Table 2.

Content outline of MODIA clusters 1 and 2.

Topic (chat title)a			Main goal of the chat		Content outlineb
Cluster 1: “Basic techniques and principles”
	1. Introduction to MODIA (“Meet and greet”)	Orient and engage patients; provide basic education and motivation to continue using MODIA.		Introduction to the program’s function and purpose Facilitating hope and positive expectancies Interactive exploration of patient’s background Risk and safety information Recommendations for optimal program use
	2. Enhancing motivation (“Taking the measurements”)	Build motivation by encouraging patients to reflect on the advantages of abstaining and the disadvantages of continuing to use opioids.		Interactive exploration of current motivation to stop using opioids Exploration of motivational stages of change Enhancing motivation by building awareness of personal reasons for and ability to change
	3. Functional analysis (“The bird’s eye view”)	Empower patients to gain greater clarity on trigger situations and teach simple techniques to improve their ability to resist urges to use opioids.		Build awareness of personal high-risk situations and triggers Introduction to functional analysis Simple techniques to cope with triggers Audio mental imagery/mindfulness meditation exercise to build skills to resist triggers and cravings
	4. Behavioral coping with triggers (“Look over there!”)	Empower patients by teaching them how to identify and avoid high-risk situations and use simple behavioral techniques to cope with such situations.		Interactive functional analysis and structured assessment of: Personal trigger situations Automatically elicited thoughts and feelings Typical behaviors in high-risk situations Short-term consequences Negative long-term consequences Interactive exploration of potential approaches to altering contingencies; using behaviors for distraction coping
	5. Cognitive coping with triggers (“The stranger in the mirror”)	Empower patients by teaching them simple methods targeting cognitions that increase risk for opioid use.		Use of mental strategies rather than physical distraction activities to cope with triggers or urges to use Audio exercise: revisiting the “healthy future self” Fictional case example to illustrate successful and unsuccessful coping Interactive exploration of cognitive coping techniques Recognizing common cognitive distortions
	6. Review of first cluster (“Let’s get physical”)	Review previously learned CBTc techniques and educate patients on role of healthy lifestyle in recovery.		Review of key techniques from previous five “chats” Integrating the CBT techniques to encourage having a healthy lifestyle Interactive exploration of the role of nutrition in opioid dependence Interactive exploration of sleep habits and review of principle of sleep hygiene Audio exercise: mental imagery to review key techniques from Cluster 1
Cluster 2: “Learning psychological flexibility skills”
	7. Defusion and emotional distancing (“The defusion solution”)	Teach patients to learn “defusion” techniques to distance themselves from unhelpful thoughts and feelings.		Introduction to the core topic of Cluster 2: “psychological flexibility” Overview and interactive exploration of the 6 components of PFd (eg, defusion, acceptance, presence, self-discovery, values, and committed action)
	8. Acceptance and distress tolerance (“The acceptance conundrum”)	Teach patients acceptance skills to improve distress tolerance while remaining committed to recovery-related goals.		Introduction to acceptance as a key psychological flexibility technique Interactive exploration of aversive thoughts and feelings Experiential exercise to illustrate difficulties with thought suppression Therapeutic metaphors to convey the principle of acceptance Introduction of the acceptance and commitment therapy concept and the skill of “willingness” Mental imagery story-based exercise to experience and practice willingness
	9. Mindfulness and presence (“Enter the Buddha”)	Teach patients mindfulness techniques to reduce stress and improve coping with cravings, urges to use, and other aversive mental and emotional experiences.		Brief step-by-step guided experiential mindfulness exercise Mindfulness meditation exercises Guided mindfulness exercise Fictional case examples to convey the personal relevance of mindfulness meditation
	10. Self-discovery (“Who am I?”)	Teach patients self-discovery skills to help them cope with high-risk situations and improve their general ability to remain committed towards healthy life goals.		Introduction to the 3 facets of self-discovery: the “conceptual self,” contacting the “stream of consciousness,” and “the observing self” Invitation to engage in expressive writing exercise Fictional case example to illustrate expressive writing; exercises to discover and observe the stream of consciousness Experiential exercise on the “observing self”
	11. Values clarification (“The best values”)	Teach patients to clarify valued life directions to orient them toward a healthy life “beyond opioid dependence” and thereby support their recovery goals.		Mental imagery exercise (“revisiting your healthy future self”) Interactive introduction to personal values clarification as a key component of psychological flexibility Fictional case example to illustrate the relevance of personal values Interactive review of importance and time investment with regard to common core values Interactive exploration of relevance of personal values in the context of opioid dependence
	12. Commitment to healthy actions (“Do it!”)	Teach patients “behavioral commitment” techniques to support their efforts to achieve healthy recovery goals.		Introduction to the “committed action” psychological flexibility facet Review of potential obstacles that might prevent patient from pursuing core values Fictional story to illustrate the concept of “SMART” (specific, measurable, adaptive, realistic, and time-framed) goals Exploration of simple strategies to increase commitment to value-consistent actions Mindfulness-based audio recording on committed action

^aPlease see Multimedia Appendix 1 for a full outline of all 4 MODIA content clusters.

^bMost “chats” also include a brief review of the patients’ emotional state, a review quiz, and homework assignment.

^cCBT: cognitive behavioral therapy.

^dPF: psychological flexibility.