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1
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Behavioral activation I
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- Psycho-education about the relationship between behavior and emotion: explanation of the downward mood spiral [60]
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- Selection of individual positive activities from a checklist [61] and rating of the selected activities
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- Scheduling three positive activities for the next week
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2
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Behavioral activation II
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- Review of homework
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- Information about the effects of physical activity on depression, physical health and wellbeing
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- Brainstorming on personal health objectives and possible physical activities to reach these objectives
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- Introduction of the MoVo concept [62] and illustration of the different steps in the motivational and volitional process of physical activity. Personal elaboration of the different steps (such as building a concrete intention, generating implementation intentions and developing counter strategies for anticipated barriers)
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3
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Cognitive restructuring I
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- Psycho-education about the relationship between thoughts and depressive mood
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- Introduction of the ABC model [63] by means of a role-playing activity
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- Practicing the categorization in A (activating event), B (beliefs) and C (consequences) using patients’ examples. Further explanation and illustration of the relevance and changeability of cognitions
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4
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Cognitive restructuring II
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- Introduction of typical cognitive distortions and irrational beliefs [64]
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- Identification of individual maladaptive thoughts and development of alternative thoughts
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5
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Coping with illness
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- Information about the coping concept. Psycho-education about the person and situation specificity of adaptive coping
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- Collection of disease-related stressors (such as pain, disabilities and unclear illness course). Small group discussion about helpful coping strategies concerning one stressor. Gathering the coping strategies for the different stressors
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- Group conversation about personal intentions to try other strategies
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6
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Social support
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- Introduction to the concept of social support and its relevance concerning chronic illness
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- Reflection on the personal social relations through drawing a social atom [65], and clarification about who in the network gives social support and how
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- Group conversation about the social network and received social support (for example wishes of change)
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7
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Self-esteem
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- Joint development of a definition of self-esteem
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- Introduction of the four pillar model of self-esteem (self-acceptance, self-confidence, social skills and social networks) [66]
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- Reflection of personal strengths and weaknesses in different aspects of the self (for example me as a wife, me as a professional)
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- Wheel of life exercise to reflect the actual and target distribution of life energy on different life domains
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8
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Meaning
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- Introduction of the meaning concept
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- Reflection and group conversation about meaningful moments in life
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- Illustration that everyday activities (such as a job) can be done technically or meaningfully, and that meaning can be a resource for coping
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- Reflection and group conversation about ideas for more sense of meaning in life
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