Table 1 timing and content of cognitive behavioral therapy sessions
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 |