Table 1 Summary of key components of cognitive behavioural therapy sessions delivered pre and post-surgery
Timing | Aim(s) | Content |
|---|---|---|
Pre-surgery | ||
Session 1: 1–2 weeks pre-surgery 60 min Video-teleconference | Establish rapport Discussing treatment rationale Pain education Relaxation methods | Introductions 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 Video-teleconference | 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 |
Post-surgery | ||
Session 3: 1–3 days post-surgery 60 min Video-teleconference | 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 Video-teleconference | Check-in 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 |