Table 1.
Details of the contents of the cognitive behavioural intervention group sessions
| Session number | 1 | 2 | 3 | 4 | 5 | 6 |
|---|---|---|---|---|---|---|
|
Assessment
|
|
|
|
|
|
|
| History taking including current problems and eliciting beliefs on LBP and activity | ||||||
| Collaborative goal setting with plan to start activity goal | ||||||
| Exercises chosen collaboratively from options with level negotiated | ||||||
| Exercises practised and progression discussed | ||||||
|
Understanding pain
|
✓ |
|
|
|
|
|
| Group activity to demonstrate hurt does not equal harm | ||||||
| Current thinking on causes of long-term pain explained | ||||||
| Discussion on groups experience of alternative treatments for LBP with reference to research evidence and need to self manage | ||||||
|
Benefits of exercise
|
✓ |
|
|
|
|
|
| Discussion of physical impact of inactivity or altered activity and how changes impact on pain (disuse syndrome) | ||||||
| Discussion on effects of activity/exercise | ||||||
| Introduction to LBP model | ||||||
|
Pain fluctuations
|
|
✓ |
|
|
|
|
| Overactivity/underactivity cycle explained | ||||||
| Use of pacing | ||||||
| Group problem solving for a specific task that tends to be ‘overdone’ e.g. gardening | ||||||
|
Working out starting point for exercises or activities
|
|
✓ |
|
|
|
|
| How to use baseline setting | ||||||
|
How to set goals
|
|
✓ |
|
|
|
|
| SMART system used to break down an example goal | ||||||
| Feedback from group on how progressing with goals from assessment | ||||||
| Group problem-solving problems with goals | ||||||
|
Unhelpful thoughts and feelings
|
|
|
✓ |
|
|
|
| Styles of unhelpful thinking discussed, including catastrophising | ||||||
| Link with unhelpful behaviours | ||||||
| Identifying unhelpful thoughts | ||||||
| Group problem-solving for challenging unhelpful thoughts | ||||||
|
Restarting activities or hobbies
|
|
|
|
✓ |
|
|
| Discussion on activities commonly avoided in LBP | ||||||
| Fear avoidance cycle | ||||||
| Group problem-solving out of cycle | ||||||
| Development of specific goals relating to restarting activities | ||||||
|
When pain worries us
|
|
|
|
|
✓ |
|
| Effect of attention to pain explored through group activity | ||||||
| Hypervigilance cycle used to link unhelpful thoughts and behaviours | ||||||
| Group problem-solving out of cycle | ||||||
| Discussion on the use of medication/distraction/alternating activities | ||||||
|
Coping with flare-ups
|
✓ | |||||
| Discussion on causes of flare-ups | ||||||
| Plan of what to do in and out of flare-ups | ||||||
| Revision of topics over previous sessions and questions |
LBP, lower back pain.