Table 1.

Outline of Goals and Procedures for Psychological Intervention for pediatric chest pain

Visit	Goals	Procedures
1. Psychoeducation	Overview of intervention Validate chest pain as real but not dangerous Provide model of pain as multi-causal Introduce symptom “amplification”	Discussion Review of medical findings to date Illustrate psychological effects on pain Reading materials
2a. (Child) Breathing retraining	Present rationale for breathing retraining Describe and identify shallow breathing Learn deep abdominal breathing Learn “calming breath”	Demonstrate shallow breathing and its effects Demonstrate/ Practice deep abdominal breathing Homework (practice new breathing) Breathing Retraining Record
2b. (Parent/s) “How you can help”	Psychoeducation and enlist cooperation Learn principles of contingency/reinforcement Decrease positive reinforcement of illness behaviors Increase positive reinforcement of positive coping and non-illness behaviors	Discussion Reading materials Illustrate how illness behavior is reinforced Identify and record target behaviors
3. “Taking charge of your thoughts about pain”	Learn how thoughts affect pain Identify automatic thoughts (ATs) Establish repertoire of rational responses (RRs) Identify catastrophic thoughts and highly likely thinking	Discuss thinking-feeling-doing Provide typical examples of ATs Assist in identifying ATs and their triggers Practice RRs Thought record (trigger, AT, RR, rate feeling)
4. “Pulling it all together”	Review and reinforce 1-3. Anticipate challenging situations and practice coping	Review homework Review all components and plan ahead