Table 1 Overview of the eight modules included in the tailored CBT intervention
Title and description | CBT strategies | |
|---|---|---|
Module 1 | Introduction to the tailored CBT program | Psycho-education on CBT model for treatment of depression and anxiety, fatigue and pain management, sleep hygiene; the link between thoughts, emotions, and behaviour; self-assessment activity identifying depressive, anxiety and MS symptoms; introduction to grief and loss model and acceptance of MS illness; self- assessment of stage of grief/loss; introduction of thought monitoring forms and provision of psycho-educational reading materials on depression, anxiety and MS and adjusting to living with MS |
Module 2 and Module 3 | Managing depressive and anxiety symptoms | Assist client to identify link between trigger events, thoughts, emotions and behaviour; identify situations that trigger low mood and anxiety; introduction to unhelpful thinking styles and how they contribute and maintain low mood and anxiety; introduce and discuss behavioural activation strategies such as pleasant activity scheduling including physical activity; mindfulness-based controlled breathing; progressive muscle relaxation to assist in the management of negative emotions; provide guided controlled breathing, progressive muscle relaxation and sleep hygiene audio tracks; provide psycho-educational material on the benefits of controlled breathing, progressive muscle relaxation and sleep hygiene |
Module 4 | Challenging unhelpful thoughts | Identifying own unhelpful thinking styles/errors using the thought monitoring form; discussion of how unhelpful thinking styles lead to negative emotions and unhelpful behaviours; introduction of how to manage and challenge unhelpful thoughts; finding alternative thoughts activity in session; provide psycho-educational material about challenging negative thoughts and coming up with alternative more helpful thoughts; provide thought monitoring, relaxation and pleasant activities forms for homework |
Module 5 | Managing fatigue and pain | Understanding pain and fatigue in MS from a cognitive behavioural perspective; discussion of pain and fatigue “traps”; provide psycho-educational material on fatigue and pain and depression cycle; identification of individual fatigue and pain cycle; identification of negative thoughts; identifying unhelpful thinking styles related to fatigue and pain; identification and discussion of more helpful thoughts |
Module 6 | Sleep hygiene | What is good sleep hygiene? Discussion of strategies to improve sleep such as establishing good sleep habits; provide psycho-educational material around factors that influence sleep |
Module 7 | Problem solving | Introduction to problem solving; discussion of how to problem solve in session using a client’s example; provide psycho-educational reading material on problem solving |
Module 8 | Relapse prevention and preparing for the future | Recap on all homework exercises and strategies covered in the intervention; discussion around managing depressive and anxiety symptoms, fatigue, pain and sleep problems; identifying triggers and early warning signs of depression relapse; discussion of strategies that have helped client; completion of depression relapse prevention plan in session |