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In this study, we sought to investigate three questions that can be drawn from this model: (1) Do patients with\n                      <jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content>\n                      show high levels of neuroticism? (2) Does neuroticism affect physical health and social functioning, either directly or indirectly through maladaptive coping? (3) Does more adaptive coping mediate the effect of cognitive\u2010behavioural therapy (\n                      <jats:styled-content style=\"fixed-case\">CBT<\/jats:styled-content>\n                      ) on outcome?\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      Secondary analysis of a randomized controlled trial (\n                      <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>\n                      ) using additional data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      We used yet unpublished data on neuroticism (measured with Temperament and Character Inventory, Revised) and coping (measured with Coping Strategies Questionnaire) together with already reported outcomes (physical health and social functioning measured with\n                      <jats:styled-content style=\"fixed-case\">SF<\/jats:styled-content>\n                      \u201036) from an\n                      <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>\n                      comparing group\n                      <jats:styled-content style=\"fixed-case\">CBT<\/jats:styled-content>\n                      with enhanced usual care in 120 patients with a range of\n                      <jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content>\n                      . Neuroticism was measured at referral, while coping and outcomes were measured at referral, baseline, 4 and 16\u00a0months after randomization. Our hypotheses were explored through a series of cross\u2010sectional (linear regression and structural equation\u00a0models) and longitudinal (mediation) analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with\n                      <jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content>\n                      showed higher levels of neuroticism than two healthy comparison groups. At referral, symptom catastrophizing partly mediated the negative association between neuroticism and outcome. Reduction in symptom catastrophizing during group\n                      <jats:styled-content style=\"fixed-case\">CBT<\/jats:styled-content>\n                      partially mediated its long\u2010term effect.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The results give support to a generic cognitive\u2010behavioural model of\n                      <jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content>\n                      . Targeting symptom catastrophizing may be an essential component in\n                      <jats:styled-content style=\"fixed-case\">CBT<\/jats:styled-content>\n                      for patients with\n                      <jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content>\n                      , regardless of their specific diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Statement of contribution<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:italic>\n                            <jats:bold>What is already known on this subject?<\/jats:bold>\n                          <\/jats:italic>\n                        <\/jats:p>\n                        <jats:p>\n                          Previous studies have found support for single components of the cognitive\u2010behavioural model such as dysfunctional illness beliefs or avoidant coping. Most studies have investigated single functional somatic syndromes (\n                          <jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content>\n                          ) such as fibromyalgia or irritable bowel syndrome.\n                        <\/jats:p>\n                        <jats:p>\n                          <jats:italic>\n                            <jats:bold>What does this study add?<\/jats:bold>\n                          <\/jats:italic>\n                        <\/jats:p>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>\n                                Predisposing neuroticism was linked to poor physical health through symptom catastrophizing across a range of\n                                <jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content>\n                                .\n                              <\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Reduced symptom catastrophizing during group cognitive\u2010behavioural therapy partially mediated its long\u2010term effect.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>\n                                Addressing symptom catastrophizing may be a key element of the management of patients with\n                                <jats:styled-content style=\"fixed-case\">FSS<\/jats:styled-content>\n                                .\n                              <\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  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