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Table 4 Summary of evidence-based cognitive behavioral therapy

From: The OPTIMIZE study: protocol of a pragmatic sequential multiple assessment randomized trial of nonpharmacologic treatment for chronic, nonspecific low back pain

Session

Topics

Content and Patient Activitiesa

1

Assessment, stress and coping model of pain

Discuss attitude and beliefs about chronic pain and patient’s current approach to pain coping; identify relationships between stress, thoughts, feelings, behaviors, and physiology; learn relaxation exercise; complete assigned daily relaxation exercise and thought record

2

Behavioral activation

Learn techniques for activity pacing; develop graded activity plan; use goal-setting strategies to set specific physical and pleasant activity goals; assign goal setting activities.

3

Identifying negative automatic thoughts

Learn “gate control” theory of chronic pain; learn stress judging coping model of pain; learn types of negative thinking; identify negative thoughts and how they relate to thoughts, feelings, behaviors and physiology; assign daily thought record.

4

Changing negative automatic thoughts

Learn techniques for changing negative automatic thoughts to be more realistic; practice reframing negative automatic thoughts; assign daily thought record.

5

Changing core beliefs

Learn to identify “should” beliefs and core beliefs; learn techniques for changing core beliefs to be more realistic; practice reframing core beliefs; assign daily thought record.

6

Pain coping strategies

Create and use positive coping statements; practice passive muscle relaxation; assign regular positive coping statements and passive muscle relaxation at-home practice.

7

Effective communication

Learn and practice expressive writing; learn and practice assertive communication; assign regular at-home expressive writing and assertive communication.

8

Relapse prevention

Review skills learned in treatment; develop plan for using skills in future; assign ongoing practice of skills.

  1. aEach session includes reassessment of patient’s beliefs and attitudes toward pain and review of prior session