More trouble with BTT and Wacom tablet: won't scroll downward

Describe the bug
Wacom pen will scroll up, but not down, in apps like Safari and Preview when BTT is running. As soon as I quit BTT all is fine. I set BTT to be disabled when I hold Ctrl key, and down-scrolling works with that key held.

Affected input device (e.g. MacBook Trackpad, Magic Mouse/Trackpad, Touch Bar, etc.):
Wacom tablet with current driver

Device information:

  • Type of Mac: M1 MacBook Air
  • macOS version: 13.4.1
  • BetterTouchTool version: 4.157 (Setapp)

Additional information (e.g. crash logs, related issues, etc.):

Tried with BTT as my only login item and had the same problem. Scrolled through the 588 processes in Activity Monitor and saw nothing that looked like it dealt with remapping inputs and the like.

Though I don't use it often, I noticed that my Kensington track ball scroll wheel won't scroll downward, either.