diff --git a/src/cdk-experimental/ui-patterns/behaviors/list-selection/list-selection.ts b/src/cdk-experimental/ui-patterns/behaviors/list-selection/list-selection.ts
index f926fe6fc988..c51a65996d8d 100644
--- a/src/cdk-experimental/ui-patterns/behaviors/list-selection/list-selection.ts
+++ b/src/cdk-experimental/ui-patterns/behaviors/list-selection/list-selection.ts
@@ -115,29 +115,56 @@ export class ListSelection<T extends ListSelectionItem<V>, V> {
     this._selectFromIndex(this.inputs.navigation.prevActiveIndex());
   }
 
-  /** Selects the items in the list starting at the given index. */
-  private _selectFromIndex(index: number) {
-    if (index === -1) {
-      return;
-    }
-
-    const upper = Math.max(this.inputs.navigation.inputs.activeIndex(), index);
-    const lower = Math.min(this.inputs.navigation.inputs.activeIndex(), index);
-
-    for (let i = lower; i <= upper; i++) {
-      this.select(this.inputs.items()[i]);
-    }
-  }
-
   /** Sets the selection to only the current active item. */
   selectOne() {
     this.deselectAll();
     this.select();
   }
 
+  /** Toggles the items in the list starting at the last selected item. */
+  toggleFromPrevSelectedItem() {
+    const prevIndex = this.inputs.items().findIndex(i => this.previousValue() === i.value());
+    const currIndex = this.inputs.navigation.inputs.activeIndex();
+    const currValue = this.inputs.items()[currIndex].value();
+    const items = this._getItemsFromIndex(prevIndex);
+
+    const operation = this.inputs.value().includes(currValue)
+      ? this.deselect.bind(this)
+      : this.select.bind(this);
+
+    for (const item of items) {
+      operation(item);
+    }
+  }
+
   /** Sets the anchor to the current active index. */
   private _anchor() {
     const item = this.inputs.items()[this.inputs.navigation.inputs.activeIndex()];
     this.previousValue.set(item.value());
   }
+
+  /** Selects the items in the list starting at the given index. */
+  private _selectFromIndex(index: number) {
+    const items = this._getItemsFromIndex(index);
+
+    for (const item of items) {
+      this.select(item);
+    }
+  }
+
+  /** Returns all items from the given index to the current active index. */
+  private _getItemsFromIndex(index: number) {
+    if (index === -1) {
+      return [];
+    }
+
+    const upper = Math.max(this.inputs.navigation.inputs.activeIndex(), index);
+    const lower = Math.min(this.inputs.navigation.inputs.activeIndex(), index);
+
+    const items = [];
+    for (let i = lower; i <= upper; i++) {
+      items.push(this.inputs.items()[i]);
+    }
+    return items;
+  }
 }
diff --git a/src/cdk-experimental/ui-patterns/listbox/listbox.spec.ts b/src/cdk-experimental/ui-patterns/listbox/listbox.spec.ts
index 0b70d65500ec..12701bc18606 100644
--- a/src/cdk-experimental/ui-patterns/listbox/listbox.spec.ts
+++ b/src/cdk-experimental/ui-patterns/listbox/listbox.spec.ts
@@ -46,13 +46,15 @@ describe('Listbox Pattern', () => {
 
