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Table 1 Summary of key components of cognitive behavioural therapy sessions delivered pre and post-surgery

From: Effect of perioperative cognitive behavioural therapy on chronic post-surgical pain among breast cancer patients with high pain catastrophising characteristics: protocol for a double-blinded randomised controlled trial

Timing Aim(s) Content
 Session 1:
1–2 weeks pre-surgery
60 min
Establish rapport
Discussing treatment rationale
Pain education
Relaxation methods
Gather personal history info
Discuss pain education re: relations between cognition, emotions, behaviour and consequences
Introduce concept of fear avoidance
Build awareness on the potential impact of stress and pain experience
Practice relaxation methods (PMR)
Homework: Monitoring cognitions, emotions and consequences; identify ‘challenging’ moments; practice PMR
 Session 2:
1–3 days pre-surgery
60 min
Discuss surgery and associated fears/emotions/cognitions
Validate these fears and support person’s emotional state
Focus discussion on any catastrophizing thoughts (e.g. “what if it goes wrong…,” “something bad might happen…,” etc.
Homework review
Relaxation practice
Defining ‘catastrophizing’ and ‘state anxiety’ linking to any relevant homework material
Explaining their importance in context of surgery and recovery from
Practicing the identification of anxiety and catastrophizing thoughts
Practicing cognitive restructuring (challenging and replacing catastrophic thoughts with more adaptive/helpful/constructive ‘facts’)
End with PMR exercise
Homework: PMR; continued mental monitoring and cog restructuring
 Session 3:
1–3 days post-surgery
60 min
Support participant post operatively
Validate their reported state of health/any concerns
Maintain conversational focus on catastrophizing tendencies, identifying them as they arise and reinforcing the ability to challenge, restructure, etc.
Homework review
Discussion of catastrophizing tendency perioperatively and its links to consequences
Discuss potential for fear avoidance and link to consequences
Discuss goals and barriers
Framing conversation around adaptive coping versus maladaptive coping
Acknowledge challenges
End with PMR exercise
Homework: continued PMR practice; continued mental monitoring to detect and challenge catastrophizing cognitions
 Session 4:
1–2 weeks post-surgery
60 min
Maintaining progress
Promoting continued practice
Homework review
Note and discuss progress
Validate scale of the experience
Contextualise content of thought processes and encourage continued cognitive restructuring in situations of ‘catastrophisation’
Reinforce continued PMR methods
Discuss medium term goals and barriers
Reviewing and summarising main learning points from the last few weeks