Table 1.

PainTRAINER Modules

#	Coping Skill(s)	Content
1	Progressive Muscle Relaxation	• Introduce program and concept of pain coping skills • Therapeutic rationale (how thoughts, feelings, and actions affect pain through pain “gate”) • Introduce progressive muscle relaxation • Exercise: Provide opportunity to practice progressive muscle relaxation • Help user identify positive aspects of experience to reinforce use of skill • Help user identify and address barriers to use of skill • Describe importance of regular practice and how to set up practice reminders • Set practice goal
2	Mini Relaxation Practices	• Review progressive muscle relaxation and practices completed in prior week • Introduce “mini-practices” (brief relaxation) • Exercise: Provide an opportunity to do sitting and standing mini-practices • Help user identify positive aspects of experience to reinforce use of skill • Help user identify and address barriers to use of skill • Describe how to set up practice reminders and set practice goal
3	Activity / Rest Cycling	• Review mini-practice and practices completed in prior week • Introduce activity/rest cycling • Exercise: Identify activities user tends to overdo • Vicarious learning: Demonstrate how others have changed overdone activities • Exercise: Create personal plan to use skill that fits personal activities and goals • Discuss how other skills help with use of this one • Set practice goals for this skill and review practice goals for other skills
4	Pleasant Activity Scheduling, Negative Automatic Thoughts	• Review activity/rest cycling and practices completed in prior week • Introduce pleasant activity scheduling • Exercise demonstrating how to select and add pleasant activities to routine • Schedule 3 pleasant activities for week • Problem-solve barriers with interactive vicarious learning exercise • Introduce concept of negative automatic thoughts • Exercise demonstrating how to identify negative automatic thoughts • Set practice goals for week and review practice goals for other skills
5	Negative Automatic Thoughts, Coping Thoughts	• Review pleasant activity scheduling and practices completed in prior week • Continue lesson on automatic thoughts, then introduce concept of coping thoughts • Exercise: Identifying negative thoughts and reactions to them • Exercise: Creating coping thoughts to address negative thoughts • Exercise: Identify and address circumstances that hinder use of skill • Set practice goals for week and review practice goals for other skills
6	Pleasant Imagery and other Distraction Techniques	• Review coping thoughts and practices completed in prior week • Introduce pleasant imagery and other distraction techniques • Provide an opportunity to practice pleasant imagery and explore experience • Exercise on identifying negative thoughts and reactions to them • Set practice goals for week and review practice goals for other skills
7	Problem Solving	• Review pleasant imagery, distraction, and practices completed in prior week • Introduce concept of problem solving • Demonstrate problem solving, illustrated by stories told by other people • Exercise: Select skills for different situations, with personal plan for overcoming barriers • Set practice goals for week and review practice goals for other skills
8	Monitoring for Maintenance	• Review content of all modules • Exercise: Evaluate skill use and helpfulness, including comparison with others’ experiences • Exercise: Develop plan for maintaining use of skills • Present rationale to motivate continued practice and skill development • Review practice goals for skills