "to": "function", "label": "Bodily constraints can affect function", "role": "hypothesis", "detail": "Candidate condition-specific capacity pathway. Tissue and metabolic findings motivate measuring bodily constraints; they do not supply a universal function equation or prove every impairment mechanism.", "sources": [ "SYS5" ], "points": [ [ 160, 440 ], [ 160, 545 ], [ 945, 545 ], [ 945, 895 ], [ 1055, 895 ], [ 1055, 925 ] ], "badge": [ 745, 545 ] }, { "id": "experience-function", "from": "experience", "to": "function", "label": "Symptoms can constrain participation", "role": "hypothesis", "detail": "Candidate experiential-to-function relationship, distinct from symptom reporting. Opportunity, support, priorities and disease constraints also matter; this is not a fixed conversion from symptom intensity to ability.", "sources": [], "points": [ [ 900, 440 ], [ 900, 485 ], [ 1000, 485 ], [ 1000, 875 ], [ 1090, 875 ], [ 1090, 925 ] ], "badge": [ 1000, 736 ] }, { "id": "daily-function", "from": "daily", "to": "function", "label": "Behavior changes participation and future capacity", "role": "hypothesis", "detail": "Candidate action-to-outcome relationship. Actual activity may support participation or impose delayed functional costs. More activity is not itself proof of greater capacity.", "sources": [ "SYS5" ], "points": [ [ 585, 700 ], [ 600, 700 ], [ 600, 815 ], [ 1130, 815 ], [ 1130, 925 ] ], "badge": [ 855, 815 ] }, { "id": "function-record", "from": "function", "to": "record", "label": "Capacity and participation have their own measures", "role": "hypothesis", "detail": "Readout dependency. Measure capacity and participation with opportunity context and delayed follow-up, separately from current activity dose, symptoms and disease measures.", "sources": [ "SYS5" ], "points": [ [ 1210, 925 ], [ 1210, 710 ] ], "badge": [ 1210, 804 ] }, { "id": "function-choice", "from": "function", "to": "choice", "label": "Capacity and opportunity constrain choices", "role": "hypothesis", "detail": "Operational feedback. Actual constraints and perceived capacity shape available actions without implying perfect knowledge of physiology or an optimal decision.", "sources": [], "points": [ [ 1235, 980 ], [ 1290, 980 ], [ 1290, 235 ], [ 855, 235 ], [ 855, 170 ] ], "badge": [ 1184, 235 ] }, { "id": "function-practice", "from": "function", "to": "practice", "label": "Capacity affects actual delivered dose", "role": "hypothesis", "detail": "Operational delivery dependency. A selected practice may be reduced, interrupted or impossible under current capacity and support. Distinguish intended dose from what occurs.", "sources": [], "points": [ [ 1235, 950 ], [ 1260, 950 ], [ 1260, 185 ], [ 1165, 185 ], [ 1165, 170 ] ], "badge": [ 1260, 525 ] }, { "id": "experience-learning", "from": "experience", "to": "learning", "label": "Experiences may update response dispositions", "role": "hypothesis", "detail": "Candidate learning update from temporally prior experience and consequences, without requiring conscious explanatory endorsement or an intermediate questionnaire. Its condition-specific operation and timescale require measurement.", "sources": [ "E3" ], "points": [ [ 730, 440 ], [ 730, 525 ], [ 665, 525 ], [ 665, 850 ], [ 760, 850 ], [ 760, 925 ] ], "badge": [ 665, 691 ] }, { "id": "learning-regulation", "from": "learning", "to": "regulation", "label": "Learned responses may influence physiology", "role": "hypothesis", "detail": "Untested broad coupling in this model family. A learned disposition need not operate only through conscious appraisal. Specify a measurable response and test the link; the seven-source set establishes no general chronic-illness maintenance effect.", "sources": [], "points": [ [ 690, 990 ], [ 675, 990 ], [ 675, 455 ], [ 565, 455 ], [ 565, 440 ] ], "badge": [ 675, 734 ] }, { "id": "context-regulation", "from": "inputs", "to": "regulation", "label": "Context can change physiological dynamics", "role": "hypothesis", "detail": "Candidate context-to-state dependency. Healthy sleep coordination and acute challenge models motivate specifying context; they do not establish a generic safety variable or one chronic-disease coupling law.", "sources": [ "SYS1", "SYS2", "SYS3" ], "points": [ [ 260, 975 ], [ 340, 975 ], [ 340, 455 ], [ 405, 455 ], [ 405, 440 ] ], "badge": [ 340, 715 ] }, { "id": "physiology-learning", "from": "regulation", "to": "learning", "label": "Physiology may affect learning-related processing", "role": "hypothesis", "detail": "Narrow research motivation: Queirazza randomized an acute inflammatory challenge and measured altered learning-related neural task signatures. Behavioral performance and fitted behavioral parameters did not significantly differ. The displayed extension to persistent learned dispositions is untested; the study does not establish a bidirectional maintenance loop.", "sources": [ "SYS4" ], "points": [ [ 500, 440 ], [ 500, 465 ], [ 640, 465 ], [ 640, 870 ], [ 720, 870 ], [ 720, 925 ] ], "badge": [ 640, 776 ] } ], "loops": [ { "id": "adaptation", "label": "Practice and adjustment", "description": "Candidate dependencies for study. Selecting this loop does not assert that it is present, dominant, reinforcing or beneficial in every condition.", "edgeIds": [ "choice-use", "practice-reg", "reg-symptom", "experience-observe", "observe-record", "record-choice" ] }, { "id": "illness", "label": "Illness and regulation", "description": "Candidate dependencies for study. Selecting this loop does not assert that it is present, dominant, reinforcing or beneficial in every condition.", "edgeIds": [ "body-reg", "reg-body" ] }, { "id": "attention", "label": "Attention and reaction", "description": "Candidate dependencies for study. Selecting this loop does not assert that it is present, dominant, reinforcing or beneficial in every condition.", "edgeIds": [ "reg-symptom", "experience-observe", "observe-response", "response-reg" ] }, { "id": "progression", "label": "Learning