One of the most unfortunate aspects of ME/CFS, POTS and Long COVID is that predictive processing, active inference and interoceptive processes are often neglected in treatment. 🚨 Because this regulatory world is not well understood, the moment it is introduced it is often rejected as “psychologising” - which is why FND is also rejected and misunderstood. These are core brain–body regulatory processes operating largely outside conscious awareness. They shape cognition, emotion and behaviour, but also autonomic function, immune responses and the way the body prepares for and responds to threat. But that is exactly the misunderstanding. Predictive processing is not about symptoms being imagined or consciously generated. When what we observe does not fit our existing model, we have three options: 1/ Change the model. 2/ Ignore what does not fit. 3/ Change the environment or act on the system to test the prediction and learn. That third process is active inference. If we cannot conceive of a brain–body regulatory world outside conscious awareness, we may simply refute it because we do not understand it. And in doing so, we risk ignoring an entire level of illness, and an entire level of treatment. As a clinician i see it in practice. Not everyone needs this approach - but in ‘resistant’ long standing cases it is crucial to integrate this formulation.