Table 1.
Intervention techniques used in the Group CBT treatment
| Intervention Component | Change Technique |
|---|---|
| SESSION 1 | |
| ▪ Participants discuss experiences of breast cancer, HF/NS, and personal goals for treatment | 28, 6 |
| ▪ Provide information about physiology of HF/NS and the role of thoughts, feelings and behaviours | 1 |
| ▪ Discuss triggers of HF/NS and ways to modify them | 28, 8 |
| ▪ Introduction to full body relaxation | 21, 26 |
| HOMEWORK: | |
| ▪ Monitor and modify triggers of HF/NS | 16, 17 |
| ▪ Practice full body relaxation | 9, 26 |
| SESSION 2 | |
| ▪ Participants feedback on homework from previous session, with group support and problem solving of difficulties and focus on positives | 19, 28, 29, 8, 18 |
| ▪ Provide information on stress and discuss its impacts on HF/NS | 36, 1, 2 |
| ▪ Provide examples of cognitive and behavioural stress management techniques | 36, 21 |
| ▪ Participants create a specific stress goal to enhance wellbeing | 7 |
| ▪ Introduce paced breathing to relaxation | 21, 26 |
| HOMEWORK as before plus: | |
| ▪ Implement stress goal | 7 |
| ▪ Practice paced breathing | 9, 26 |
| SESSION 3 | |
| ▪ Participants feed back on homework from previous sessions, as above | 19, 28, 29, 8, 18 |
| ▪ Discuss cognitive, emotional and behavioural reactions to HF/NS and generate more helpful responses | 8 |
| ▪ Participants try out some cognitive and behavioural strategies for managing HF/NS | 26 |
| ▪ Introduce use of paced breathing and cognitive strategies at onset of HF/NS to reduce impact of flush | 21, 26 |
| HOMEWORK as before plus: | |
| ▪ Monitor thoughts, feelings and behavioural reactions to HF/NS, practice more helpful reactions | 17, 26 |
| ▪ Practice paced breathing at the onset of a HF/NS | 9, 26 |
| ▪ Complete a sleep diary for a week | 17 |
| SESSION 4 | |
| ▪ Participants feedback on homework from previous sessions as above | 19, 28, 29, 8, 18 |
| ▪ Provide information on sleep and discuss sleep diaries | 1, 2 |
| ▪ Discuss behavioural strategies for improving sleep quality | 21 |
| ▪ Participants create an action plan to implement two sleep goals | 7 |
| ▪ Practice relaxation and paced breathing | 21, 26 |
| HOMEWORK as before plus: | |
| ▪ Implement sleep goals | 24 |
| SESSION 5 | |
| ▪ Participants feedback on homework from previous session as above | 19, 28, 29, 8, 18 |
| ▪ Provide information on thoughts and sleep | 1 |
| ▪ Provide tips on managing cognitive and emotional reactions to sleep difficulties | 21 |
| ▪ Create action plan to change thinking and behaviour when having sleep difficulties | 7 |
| ▪ Practice Relaxation and Paced breathing | 21, 26 |
| HOMEWORK as before plus: | |
| ▪ Implement second set of sleep goals | 7 |
| SESSION 6 | |
| ▪ Participants feedback on homework from previous sessions as above | 19, 28, 29, 8, 18 |
| ▪ Discuss overall progress and write a therapy blueprint by identifying helpful strategies, potential barriers or setbacks, ways of spotting setbacks and overcoming them, and a maintenance plan for future goals relating to the treatment | 35, 16, 17 |
| ▪ Group discussion of managing uncertainty and future plans, and symptoms in the context of breast cancer | 29, 28 |
| ▪ Practice Relaxation and Paced breathing | 21, 26 |
| ▪ Goodbye and how to access help in the future | 29 |
Notes:
1: Provide information on consequences of behaviour in general*; 2: Provide information on the consequences of behaviour to the individual*; 6: Goal setting (outcome); 7: Action planning; 8: Barrier identification/Problem solving; 9: Set graded tasks; 16: Prompt self-monitoring of behaviour; 17: Prompt self-monitoring of outcome; 18: Prompting focus of past success; 19: Provide feedback on performance**; 21: Provide instruction on how to perform a behaviour; 24: Environmental restructuring; 26: Prompt practice; 28: Facilitate social comparison; 29; Plan social support; 35: Relapse prevention/Coping planning; 36: Stress Management.
*The definition is interpreted broadly to include consequences of cognition and emotion. According to cognitive behaviour theory there are cognitive and emotional consequences and antecedents of behaviour which impact upon health outcomes (in this case HF/NS).
**The term performance may be slightly misleading as it suggests that feedback should be judgemental (good or bad), although it is not specifically defined this way in the taxonomy.
The definitions of change techniques are available on request from Stephanie Ashford (s.ashford@coventry.ac.uk).