Table 1 Summary of the internet-based PainCOACH content

1

Progressive relaxation

Teach Gate Control Theory (how thoughts, feelings, and actions affect and are affected by pain). Introduce and demonstrate progressive relaxation with animation; walk user through use of the technique and active practice; help user identify/address circumstances that might impede relaxation and chose strategies to overcome obstacles; plan regular practice times; set practice goal.

2

Mini-practices

Review prior session content and practices; Introduce and demonstrate “mini-practices” (brief relaxation) with animation; walk user through use of the technique and active practice, gather/evaluate pre- and post- activity pain; help user identify/address circumstances that might impede relaxation and chose strategies to overcome obstacles; discuss benefits and reminders for practicing; plan regular practice times; set and review practice goals.

3

Activity/rest cycling

Review prior session content and practices; Introduce concept of activity/rest cycling; identify activities user tends to overdo; vicarious learning exercise demonstrate how to change overdone activities; create personal plan to fit daily routine and personal goals; review how other skills help with use of this one; plan regular practice times; set and review practice goals.

4

Pleasant activity scheduling and identify negative automatic thoughts

Review prior session content and practices; Introduce concept of pleasant activity scheduling; lead user through exercise for adding pleasant activities to their lives; mini-practice of 10-minute pleasant activity to be done immediately (gather/ evaluate pre- and post- activity pain); schedule 3 pleasant activities for week; problem-solve barriers with interactive vicarious learning exercise; Introduce concept of negative automatic thoughts; describe connections between thoughts, emotions, behaviors, and pain; walk user through a thoughts exercise; plan regular practices; set and review practice goals.

5

Identify/change negative automatic thoughts and coping thoughts

Review prior session content and practices; Continue and advance prior session’s activities related to automatic thoughts and introduce coping thoughts. Practice identifying negative thoughts and accompanying emotional and physical reactions of virtual patients, then self; exercise to teach generation of alternative thoughts, then practice and record accompanying sensations. Focus on teaching generation of alternative thoughts, practice generating calming self-statements; practice skills and get feedback; identify and address circumstances that impede use of these skills and strategies to overcome obstacles; “mini-practices” for specific circumstances; plan regular practices; set and review practice goals.

6

Pleasant imagery and distraction techniques

Review prior session content and practices; Introduce pleasant imagery and auditory and focal point distraction techniques; complete exercises with audio instructions; plan regular practices; set and review practice goals.

7

Problem Solving

Review prior session content and practices;; Introduce concept of problem solving and describe steps; demonstrate problem solving with character stories; generate list of challenging situations; exercise to help users select skills for each situation, with personalized plan for overcoming barriers; plan regular practices; set and review practice goals.

8

Monitoring for maintenance

Review all session content; evaluate skill frequency, helpfulness and comparison to other users; exercises to develop plan for maintenance of skills; motivate further practice and skill development; remind how skills facilitate personal goals; review practice goals.

Booster sessions

Review module 8 as well as revisit any useful/meaningful sessions.