Table 1 Overview of the STEpS group program
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 |