Table 1 An overview of the content of each of the seven sessions in the cognitive-behavioral intervention
Session/time | Focus and skills |
|---|---|
1. session | Introduction to the patient education. |
2 weeks preoperative | Causes and consequences of pain. Different types of pain. |
Introduction to the cognitive triangle – The link between thoughts, feelings, bodily reactions and behavior. | |
Homework: Identify and write down thoughts in relation to painful or stressful situations. | |
2. session | Active and passive coping strategies. |
1 week preoperative - relatives are invited to participate | How to cope with pain and distress in relation to family, relatives and work. |
The consequences of fear avoidance and the link between activity and pain. | |
Relaxation and mindfulness exercise. | |
Homework: Identify and write down your own coping strategies when in pain or distress. Relaxation and mindfulness exercise. | |
3. session | Appropriate activity management – activity pacing. |
3–5 days preoperative | Pleasant activity scheduling. |
Goal setting. | |
Introduction to pain diary. | |
Homework: Identify five activities you used to enjoy and would like to do again. | |
4. session | Summary of learned skills from previous sessions. |
During hospitalization | Goal setting for the next 14 days. |
1–2 days postoperative | Appropriate rest and activity. |
Homework: Use the pain diary the next 14. days. | |
5. session | The cognitive triangle – The link between thoughts, feelings, bodily reactions and behavior. |
14 days postoperative | Learning how to change negative automatic thoughts and catastrophic pain-related thoughts into more realistic thoughts by using cognitive restructuring techniques |
Pleasant activity scheduling and activity pacing. | |
Homework: Use pacing techniques and pleasant activity scheduling to restart daily activities and hobbies. Write down how it affects your mood and pain level. | |
Identify and write down troubled thoughts and how they affect your feelings, bodily reactions and behavior. Consider alternative realistic thoughts. | |
6. session | Restructuring of inappropriate thoughts. |
4 weeks postoperative | Working with the patient’s individual problems. |
Goal setting for the next 2 months. | |
Homework: Identify catastrophic and negative thoughts and try to change them to alternative more realistic thoughts. | |
7. session | Brush up from the 6 previous sessions and a reflection of which coping techniques and cognitive techniques the patient can and will use in the future |
3 months postoperative | How to manage and control flare-ups |
Plan for the future |