Table 3 Overview of the content in each of the 10 sessions of the cognitive-behavioral intervention
Session | Theme | Content | Exercise | Theory and goal |
|---|---|---|---|---|
1. | Getting started | • Gate control theory (video) • Learn to know Kathrine (video) • The relation between thoughts, feelings and behavior (video) • Relaxation technique | • Try the relaxation technique • Writing exercise: Life Story | • Knowledge about pain mechanisms and the interaction of thoughts, emotions and behavior form the basis of change • Learn relaxation technique to reduce muscle tension and autonomic arousal |
2. | Goals for the recovery | • Five key elements important for coping with pain (medical, mental wellbeing, lifestyle, life story, physical activity) (video) • FAQ physical activity • Follow Kathrine • Goals for recovery | • Make a pie chart; important areas to focus on • My goal for recovery • Writing exercise: Affirmative Writing • Reminder: relaxation technique | • Awareness of how it is possible to cope with pain form the basis of changing unhelpful behavior • Knowledge about physical activity reduce fear-avoidance behavior • Goalsetting increase motivation and adherence to the program |
3. | Stress and pain | • How to change habits (video) • Understanding and managing stress (video) • Identifying main stressors • Locus of control (video) | • Identifying main stressors • Writing exercise: How has pain affected you? • Update goals for recovery • Reminder: relaxation technique | • Understanding stress, how to change habits and locus of control promotes changing processes • Reflective practice to increase awareness of own stressors |
4. | Lifestyle | • How different kind of lifestyle can contribute to the symptoms (training and restitution) (video) • How worry and anxiety influence behavior (video) • Safety behavior (video) | • Identify and challenge safety behavior • Writing exercise: Safety behavior and lifestyle • Update goals for recovery • Reminder: relaxation technique | • Knowledge about how lifestyle factors, worry and anxiety influence behavior, can motivate to change behavior • Be aware of own safety behavior and challenge it to start the process of changing behavior |
5. | Identifying automatic thoughts | • Thinking errors (video) • How challenging situations can be perceived as threat, loss or challenge (video) • The inner dialogue (video) | • Exploration of internal dialogue • Writing exercise: Pain triggers and alternative thoughts • Update goals for recovery • Reminder: relaxation technique | • Education about thinking errors and internal dialogue to start reflecting on own thoughts • Use the writing exercise to raise awareness about pain triggers and generate alternative thoughts |
6. | Creating alternative thoughts | • Common thinking errors (video) | • Identify thinking errors and generate alternative thoughts • Writing exercise: Emotional expression • Update goals for recovery • Reminder: relaxation technique | • Practice in identifying thinking errors and generating alternative thoughts to continue the process of changing thoughts and behavior |
7. | Be more mindful | • Default Mode Network (DNM) and mental habits (video) • Focused attention (video) • Conscious refocusing (audio file) | • Practice conscious refocusing • Writing exercise: Going Deeper • Update goals for recovery • Reminder: relaxation technique | • Practice focused attention and conscious refocusing to reduce DNM activity |
8. | Selective attention | • Becoming more mindful (video) • Selective attention (video) | • Mindfulness exercise: “Floating leaves” (audio file) • Writing exercise: Choose perspective • Update goals for recovery • Reminder: relaxation technique | • Practice guided imagery and selective attention to reduce muscle tension and autonomic arousal |
9. | Postponing worry and rumination | • Worry and rumination • Why worry escalates • Postponing worry and rumination • Postponement log | • Make worry postponement log • Writing exercise: Living with loss and changes • Update goals for recovery • Reminder: relaxation technique | • Learn about worry and rumination. • Practice making a worry postponement log • Reflecting on how loss and changes in life affect you, and how to live with it |
10. | What’s next? | • What have I learned? • What’s next? | • Writing exercise: What have I learned | • Reflection on what that has been learned and future plans |