APPENDIX B Sample Thought Diary for Use in Chronic Pain
Day & Time Stressful Situation Thoughts
Emotional Response Behavior
Change in Pain?
06/12/15, 8:25am
Pain really bad this morning! Slept wrong.
• This is terrible! • I’ll be late for work again. • This is never going to get better, why keep trying? • My wife is sick of my complaining.
• Angry at myself. • Guilty. • A little hopeless.
Irritable, just get to work already.
A little worse.
APPENDIX C Sample 8-Session Treatment Outline of a Typical CBT Intervention for Chronic Pain
Session
Topic
Content
1. Introduction to CBT treatment
Treatment introduction.
• Agenda setting (ask patient to contribute to agenda). • Introduce rationale for treatment (CBT model). • Discuss where stress and distress come from in CBT approach (including the stressor-cognition-behavior-emotion model). • Discuss five common responses to stressful life events (thoughts, emotions, behaviors, physical symptoms, social interactions). • Discuss “reversing the vicious cycle” (i.e., core CBT premise of breaking the stressor-emotion cycle). • Introduction to pleasant activities scheduling, and first attempt to schedule pleasant activities. • Discussion of role of homework in treatment. • Summary.
2. Problem solving and goal setting
Identification of core problems and development of an action plan to address them.
• Agenda setting (ask patient to contribute). • Review of previous session: stress and distress. • Homework review (including review of weekly pleasant activities). • Identify target problems related to pain. • Develop a goal and action plan for these specific problems. • Ongoing pleasant activities scheduling. • Summary.
3. Chronic pain and CBT
Introduction to chronic pain and disability.
• Agenda setting (ask patient to contribute). • Review of previous session: problem solving and goal setting. • Homework review (goal and action plan; review of weekly pleasant activities). • Discuss chronic pain and impact, including effects on functioning. • Discuss difference between acute and chronic pain. • Discuss difference between pain intensity and pain interference. • Discuss pain-stress relationship. • Introduce role of behavior and cognitions in chronic pain. • Discuss cognitions particularly associated with pain-related interference (including catastrophizing). • Ongoing pleasant activities scheduling. • Summary.
4. Cognitive therapy, part 1
Identifying and evaluating unhelpful thoughts.
• Agenda setting (ask patient to contribute). • Review of previous session: CBT and chronic pain. • Homework review (review of weekly pleasant activities). • Introduction to thought monitoring. • Instruction in use of the Thought Diary. • Discussion of unhelpful thinking patterns in chronic pain. • Ongoing pleasant activities scheduling. • Summary.
5. Cognitive therapy, part 2
• Agenda setting (ask patient to contribute). • Review of previous session: Identifying unhelpful thoughts. • Homework review (Thought Diary; review of weekly pleasant activities). • Practice identifying and challenging pain-related unhelpful thoughts in session. • Introduction to challenging unhelpful thoughts, including CBT techniques (e.g., decatastrophizing, evaluating the evidence). • Introduce Thought Diary, Part 2: Challenging Your Unhelpful Thoughts. • Ongoing pleasant activities scheduling. • Summary.
Challenging unhelpful thoughts.
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