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Table 3 Content of cognitive-behavioral therapy and mindfulness-based stress reduction class sessions a

From: Comparison of complementary and alternative medicine with conventional mind–body therapies for chronic back pain: protocol for the Mind–body Approaches to Pain (MAP) randomized controlled trial





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


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


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


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


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)


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)


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


Maintenance of coping skills, relapse prevention, personal plan for the future

This is the rest of your life, review mindfulness techniques and applications, closure

  1. aCBT, Cognitive-behavioral therapy; MBSR, Mindfulness-based stress reduction.