Table 3 CBT modules
Module | Questionnaires and instruments |
|---|---|
1. Formulating goals | For all participants |
This module applies to all participants. Concrete and obtainable treatment goals are formulated during therapy. Goals comprise activities that the participant wishes to do when the fatigue has decreased or disappeared. | |
2. Sleep/wake rhythm | SIP sleep and rest ≥60 [49] |
The importance of a regular sleep/wake rhythm and good sleep hygiene is explained to the patient. Furthermore, the sleep/wake rhythm of will be discussed and suggestions for improvement given. | |
3. Beliefs regarding MS | Impact of Event Scale (IES) ≥20 [50] |
Participants will receive realistic information about MS. Dysfunctional cognitions about MS or the future are identified and challenged, and the participant is supported in forming more functional cognitions. Problems regarding acceptance of the disease are also addressed. | Pictorial Representation of Illness Measure (PRISM): Burden of MS heavier than burden of fatigue [51] |
Illness Cognition Questionnaire (ICQ), concentration ≤12 [52] | |
Cognitive Behavioural Responses to Symptoms Questionnaire (CBRSQ) [53, 54]: | |
Resting behaviour >14,3; | |
All-or-nothing behaviour >12.9; | |
Symptom focusing >15.5; | |
Catastrophising >12.6; | |
Embarrassment >16.4; | |
Damage >20.5; | |
Fear avoidance >15.3 | |
HADS [55] | |
Depression >9 | |
Anxiety >9 | |
Fear of disease Progression Questionnaire (FoP-Q), ≥4 on at least 75% of the 34 | |
4. Beliefs regarding fatigue | SES-28 fatigue ≤19 |
Participants are supported in changing dysfunctional views about fatigue such as a lack of self-efficacy, catastrophising fatigue and somatic attributions. | |
5. Focusing on fatigue | Illness Management Questionnaire (IMQ), focusing on symptoms ≥4 [60] |
The concept of persistent focusing on fatigue and its consequences are discussed. Participants practise redirecting their attention from fatigue to activities and other sensations. Talking about fatigue is discouraged. | |
6. Regulation of physical activity | Activity Interview and Activity Monitor |
Depending on their level of activity, participants learn how to divide their activities, followed by a systematic increase in regular physical activity to obtain predefined goals. | |
7. Regulation of social activity | SIP social interaction ≥100 [49] |
Patients are empowered to expand social activities and deal with problems that can arise during social interaction. | SF36 social functioning ≤65 [61] |
8. Regulation of mental activity | CIS20r concentration ≥18 [62] |
Participants are supported with regards to practising and expanding mental activities such as working on the computer or reading. Participants learn how to deal with possible cognitive deficits such as concentration or memory problems. | |
9. Role of the environment | Social Support List (SSL) [63] |
Unrealistic expectations of the environment are addressed and more realistic expectations are promoted. Participants learn how to express their limits and boundaries to ‘significant others’. | Discrepancies ≥50; |
Negative interactions ≥14 | |
10. Handling pain | SF36 bodily pain ≤60 [61] |
Dysfunctional cognitions about pain are challenged and replaced by more functional cognitions. | Pain Catastrophising Scale (PCS) ≥16 [64] |