{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T08:02:27Z","timestamp":1779782547807,"version":"3.53.1"},"reference-count":49,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100015620","name":"Center for Innovations in Quality, Effectiveness and Safety","doi-asserted-by":"publisher","award":["#CIN 13\u2013413"],"award-info":[{"award-number":["#CIN 13\u2013413"]}],"id":[{"id":"10.13039\/100015620","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bpspsychub.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["British J Health Psychol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Persistent \u2018medically unexplained\u2019 physical symptoms and syndromes (PPS), an umbrella term for symptom\u2010based conditions with poorly understood pathophysiology and aetiology, disproportionately impact Gulf War Veterans. Behavioural interventions are efficacious and recommended as first\u2010line treatments for PPS, but the mechanisms by which these interventions work remain unknown. This study sought to identify mechanisms of change that make problem\u2010solving treatment (PST) efficacious for Veterans living with Gulf War Illness (GWI), a common form of PPS among Veterans who served in Operations Desert Shield\/Storm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Veterans with GWI were randomized to receive either PST or an active control intervention. Analyses focused on the 135 Veterans who were randomized to the PST condition. Outcomes of interest included disability, depressive symptoms, and physical symptoms. Threatening and protective illness perceptions as well as maladaptive and adaptive behavioural responses to illness were analysed as mechanisms of change (i.e., mediators) of these outcomes over time in single\u2010arm mediation models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All three outcomes were mediated by reduced threatening illness perceptions (\n                      <jats:italic>p<\/jats:italic>\n                      \u2010values .032\u2013.047) and reduced maladaptive behavioural responses (all\u2010or\u2010nothing and limiting responses;\n                      <jats:italic>p<\/jats:italic>\n                      \u2010values .004\u2013.007). Changes in protective illness perceptions and adaptive behavioural responses to illness were not significant mediators of PST outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Consistent with the cognitive behavioural model of PPS and the Common\u2010Sense Model of Self\u2010Regulation, changes in negative illness perceptions and behavioural responses may act as mechanisms of change in PST for GWI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bjhp.70062","type":"journal-article","created":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T06:04:44Z","timestamp":1773468284000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Illness perceptions and behavioural responses as mechanisms of change in problem\u2010solving treatment for Veterans with Gulf War Illness"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8804-6385","authenticated-orcid":false,"given":"Laura M.","family":"Lesnewich","sequence":"first","affiliation":[{"name":"War Related Illness and Injury Study Center (WRIISC) Veterans Affairs New Jersey Healthcare System  East Orange New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren M.","family":"Winograd","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center (WRIISC) Veterans Affairs New Jersey Healthcare System  East Orange New Jersey USA"},{"name":"Department of Educational and Counseling Psychology University at Albany, State University of New York  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shou\u2010En","family":"Lu","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center (WRIISC) Veterans Affairs New Jersey Healthcare System  East Orange New Jersey USA"},{"name":"Department of Biostatistics and Epidemiology Rutgers School of Public Health  Piscataway New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen S.","family":"Quigley","sequence":"additional","affiliation":[{"name":"Department of Psychology Northeastern University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfred R.","family":"Pigeon","sequence":"additional","affiliation":[{"name":"VISN 2 Center of Excellence for Suicide Prevention Veterans Affairs Finger Lakes Healthcare System  Canandaigua New York USA"},{"name":"Department of Psychiatry University of Rochester Medical Center  Rochester New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Litke","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center (WRIISC) Veterans Affairs New Jersey Healthcare System  East Orange New Jersey USA"},{"name":"Department of Rehabilitation Medicine NYU Grossman School of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drew A.","family":"Helmer","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness &amp; Safety (IQuESt) Michael E. 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