Table 2.

Behaviour change taxonomy and opioid tapering

I-WOTCH group based sessions day 1 (week 1)	Aims	Theoretical underpinnings	Behaviour change taxonomy
Introductions, group work, aims	To allow participants to introduce themselves to the group, encourage participation in a safe and relaxed environment, explore expectations and discuss the I-WOTCH course aims	Social cognitive theory Biopsychosocial theory	Improve bonding and group cohesion. Breaking barriers and encouraging self and social awareness
What causes pain? (pain information)	To increase understanding about long-term pain	Biopsychosocial theory Principles of self-efficacy and acceptance	Credible source
Living with pain (Opioid education I)	To increase understanding about use of opioids for long-term pain and encourage participants to start questioning their own knowledge and beliefs about opioids and why they take them	Biopsychosocial theory Theory of planned behaviour and reasoned action Health beliefs	Information about health consequences
Acceptance	To understand and start to accept pain, with a view to implementing self-management strategies as reduction of opioids occurs	Acceptance and self-management of chronic pain	Goal setting Commitment
Attention control and distraction	To learn how to focus the mind away from pain thoughts and use of opioids	Cognitive–behavioural change Self-management of chronic pain Health beliefs	Distraction
Distraction activity—drawing	An opportunity to practise distraction activity and socially interact with group informally	Cognitive–behavioural change Social learning	Behavioural practice Distraction
Good days, bad days—pain, bearable or not?	To reinforce that pain is not just physiological, it is a psychological, social and an emotional phenomenon	Biopsychosocial theory Health beliefs	Information and antecedents Information about health consequences Reattribution of behaviour
The pain cycle (including opioids) and breaking the pain cycle	To explain and identify unhelpful factors in the pain cycle and learn strategies to break the cycle	Biopsychosocial theory Health beliefs	Behaviour substitution (adding in other behaviours to break cycle)
Posture and movement	To promote body awareness, posture and muscle weakness (managing pain without opioids)	Theory of planned behaviour and reasoned action	Guidelines on exercise, physical therapy principles Mindfulness
Relaxation and breathing	To reduce muscle tension and introduce breathing as a relaxation technique	Cognitive—behavioural change Self-management of chronic pain	Behavioural practice Distraction Body changes
Summary of the day	To consolidate learning of the day and outline aims for group day 2.	Acceptance and principles of self-efficacy	Action planning Verbal persuasion about capability

I-WOTCH group-based Sessions Day 2 (week 2)	Aims	Theoretical underpinnings	Behaviour change taxonomy
Reflections from day 1	To understand and empathise with the group	Social learning Self-efficacy	Improve bonding and group cohesion, social cognitive theory
Stress-busting for Health: Action planning, problem-solving, pacing, SMART goal setting	To help the participants logically and systematically identify problems, free think solutions, set achievable goals and create action plans, as a means of escaping the pain cycle	Cognitive–behavioural change Theory of planned behaviour and reasoned action	Goal setting Comparative imagining of future outcomes Reduce negative emotions Problem-solving
Withdrawal symptoms, case studies (Opioid education II)	To discuss potential withdrawal symptoms that participants might experience if their taper is too quick	Health beliefs Social learning	Social comparison (drawing attention to others’ performance to allow comparison with the person’s own performance) Credible source Comparative imagining of future outcomes
Distraction activity—origami	To learn how to focus the mind away from pain thoughts and use of opioids	Cognitive–behavioural change Social learning	Behavioural practice Distraction
Identifying and overcoming barriers to change	Introduce ideas about unhelpful thoughts, automatic thoughts and errors in thinking. To identify reasons why people stay in the pain cycle, and barriers to change. Introduce positive reframing	Cognitive–behavioural change Self-management of pain	Problem-solving Reduce negative emotions Framing/reframing
Mindful attention control	To introduce Mindfulness as a tool to train attention and distract from pain	Principles of mind body therapies and biofeedback and visualisation	Behavioural practice Distraction Body changes
Balance and stretch	To promote body awareness and core strength	Guidelines on exercise Physical therapy principles	Demonstration of behaviour Behavioural practice
Summary of the day	To consolidate learning of the day and outline aims for final group day 3. A reminder to attend the one to one appointment with the clinical facilitator.	Acceptance and principles of self-efficacy	Action planning Verbal persuasion about capability

I-WOTCH group based Sessions day 3 (week 3)	Aims	Theoretical underpinnings	Behaviour change taxonomy
Reflections from day two	To understand and empathise with the group and ascertain current thoughts	Social learning Self-efficacy	Review of behaviour
Anger, irritability and frustration	Identifying reasons for negative emotions and implementing goal setting and action planning	Cognitive–behavioural change Theory of planned behaviour and reasoned action	Reduce negative emotions Goal setting Action planning
Relationships: getting the most from your healthcare team (part1)	To reflect on consulting behaviour and promote effective communication and constructive consultations	Biopsychosocial theory Theory of planned behaviour and reasoned action	Information about antecedents Instruction on how to perform a behaviour (communication skills)
Relationships (part 2) listening skills	To improve listening and communication skills	Biopsychosocial theory Theory of planned behaviour and reasoned action	Social support (emotional)
Managing setbacks and non-drug management techniques	To know what to do when experiencing a setback or a flare up	Cognitive–behavioural change Self-efficacy	Anticipated regret Focus on past success
Mindful distraction activity –colouring	To learn how to focus the mind away from pain thoughts and use of opioids	Principles of mind body therapies and biofeedback and visualisation	Behavioural practice Distraction Body changes
Stretch	To learn how to stretch muscles gently with low risk of injury and pain	Biopsychosocial theory Self-efficacy Principles of acceptance	Demonstration of behaviour Behavioural practice
Mindfulness of thoughts and senses	To learn how to apply mindfulness of thoughts by detaching emotion from reality, to appreciate ‘the now’	Principles of mind body therapies Biofeedback and visualisation	Distraction
Summary of the day	To consolidate the days learning.	Acceptance and principles of self-efficacy	Action planning
Summary of the course	To clarify learning from past three group days and motivation to continue with opioid reduction	Acceptance and principles of self-efficacy	Review of behaviour Verbal persuasion about capability

One to one session	Aim	Theoretical Underpinnings	Behaviour Change Taxonomy
Interaction one: face to face with clinical facilitator	To reflect on group learning days, agree tapering goals and generate tapering plan	Cognitive–behavioural change Motivational Interviewing	Goal setting behaviour Action planning Graded task Pros and cons
Interaction two: 30 min via telephone call with clinical facilitator	To reflect on progress and offer support during the tapering process	Cognitive–behavioural change Motivational Interviewing	Review behaviour Behavioural contract (adapted – as generated plan written) Social reward (congratulating on effort made and progress towards tapering-verbal)
Interaction three: 30 min via telephone with clinical facilitator	To reflect on progress and offer support during the tapering process	Cognitive–behavioural change Motivational Interviewing	Identification of self as role model (their own behaviour may be an example to others as they taper)
Interaction four: face to face with clinical facilitator	To reflect on progress so far and discuss goals for future	Cognitive–behavioural change Motivational Interviewing	Review behaviour Review outcome goal If applicable: discrepancy between current behaviour and goal feedback on behaviour Goal setting (behaviour) Goal setting (outcome) Action planning