Table 1.

Integrated cognitive behavioral therapy protocol for chronic pain.

Integrated CBT protocol for chronic pain
Session 1	Introduction	Therapists explained the purpose of CBT and set short, medium, and long term treatment goals.
Session 2	Psychoeducation	Patients studied ideas such as mechanism of pain, gate-control theory, and acceptance of pain.
Session 3	Relaxation	Patients practiced progressive muscle relaxation and abdominal breathing techniques.
Session 4	Tactile attention-shift training	Patients practiced shifting their excessive attention of pain flexible.
Session 5	Case formulation	Patients learned their own cognitive behavioral models and vicious pain-causing cycles.
Session 6	Safety behaviors	For behavioral activation, patients understand avoiding action due to pain and to learn the demerits of continuing safety action such as avoid, makeshift action.
Session 7	Cognitive restructing 1	Examining patients’ thinking habits and learning how to change their irrational thinking.
Session 8	Cognitive restructing 2
Session 9	Activity pacing	Spacing out activities to manage pain
Session 10	Memory work using the peak end rule.	By re-examining patients’ pain memory, patients learn that their pain memory influences chronic pain.
Session 11	Mental practice	Patients practice imagining the movement of their body that is in pain and maintain hope.
Session 12	Visual feedback	Performing mirror therapy as an alternative, recording patients’ own actions, and observing ideal movement.
Session 13	Behavioral experiments 1	Practicing step by step actions which could not be performed because of pain.
Session 14	Behavioral experiments 2
Session 15	Summary	Review the entire session and confirm whether there are any remaining issues.
Session 16	Relapse prevention	Thinking about how to respond when the pain recurs.

CBT = cognitive behavioral therapy.