   function getOptions(listbox: TestListbox, values: string[]): TestOption[] {
     return values.map((value, index) => {
+      const element = document.createElement('div');
+      element.role = 'option';
       return new OptionPattern({
         value: signal(value),
         id: signal(`option-${index}`),
         disabled: signal(false),
         searchTerm: signal(value),
         listbox: signal(listbox),
-        element: signal({focus: () => {}} as HTMLElement),
+        element: signal(element),
       });
     });
   }
@@ -439,4 +441,158 @@ describe('Listbox Pattern', () => {
       });
     });
   });
+
+  describe('Pointer Events', () => {
+    function click(options: WritableSignal<TestOption[]>, index: number, mods?: ModifierKeys) {
+      return {
+        target: options()[index].element(),
+        shiftKey: mods?.shift,
+        ctrlKey: mods?.control,
+      } as unknown as PointerEvent;
+    }
+
+    describe('follows focus & single select', () => {
+      it('should select a single option on click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(false),
+          selectionMode: signal('follow'),
+        });
+        listbox.onPointerdown(click(options, 0));
+        expect(listbox.inputs.value()).toEqual(['Apple']);
+      });
+    });
+
+    describe('explicit focus & single select', () => {
+      it('should select an unselected option on click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(false),
+          selectionMode: signal('explicit'),
+        });
+        listbox.onPointerdown(click(options, 0));
+        expect(listbox.inputs.value()).toEqual(['Apple']);
+      });
+
+      it('should deselect a selected option on click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(false),
+          value: signal(['Apple']),
+          selectionMode: signal('explicit'),
+        });
+        listbox.onPointerdown(click(options, 0));
+        expect(listbox.inputs.value()).toEqual([]);
+      });
+    });
+
+    describe('explicit focus & multi select', () => {
+      it('should select an unselected option on click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(true),
+          selectionMode: signal('explicit'),
+        });
+        listbox.onPointerdown(click(options, 0));
+        expect(listbox.inputs.value()).toEqual(['Apple']);
+      });
+
+      it('should deselect a selected option on click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(true),
+          value: signal(['Apple']),
+          selectionMode: signal('explicit'),
+        });
+        listbox.onPointerdown(click(options, 0));
+        expect(listbox.inputs.value()).toEqual([]);
+      });
+
+      it('should select options from anchor on shift + click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(true),
+          selectionMode: signal('explicit'),
+        });
+        listbox.onPointerdown(click(options, 2));
+        listbox.onPointerdown(click(options, 5, {shift: true}));
+        expect(listbox.inputs.value()).toEqual(['Banana', 'Blackberry', 'Blueberry', 'Cantaloupe']);
+      });
+
+      it('should deselect options from anchor on shift + click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(true),
+          selectionMode: signal('explicit'),
+        });
+        listbox.onPointerdown(click(options, 2));
+        listbox.onPointerdown(click(options, 5));
+        listbox.onPointerdown(click(options, 2, {shift: true}));
+        expect(listbox.inputs.value()).toEqual([]);
+      });
+    });
+
+    describe('follows focus & multi select', () => {
+      it('should select a single option on click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(true),
+          selectionMode: signal('follow'),
+        });
+        listbox.onPointerdown(click(options, 0));
+        expect(listbox.inputs.value()).toEqual(['Apple']);
+        listbox.onPointerdown(click(options, 1));
+        expect(listbox.inputs.value()).toEqual(['Apricot']);
+        listbox.onPointerdown(click(options, 2));
+        expect(listbox.inputs.value()).toEqual(['Banana']);
+      });
+
+      it('should select an unselected option on ctrl + click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(true),
+          selectionMode: signal('follow'),
+        });
+        listbox.onPointerdown(click(options, 0));
+        expect(listbox.inputs.value()).toEqual(['Apple']);
+        listbox.onPointerdown(click(options, 1, {control: true}));
+        expect(listbox.inputs.value()).toEqual(['Apple', 'Apricot']);
+        listbox.onPointerdown(click(options, 2, {control: true}));
+        expect(listbox.inputs.value()).toEqual(['Apple', 'Apricot', 'Banana']);
+      });
+
+      it('should deselect a selected option on ctrl + click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(true),
+          selectionMode: signal('follow'),
+        });
+        listbox.onPointerdown(click(options, 0));
+        expect(listbox.inputs.value()).toEqual(['Apple']);
+        listbox.onPointerdown(click(options, 0, {control: true}));
+        expect(listbox.inputs.value()).toEqual([]);
+      });
+
+      it('should select options from anchor on shift + click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(true),
+          selectionMode: signal('follow'),
+        });
+        listbox.onPointerdown(click(options, 2));
+        listbox.onPointerdown(click(options, 5, {shift: true}));
+        expect(listbox.inputs.value()).toEqual(['Banana', 'Blackberry', 'Blueberry', 'Cantaloupe']);
+      });
+
+      it('should deselect options from anchor on shift + click', () => {
+        const {listbox, options} = getDefaultPatterns({
+          multi: signal(true),
+          selectionMode: signal('follow'),
+        });
+        listbox.onPointerdown(click(options, 2));
+        listbox.onPointerdown(click(options, 5, {control: true}));
+        listbox.onPointerdown(click(options, 2, {shift: true}));
+        expect(listbox.inputs.value()).toEqual([]);
+      });
+    });
+
+    it('should only navigate when readonly', () => {
+      const {listbox, options} = getDefaultPatterns({readonly: signal(true)});
+      listbox.onPointerdown(click(options, 0));
+      expect(listbox.inputs.value()).toEqual([]);
+      listbox.onPointerdown(click(options, 1));
+      expect(listbox.inputs.value()).toEqual([]);
+      listbox.onPointerdown(click(options, 2));
+      expect(listbox.inputs.value()).toEqual([]);
+    });
+  });
 });
diff --git a/src/cdk-experimental/ui-patterns/listbox/listbox.ts b/src/cdk-experimental/ui-patterns/listbox/listbox.ts
index bba0f2444ba6..0c5bcaf3c593 100644
--- a/src/cdk-experimental/ui-patterns/listbox/listbox.ts
+++ b/src/cdk-experimental/ui-patterns/listbox/listbox.ts
@@ -26,6 +26,7 @@ interface SelectOptions {
   selectAll?: boolean;
   selectFromAnchor?: boolean;
   selectFromActive?: boolean;
+  toggleFromAnchor?: boolean;
 }
 
 /** Represents the required inputs for a listbox. */
@@ -167,13 +168,28 @@ export class ListboxPattern<V> {
       return manager.on(e => this.goto(e));
     }
 
-    if (this.inputs.multi()) {
+    if (!this.multi() && this.followFocus()) {
+      return manager.on(e => this.goto(e, {selectOne: true}));
+    }
+
+    if (!this.multi() && !this.followFocus()) {
+      return manager.on(e => this.goto(e, {toggle: true}));
+    }
+
+    if (this.multi() && this.followFocus()) {
+      return manager
+        .on(e => this.goto(e, {selectOne: true}))
+        .on(Modifier.Ctrl, e => this.goto(e, {toggle: true}))
+        .on(Modifier.Shift, e => this.goto(e, {toggleFromAnchor: true}));
+    }
+
+    if (this.multi() && !this.followFocus()) {
       return manager
         .on(e => this.goto(e, {toggle: true}))
-        .on(Modifier.Shift, e => this.goto(e, {selectFromActive: true}));
+        .on(Modifier.Shift, e => this.goto(e, {toggleFromAnchor: true}));
     }
 
-    return manager.on(e => this.goto(e, {toggleOne: true}));
+    return manager;
   });
 
   constructor(readonly inputs: ListboxInputs<V>) {
@@ -270,6 +286,9 @@ export class ListboxPattern<V> {
     if (opts?.selectFromActive) {
       this.selection.selectFromActive();
     }
+    if (opts?.toggleFromAnchor) {
+      this.selection.toggleFromPrevSelectedItem();
+    }
   }
 
   private _getItem(e: PointerEvent) {