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Table 1 Details of the contents of the cognitive behavioural intervention group sessions

From: Treatment compliance and effectiveness of a cognitive behavioural intervention for low back pain: a complier average causal effect approach to the BeST data set

Session number 1 2 3 4 5 6
 History taking including current problems and eliciting beliefs on LBP and activity
 Collaborative goal setting with plan to start activity goal
 Exercises chosen collaboratively from options with level negotiated
 Exercises practised and progression discussed
Understanding pain      
 Group activity to demonstrate hurt does not equal harm
 Current thinking on causes of long-term pain explained
 Discussion on groups experience of alternative treatments for LBP with reference to research evidence and need to self manage
Benefits of exercise      
 Discussion of physical impact of inactivity or altered activity and how changes impact on pain (disuse syndrome)
 Discussion on effects of activity/exercise
 Introduction to LBP model
Pain fluctuations       
 Overactivity/underactivity cycle explained
 Use of pacing
 Group problem solving for a specific task that tends to be ‘overdone’ e.g. gardening
Working out starting point for exercises or activities       
 How to use baseline setting
How to set goals       
 SMART system used to break down an example goal
 Feedback from group on how progressing with goals from assessment
 Group problem-solving problems with goals
Unhelpful thoughts and feelings       
 Styles of unhelpful thinking discussed, including catastrophising
 Link with unhelpful behaviours
 Identifying unhelpful thoughts
 Group problem-solving for challenging unhelpful thoughts
Restarting activities or hobbies       
 Discussion on activities commonly avoided in LBP
 Fear avoidance cycle
 Group problem-solving out of cycle
 Development of specific goals relating to restarting activities
When pain worries us       
 Effect of attention to pain explored through group activity
 Hypervigilance cycle used to link unhelpful thoughts and behaviours
 Group problem-solving out of cycle
 Discussion on the use of medication/distraction/alternating activities
Coping with flare-ups      
 Discussion on causes of flare-ups
 Plan of what to do in and out of flare-ups
 Revision of topics over previous sessions and questions
  1. LBP, lower back pain.