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Table 1 Overview of the STEpS group program

From: Immediate help through group therapy for patients with somatic diseases and depressive or adjustment disorders in outpatient care: study protocol for a randomized controlled trial

Session Topic Content
1 Behavioral activation I - Psycho-education about the relationship between behavior and emotion: explanation of the downward mood spiral [60]
- Selection of individual positive activities from a checklist [61] and rating of the selected activities
- Scheduling three positive activities for the next week
2 Behavioral activation II - Review of homework
- Information about the effects of physical activity on depression, physical health and wellbeing
- Brainstorming on personal health objectives and possible physical activities to reach these objectives
- 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)
3 Cognitive restructuring I - Psycho-education about the relationship between thoughts and depressive mood
- Introduction of the ABC model [63] by means of a role-playing activity
- 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
4 Cognitive restructuring II - Introduction of typical cognitive distortions and irrational beliefs [64]
- Identification of individual maladaptive thoughts and development of alternative thoughts
5 Coping with illness - Information about the coping concept. Psycho-education about the person and situation specificity of adaptive coping
- 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
- Group conversation about personal intentions to try other strategies
6 Social support - Introduction to the concept of social support and its relevance concerning chronic illness
- Reflection on the personal social relations through drawing a social atom [65], and clarification about who in the network gives social support and how
- Group conversation about the social network and received social support (for example wishes of change)
7 Self-esteem - Joint development of a definition of self-esteem
- Introduction of the four pillar model of self-esteem (self-acceptance, self-confidence, social skills and social networks) [66]
- Reflection of personal strengths and weaknesses in different aspects of the self (for example me as a wife, me as a professional)
- Wheel of life exercise to reflect the actual and target distribution of life energy on different life domains
8 Meaning - Introduction of the meaning concept
- Reflection and group conversation about meaningful moments in life
- Illustration that everyday activities (such as a job) can be done technically or meaningfully, and that meaning can be a resource for coping
- Reflection and group conversation about ideas for more sense of meaning in life