Table 3 Content of cognitive-behavioral therapy and mindfulness-based stress reduction class sessions a
Session | CBT | MBSR |
|---|---|---|
1 | Rationale and evidence base for CBT, pain neurobiology, overview of skills, rationale for relaxation training, diaphragmatic breathing instruction, introduction to behavioral goal setting (physical activity and home practice) | Setting expectations, defining mindfulness, engaging in mindfulness exercise and movement, abdominal breathing instructions, introducing home practice |
2 | Behavioral goal setting, physical activity and pacing activity, pleasant event scheduling, pain flare-up plan, diaphragmatic breathing and seven-muscle-group progressive muscle relaxation (PMR) instruction | Perception and responding creatively to perceptions, engaging in yoga, body scan, discussion of developing a practice |
3 | Role of thoughts and feelings in pain, introduction to the CBT model, thought-monitoring record, diaphragmatic and four-muscle-group PMR instruction, setting and working toward behavioral goals | Pleasure and power of being present, engaging in yoga, walking meditation, discussing how to bring more pleasant events into our lives |
4 | Challenging automatic thoughts related to pain, setting and working toward behavioral goals, diaphragmatic breathing and four-muscle-group/no-tension PMR instruction | Getting unstuck from old patterns, engaging in yoga and/or movement, sitting meditation, stress (define and identify how and why we stay stuck), dealing with pain |
5 | Challenging automatic thoughts and generating alternate thoughts, distraction techniques, brief body scan relaxation instruction, setting and working toward behavioral goals | Reacting and responding differently to stress, engaging in yoga, participating in guided meditation, establishing coping strategies (living with difficulties) |
6 | Alternate thoughts, thought stopping, behavioral activation, mini-relaxation instruction, setting and working toward behavioral goals | Learning about communication patterns, engaging in yoga and/or meditation, styles of communicating with others (effective and ineffective) |
7 | Rehearsing pain coping skills, identifying and challenging negative thoughts, setting and working toward behavioral goals, mini-relaxation instruction, sleep tips | Integrating learning from techniques, yoga and/or meditation, practical ways to bring mindfulness into daily life |
8 | Maintenance of coping skills, relapse prevention, personal plan for the future | This is the rest of your life, review mindfulness techniques and applications, closure |