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Bruno Schein,1,2 Gerardo Beltran,1– 3 Bárbara Regina França,1,2 Paulo RS Sanches,4 Danton P Silva Jr,4 Iraci Lucena Torres,5,6 Felipe Fegni,7 Wolnei Caumo1,2,5,8 1Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul (RS), Brazil; 2Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; 3Institute of Neurosciences, Universidad Catolica de Cuenca, Cuenca, Ecuador; 4Laboratory of Biomedical Engineer, HCPA, Porto Alegre, RS, Brazil; 5Pain and Palliative Care Service, HCPA, Porto Alegre, RS, Brazil; 6Laboratory of Pharmacology of Pain and Neuromodulation, Experimental Research Center, HCPA, Porto Alegre, RS, Brazil; 7Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, USA; 8Department of Surgery, School of Medicine, UFRGS, Porto Alegre, RS, BrazilCorrespondence: Wolnei Caumo, Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre at UFRGS, Ramiro Barcelos, 2350 - CEP 90035-003 Bairro Rio Branco, Porto Alegre, RS, Brazil, Tel/Fax +55 51- 33598083, Email wcaumo@hcpa.edu.brObjective: We compare the effect of HAS, a-tDCS on the left dorsolateral prefrontal cortex (l-DLPFC), and rest-testing on pain measures [(cold pressor test (CPT) (primary outcome) and heat pain threshold]. We also compare their effects on the motor evoked potential (MEP) (primary outcome), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP).Methods: This randomized, blind, crossover trial included 18 women with fibromyalgia, aged from 18 to 65 years old. They received at random and in a crossover order a-tDCS over the l-DLPFC (2mA), HAS, or a rest-testing.Results: HAS compared to a-tDCS increased the pain tolerance with a moderate effect size (ES) [Cohen’s f=− 0.78; (CI 95%; − 1.48 to − 0.12)]. While compared to rest-testing, HAS increased the CPT with a large ES [Cohen’s f=− 0.87; (CI 95%; − 1.84 to − 0.09)]. The a-tDCS compared to HAS increased the MEP amplitude with large ES [Cohen’s f=− 1.73 (CI 95%; − 2.17 to − 0.17)]. Likewise, its ES compared to rest-testing in the MEP size was large [Cohen’s f=− 1.03; (CI 95%; − 2.06 to − 0.08)].Conclusion: These findings revealed that HAS affects contra-regulating mechanisms involved in perception and pain tolerance, while the a-tDCS increased the excitability of the corticospinal pathways. They give a subsidy to investigate their effect as approaches to counter regulate the maladaptive neuroplasticity involved in fibromyalgia.Clinical Trial Registration: www.ClinicalTrials.gov, identifier – NCT05066568.Keywords: tDCS, hypnosis, hypnotic analgesia, chronic pain, fibromyalgia, pain threshold, cold pressor test, CPM-test

Introduction: The COVID-19 pandemic has exacerbated the mental health burden on the general population, resulting in increased demands on mental healthcare professionals, including psychotherapists. This cross-sectional study assessed the challenges and resources encountered by 513 psychotherapists based on an online survey conducted between April and May 2022., Methods: Qualitative methods content analysis of written reports was employed to investigate the emerging challenges and sources of support during the pandemic. A comparative analysis of burdens, resources, sociodemographic factors and daily physical activity was conducted to discern patterns of good and poor well-being., Results: The predominant burden identified was mental health-related issues, followed by global crises and government-imposed restrictions to mitigate virus transmission. Essential resources encompassed social connections, mindfulness, work satisfaction, and internal processes. Notably, psychotherapists demonstrating good well-being were older, more physically active, had a lower proportion of females, were employed in private practices rather than in institutionalized settings, had more years of professional experience and treated more patients weekly than their counterparts with poor well-being. Furthermore, they exhibited greater optimism, health focus, and satisfaction with their coping methods., Discussion: These findings can help develop support systems, policies, and educational programs to better support mental health professionals during global crises and offer strategies for individual practitioners to maintain their well-being., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Schaffler, Bauer, Schein, Jesser, Probst, Pieh and Humer.)