| 1 |
Rapport Building, Education, & the Pain Dilemma |
Build rapport; obtain patient history; discuss referral impressions and treatment expectations (e.g., increase in functioning vs. pain reduction); using Pain Dilemma, discuss possible life directions toward pain reduction vs. valued activities; discuss negative impact of the Cycle of Avoidance; introduce GET Living paradigm: graded exposure as means to return to valued activities |
Joint session: same content |
| 2 |
Pain-Worry Cycle & Individualized Formulation |
Build rapport; increase program engagement through motivational interviewing strategies; discuss the Fear Avoidance Model (FAM) and Interpersonal FAM (IFAM) to identify unproductive patterns of activity avoidance; resume discussion of GET Living paradigm, introducing pain willingness (attitude) and activity engagement (action) as tenets |
Joint session: same content; present parent with Interpersonal FAM to be discussed in future session. |
| 3 |
Setting Values-based Treatment Goals |
Review FAM and GET Living homework; discuss values and contrast with goals; assist in identification of adolescent's values across various life domains; discuss appropriate goal-setting; assist adolescent in completing values-based goals. |
Joint session: same content; assist in identification of parents' own values across various life domains; assist parent in completing values-based goals that support adolescent's values-based goals |
| 4 |
Establishing a Fear Hierarchy |
Review values-based goals; discuss rationale for exposures using metaphor and exposure graphs; review PHODA results to select activities for upcoming exposure sessions; place valued activities from each life domain upon hierarchy, from least to most worrisome. |
Joint session: same content; encourage parent to share any valued activities that are not listed on PHODA for inclusion as needed. |
| 5 |
Introduction of WILD scale & Exposure Action Plan |
Review completed hierarchy and rationale for exposures, as needed; discuss use of WILD scale; conduct mini-exposure with a mildly worrisome activity; modify activities and offer support as needed; plan Home Based-Exposures (HBEs) |
Joint Session: Same Content Parent observes adolescent exposure session, participating as appropriate. Psychology offers further explanation and rationale, as well as support to parent. |
| 6 |
Graded Exposure with Behavioral Experiments-1 |
Review HBEs; continuing progressing exposures as appropriate; modify activities and offer support as needed; plan HBEs |
Parent meets separately with psychologist; review IFAM to discuss and normalize cognitive and emotional responses to adolescent in pain; review values-based goals; discuss strategies for increasing distress tolerance, promoting activity engagement and independence, and conveying confidence in adolescent |
| 7 |
Graded Exposure with Behavioral Experiments-2 |
Review HBEs; continuing progressing exposures as appropriate; modify activities and offer support as needed; plan HBEs |
Parent observes adolescent exposure session, participating as appropriate. Psychology offers further explanation and rationale, as well as support to parent. Psychology provides feedback to parent about any naturally occurring responses to adolescent during exposure. |
| 8 |
Graded Exposure with Behavioral Experiments-3 |
Review HBEs; continuing progressing exposures as appropriate; modify activities and offer support as needed; plan HBEs |
Parent meets separately with psychologist; discuss strategies for increasing distress tolerance, promoting activity engagement and independence, and conveying confidence in adolescent |
| 9 |
Graded Exposure with Behavioral Experiments-4 |
Review HBEs; continuing progressing exposures as appropriate; modify activities and offer support as needed; plan HBEs |
Parent observes adolescent exposure session, participating as appropriate. |
| 10 |
Graded Exposure with Behavioral Experiments-5 |
Review HBEs; continuing progressing exposures as appropriate; modify activities and offer support as needed; plan HBEs |
Parent meets separately with psychologist; discuss strategies for increasing distress tolerance, promoting activity engagement and independence, and conveying confidence in adolescent |
| 11 |
Graded Exposure with Behavioral Experiments-6 |
Review HBEs; continuing progressing exposures as appropriate; modify activities and offer support as needed; plan HBEs |
Parent observes adolescent exposure session, participating as appropriate. |
| 12 |
Relapse Prevention, Termination & Future Goals |
Review HBEs; review general progress and accomplishments; discuss importance of relapse prevention and planning for future; target potential obstacles with Hot Seat cognitive-restructuring and problem-solving activity; assist adolescent in developing long-term goals; identify “lessons learned” throughout treatment; present graduation certificate. |
Joint session: same content. |
