Table 1.

An overview of the content of each of the seven sessions in the cognitive-behavioral intervention

Session/time	Focus and skills
1. session	Introduction to the patient education.
2 weeks preoperative	Causes and consequences of pain. Different types of pain.
	Introduction to the cognitive triangle – The link between thoughts, feelings, bodily reactions and behavior.
	Homework: Identify and write down thoughts in relation to painful or stressful situations.
2. session	Active and passive coping strategies.
1 week preoperative - relatives are invited to participate	How to cope with pain and distress in relation to family, relatives and work.
	The consequences of fear avoidance and the link between activity and pain.
	Relaxation and mindfulness exercise.
	Homework: Identify and write down your own coping strategies when in pain or distress. Relaxation and mindfulness exercise.
3. session	Appropriate activity management – activity pacing.
3–5 days preoperative	Pleasant activity scheduling.
	Goal setting.
	Introduction to pain diary.
	Homework: Identify five activities you used to enjoy and would like to do again.
4. session	Summary of learned skills from previous sessions.
During hospitalization	Goal setting for the next 14 days.
1–2 days postoperative	Appropriate rest and activity.
	Homework: Use the pain diary the next 14. days.
5. session	The cognitive triangle – The link between thoughts, feelings, bodily reactions and behavior.
14 days postoperative	Learning how to change negative automatic thoughts and catastrophic pain-related thoughts into more realistic thoughts by using cognitive restructuring techniques
	Pleasant activity scheduling and activity pacing.
	Homework: Use pacing techniques and pleasant activity scheduling to restart daily activities and hobbies. Write down how it affects your mood and pain level.
	Identify and write down troubled thoughts and how they affect your feelings, bodily reactions and behavior. Consider alternative realistic thoughts.
6. session	Restructuring of inappropriate thoughts.
4 weeks postoperative	Working with the patient’s individual problems.
	Goal setting for the next 2 months.
	Homework: Identify catastrophic and negative thoughts and try to change them to alternative more realistic thoughts.
7. session	Brush up from the 6 previous sessions and a reflection of which coping techniques and cognitive techniques the patient can and will use in the future
3 months postoperative	How to manage and control flare-ups
	Plan for the future

All sessions begins with questions and a talk about the homework from the previous session