and progression", "description": "Candidate dependencies for study. Selecting this loop does not assert that it is present, dominant, reinforcing or beneficial in every condition.", "edgeIds": [ "teaching", "frame-choice", "progress" ] }, { "id": "interpretation", "label": "Experience and conviction", "description": "Candidate dependencies for study. Selecting this loop does not assert that it is present, dominant, reinforcing or beneficial in every condition.", "edgeIds": [ "frame-choice", "choice-use", "practice-reg", "reg-symptom", "experience-observe", "observe-record", "record-frame" ] }, { "id": "daily", "label": "Daily-life changes", "description": "Candidate dependencies for study. Selecting this loop does not assert that it is present, dominant, reinforcing or beneficial in every condition.", "edgeIds": [ "frame-daily", "daily-reg", "reg-symptom", "symptom-response", "response-record", "record-frame" ] }, { "id": "learning", "label": "Learning over time", "description": "Current responses and slower learned dispositions influence one another; repeated intervention experiences can enter this process.", "edgeIds": [ "learning-experience", "symptom-response", "response-learning" ] }, { "id": "tissue", "label": "Activity and bodily response", "description": "Choices change activity, bodily response and experience, which can influence later choices. Delays, ongoing inputs and concurrent care remain explicit in the full graph.", "edgeIds": [ "choice-daily", "activity-body", "body-experience", "experience-choice" ] }, { "id": "measurement", "label": "Observation and choice", "description": "Choosing to observe creates information that can inform later choices. This operational loop does not imply that monitoring worsens disease.", "edgeIds": [ "choice-monitor", "observe-record", "record-choice" ] }, { "id": "burden", "label": "Burden and continuation", "description": "Actual participation changes burden or resources, which can change future participation. Direction, magnitude and selection effects must be measured.", "edgeIds": [ "choice-use", "practice-burden", "burden-choice" ] }, { "id": "capacity", "label": "Activity and capacity", "description": "Choices change activity and participation; resulting capacity and opportunity constrain later choices. An immediate increase in activity is not necessarily an improvement.", "edgeIds": [ "choice-daily", "daily-function", "function-choice" ] }, { "id": "care", "label": "Care and subsequent choices", "description": "Care choices enter bodily processes and experience, which can shape later choices. This is not evidence that any particular care is effective.", "edgeIds": [ "choice-care", "care-body", "body-experience", "experience-choice" ] }, { "id": "physiology-learning", "label": "Physiology and learning hypothesis", "description": "A candidate bidirectional extension. Acute inflammatory effects on neural task signals do not establish durable learning, the reverse direction or a chronic-illness loop.", "edgeIds": [ "physiology-learning", "learning-regulation" ] } ], "scope": "A proposed family of time-ordered coupled models, not a fitted universal model. Edges include operational choices, measurement dependencies and candidate biological effects; inspect the stated role in each detail. Candidate effects may be absent, delayed or context-dependent. No gain, efficacy coefficient or complete causal mechanism is supplied by this network." } ], "studies": [ { "id": "SYS1", "title": "Bartsch 2015: network physiology", "url": "https://doi.org/10.1371/journal.pone.0142143", "contribution": "Measured coordination among physiological signals in healthy sleep. This constrains how to describe changing coupling; it identifies neither a unique causal law nor chronic-illness treatment effects." }, { "id": "SYS2", "title": "Dobreva 2021: inflammation, pain and cardiovascular dynamics", "url": "https://pubmed.ncbi.nlm.nih.gov/33450068/", "contribution": "Fitted and independently checked acute endotoxin model. Nonlinear couplings are specified model structure; sustained pathological-input and treatment scenarios are simulations." }, { "id": "SYS3", "title": "Relouw 2024: acute and prolonged inflammatory input", "url": "https://doi.org/10.1038/s41540-024-00473-y", "contribution": "Validation across endotoxin doses and a three-hour infusion. Infection inputs were selected to produce plausible ranges, not measured clinical infection trajectories." }, { "id": "SYS4", "title": "Queirazza 2024: inflammation and learning-related neural activity", "url": "https://doi.org/10.1016/j.bbi.2024.03.044", "contribution": "Randomized acute inflammatory manipulation changed selected task-related neural signatures. Behavioral performance and fitted behavioral parameters did not significantly differ. No inflammation–belief maintenance loop was demonstrated." }, { "id": "SYS5", "title": "Appelman 2024: tissue and post-exertional changes", "url": "https://doi.org/10.1038/s41467-023-44432-3", "contribution": "Long-COVID cohort with PEM and muscle/metabolic observations. Keeps tissue constraints and delayed effects visible; it does not estimate a nonlinear coupling law or test retraining." }, { "id": "SYS6", "title": "Pradhan 2007: mindfulness during rheumatoid arthritis", "url": "https://pubmed.ncbi.nlm.nih.gov/17907231/", "contribution": "Small randomized package trial with continued usual care. Later psychological benefit without demonstrated disease-activity benefit; not a mechanism or component-effect estimate." }, { "id": "SYS7", "title": "Tesser 2025/2026: implanted vagus stimulation in active RA", "url": "https://doi.org/10.1038/s41591-025-04114-7", "contribution": "Sham-controlled device trial with a clinical response difference during active autoimmune illness. Its device exposure is not equivalent to breathing, felt safety or commercial retraining." } ] }