Table 2 Content topics and transdiagnostic processes of MC-CBT and content topics of education/support by treatment session

1

Clinic visit 1

Treatment orientation and rationale;

Acute vs chronic pain;

Central sensitization;

Self-monitoring (functional analysis);

Introduction to relaxation

Perceived control over aversive internal states;

Self-distancing (“fly on the wall”);

Perspective broadening;

Negative reactivity

Treatment orientation and rationale

Education about Chronic Pelvic Pain (CPP)

Emphasize value of emotional support

Acute vs chronic pelvic pain,

Symptom monitoring

2

Self-directed (no contact)

Relaxation training;

Real-time self-monitoring (functional analysis)

Perceived control over aversive internal states;

Self-distancing (“fly on the wall”);

Perspective broadening;

Reflective writing narrative (RWN) about CPP and its personal impacts

3

Self-directed (phone check-in 1)

Portable relaxation training;

Real-time self-monitoring (functional analysis)

Perceived control over aversive internal states;

Self-distancing (“fly on the wall”);

Perspective broadening

Understanding CPP;

Review RWN

Central sensitivity and CPP

4

Self-directed (no contact)

Introduction to cognitive flexibility model

Perceived control;

Maladaptive worry/rumination;

Repetitive negative thought (RNT)

Symptom triggers (emotions, relationships, family, work, etc.) of CPP

5

Clinic visit 2

Prediction testing;

Evidence-based logic

RNT: Expectancy bias/prediction error

(“What if?”)

The role of stress and CPP

Review personalized Stress Profile

6

Self-directed (no contact)

Decatastrophizing

RNT: Interpretative bias (“If only…”)

Tracking dietary and physical activity triggers

7

Self-directed (phone check-in 2)

Applying evidence-based logic vs decatastrophizing skills to meet situational demands

RNT: Expectancy bias/Interpretative bias;

Context sensitivity

Review activity and dietary triggers

Pain and the stress response

8

Clinic visit 3

Flexible problem-solving training

Coping flexibility;

Context sensitivity

Diet, activity and CPP

9

Self-directed (no contact)

Flexible problem solving

Schema (core beliefs) modification

Coping flexibility;

Context sensitivity;

Negative self-schema (e.g., perfectionism)

Integrate knowledge learned about personalized triggers with biopsychosocial model

10

Clinic visit 4

Maintenance/relapse prevention

Maintenance

Review biopsychosocial model of CPP