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Table 1 timing and content of cognitive behavioral therapy sessions

From: A randomized controlled TRIal of cognitive BEhavioral therapy for high Catastrophizing in patients undergoing lumbar fusion surgery: the TRIBECA study

Timing Aim Content
Session 1
6–3 weeks pre-surgery
90 min
Building relationship
Providing treatment rational
Pain education
Teaching relaxation
Gathering personal, medical and pain history
Education on association between, cognitions, emotions, behavior and consequences
Education on disconnection of “damage” or injury and perceived pain
Building awareness of the impact of stress and fear on pain
Explaining goals of the six sessions
Practicing progressive muscle relaxation
Homework:
ABC belief monitoring (registering thoughts, emotions and consequences in pain situations)
List “difficult” situations
Practice progressive muscle relaxation
Session 2
3–1 weeks pre-surgery
60 min
Identifying
catastrophizing thoughts
Discussing fears of surgery
Homework review from previous session
Introduction of the concept “catastrophizing”
Identifying catastrophizing thoughts from homework
Practicing with challenging and replacing catastrophizing and other maladaptive thoughts
Homework:
ABC belief monitoring (diary)
Practice relaxation techniques
Session 3
1–3 weeks post-surgery
60 min
Challenging and replacing catastrophizing thoughts Homework review
Identify and replace catastrophizing thoughts
Discussion of new fears and challenges
Homework:
ABC belief monitoring (diary)
Practice relaxation techniques
Session 4
2–5 weeks post-surgery
60 min
Challenging and replacing catastrophizing thoughts
Overcoming avoidance
Learning new ways of coping
Homework review
Discuss to which maladaptive behavior catastrophizing might lead
Discuss how to attain goals in an alternative way
Identify barriers for adaptive coping
Discuss how to deal with upcoming stressful situations
Homework:
ABC belief monitoring (diary)
Identify needs being met by avoidance behavior and list alternative options for attaining those needs
Practice relaxation techniques
Session 5
3–6 weeks post-surgery
60 min
Learning more adaptive means for accomplishing interpersonal needs Homework review
Note and discuss progress
Continue with challenging and replacing catastrophizing thoughts
Discuss challenges from previous week
Focus on how to communicate needs to environment and identify barriers in doing so.
Homework:
ABC belief monitoring (diary)
Practice relaxation techniques
Session 6
4–8 weeks post-surgery
60 min
Maintenance
Promoting continued practice
Discussing challenging catastrophizing thoughts as a longterm project
Reviewing and summarizing the most important concepts
Patients receive the completed homework binder
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