Table 1.
Summary of contents of the exposure and care-as-usual programs.
| Exposure Program | Care as Usual (GA) | |
|---|---|---|
| Underlying paradigm | Classical conditioning; cognitive behavioral | Operant learning principles |
| Main treatment aim | Restore adolescents’ age-appropriate functional abilities by reducing pain-related fear through gradual exposure to fear-provoking activities | Increase adolescents’ age-appropriate functional abilities by encouraging desired behavior and time-contingent stepwise increase in activity levels |
| Therapists | Consultant in rehabilitation medicine, psychologist, physiotherapist or occupational therapist | Consultant in rehabilitation medicine, psychologist, physiotherapist or occupational therapist |
| Number of sessions | 1 intake with consultant in rehabilitation medicine + 14 sessions of 1 h. 3 sessions for parents | Variable, from 9 to 16 sessions |
| Treatment overview in phases | Phase 1: intake + PHODA-youth (1 h): cognitive behavioral analysis of complaints and consequences Phase 2: education (1 h) about treatment rationale, personal fear-avoidance model Phase 3: Exposure with behavioral experiments (12 × 1 h), exposure to fear-provoking activities and movements, generalization and relapse prevention |
Phase 1: inventory of the problem Phase 2: problem analyses Phase 3: education Phase 4: choosing activities Phase 5: determining baseline (pain-contingent functioning) Phase 6: determining goal and scheme to increase activity Phase 7: executing scheme, time-contingent increase of activities, encouraging of successful behavior Phase 8: generalization and evaluation |
| Parent module | 3 sessions of 2 h: medical education and treatment rationale, the role of pain in the family system, generalization and relapse prevention | No separate parent program |
| Additional physical training + alternative treatment schedule | Adolescents with pain complaints related to hypermobility receive 16 (x2 h) physical training focusing on aerobic capacity, muscle strength, core stability, proprioception | No separate program for adolescents with pain complaints related to hypermobility |
PHODA-Youth = Photograph Series of Daily Activities—Youth.