Table 1.

Outline of active group sessions in NAT-FM treatment.

Review Phase (15 min)

• Comment on the duties of the previous session.

• Review of contents of the previous session.

Main Phase (1 h 40 min)

• 20 min Pain Neuroscience Education (PNE).

• 40 min Exercise therapy (TE) or Nature Activity (NA) or both (20 min each).

• 20 min Cognitive Behavioral Therapy (CBT).

• 20 min Mindfulness training (MT)

Sessions:

1. PNE (1,2) + CBT (1) + MT (1)

2. PNE (3,4) + TE (2) + CBT (2, 13–18) + MT (2)

3. PNE (5,6) + TE (2) + CBT (3, 19–23) + MT (3) + NA (3)

4. PNE (7,8) + TE (4) + CBT (4, 24–28) + MT (4)

5. PNE (9,10) + TE (4) + CBT (5, 15–28) + MT (5) + NA (3)

6. PNE (11) + TE (2) + CBT (6, 29–34) + MT (6) + TE (4)

7. PNE (12) + TE (4) + CBT (7,8, 35–40) + MT (7,8) + NA (5)

8. PNE (13) + TE (4) + CBT (9, 41–44) + MT (9) + NA (3)

9. PNE (14) + TE (2) + CBT (10, 45–48) + MT (10)

10. Family Session (PNE 1–16) + NA (3)

11. PNE (15) + TE (4) + CBT (11, 47–48) + MT (11) + NA (5)

12. PNE (16) + TE (4) + CBT (12, 18, 28, 34, 40, 48) + MT (12)

Homework (5 min)

• TE (1): first month once per week, second month twice per week, and third month three times per week. • Cognitive (related to CBT and MT) and physical tasks to do at home to increase the patient’s resistance involving a constant challenge for them.

Note: The numbers in parentheses from 1 to 16 of pain neuroscience education (PNE), from 1 to 48 of CBT, from 1 to 5 of TE/NA and from 1 to 12 of mindfulness training (MT) are explained on Table 2. The exercise therapy was designed following the recommendations of the American College of Sports Medicine (ACSM) and was performed following the same procedures described elsewhere (Serrat 2020). TE/NA, therapeutic exercise with nature exposition.