Table 2.

CBT procedural element themes and sample extracts from the post-treatment, semi-structured interviews

Themes	Example
Cognitive Components
Stress-Appraisal-Pain Connection	“Where your mind is, your body is, also. If your mind is in a stressful or negative situation, then your body’s gonna suffer from that.” (55 year-old, AA male)
Automatic thoughts/Catastrophizing	“The automatic thought process - usually when something jumps in your head, don’t have all the right reason but it end up in there, and you always take the worst and put in there.” (50 year-old, AA male)
Weighing the Evidence	“The session of it where you weigh the truth, what really was and what wasn’t, and that was cool because once we looked into it, it really wasn’t as bad as we thought it was.” (50 year-old, AA male)
Examining Beliefs	“…the “should” belief are the things that I had embedded so deep inside… just saying, Well, I’ve got to do it, or I should be able to do this, and all these things and just realizing how we can work it and get the problem solved… when we got to the end, we saw that it wasn’t always 100%, that there was a different alternate to work out our problems.” (52 year-old, AA female)
Behavioral Components
Relaxation	“…because really once you get your body relaxed and your mind relaxed, the pain kind of smooth away.” (52 year-old, AA male)
Coping Self-Statements	“And then the cards that we made, like I have a card in my mirror and I have one over my sink… I mean, I’m not taking them down. On my mirror, it says, Good morning, Beautiful. And when I brush my teeth, I always refer to that one. So that gives me a smile to send me on my way.” (36 year-old, AA female)
Expressive Writing	“We had to write about something that was on our mind and had been troubling us. And it brought up a bad memory for me. I didn’t like that. But it was something that I guess you could say it was good to deal with, because I really haven’t thought about it ever since I wrote it that day.” (60 year-old, AA female)
Assertive Communication	“I learned not to say “yes” every time somebody asks you to do something. If I say “no,” just say it in a pleasant voice, not like I’m upset or anything. Just say it and say “no” with a smile.” (68 year-old, AA female)
Information/Knowledge
The Gate Control Theory	“That is the one that stands out the most, the gates. A lot of times if you understand something, you can cope with it better.” (67 year-old, WA female)
General	“Well, it explained a lot. Like I said, we really don’t focus on different things, so it really broke things down. It had a little about our emotions. It just took us through every step about our body that we really wouldn’t - I wouldn’t have ‘thought’ of it.” (52 year-old, AA female)
Treatment Facilitators
Forms (Pre- and Post-Session Process Checks)	“It let you express how you felt and what you were going through. And then, like the things that you learned, they would go over to see that you understood it, or, did you get confused?” (52 year-old, AA female)
Notebooks	“Well, it helped me because I’m going back when I get back home, I’m going to review it and all, and I find it’s helpful because I can – if I got pain, I can start thinking about how I can control the pain and all and thinking of different things in the book to do, and I find it’s working.” (73 year-old, AA female)
Flip chart	“I liked it so much… she had the little board and she’d call on us to do a different scenario and then you would say it out of the class… and just to sit up there and look at it and then you working through problem-solving, working on through it.” (52 year-old, AA female)
Reminded of School	“I took the class as, like I said, pain management. And I went there and I listened at them talk and look at our notes and go over things and it just made me feel a whole lot better because, you know, I didn’t finish school, but coming to the class, it helped me. Felt like I was back in a classroom again and going through classes, and I really love it.” (34 year-old, AA female)
Procedural Barriers
Getting Thoughts Down on Paper	“I know I’m getting something, but I can’t put it down on paper.” (60 year-old, WA male)
Difficult at First, then Came to Understand	“At first I was having a hard time focusing and I’m like, well, this is not gonna work. Then as I got into it and I began to think, yeah, it really can because I have a lot of stress and when you stress out about a lot of things, this doesn’t help the pain at all.” (48 year-old, AA female)
Problems with Homework	“I’ve been out of school for so long, it was hard. But once I got to – you had so much to write about, and I used to always go back and look at things, why you really thought that way, why you really felt that way, and it’s good to have things written down.” (37 year-old, AA female)