Functional limitation: the subjects also included measures of things they could not do
within the 14 days.
Pain medication: the subjects also recorded the kind and quantity of pain medication.
The subjects also completed the following measures: The state–trait anxiety inventory, which consists of 20 items and asks subjects to rate
how frequently each of the items occurs.
The Von Zerssen Depression Scale (Von Zerssen 1976), which consists of 16 items
describing depressive symptoms (e.g. ‘I can’t help crying’).
General bodily symptoms: the subjects completed a checklist of 57 symptoms, such as
‘nausea’ and ‘trembling’.
Sleep disorders due to pain: the subjects were asked to rate problems they experienced in
sleep onset, sleep maintenance and sleep quality.
Bodily symptoms due to pain attacks: the subjects rated 13 symptoms for their severity
during pain attacks (e.g. heart rate increase, sweating).
Pain intensity over the last week was also measured.
In addition, at six-month follow-up (time 2), subjects who had received the treatment
were asked which of the recommended exercises they still carried out and the physicians
rated the treatment outcome on a scale from ‘extreme deterioration’ to ‘extreme
improvement’.The treatment intervention The treatment programme consisted of 12 weekly 90-
minute sessions, which were carried out in a group with up to 12 patients. All subjects in
the treatment group received a treatment manual. The following components were
included in the sessions:
Education. This component aimed to educate the subjects about the rationale of
cognitive behaviour treatment. The subjects were encouraged to take an active
part in the programme, they received information about the vicious circle of pain,
muscular tension, demoralization and about how the programme would improve
their sense of self-control over their thoughts, feelings and behaviour.
Relaxation. The subjects were taught how to control their responses to pain using
progressive muscle relaxation. They were given a home relaxation tape, and were
also taught to use imagery techniques and visualization to distract themselves from
pain and to further improve their relaxation skills.
Modifying thoughts and feelings. The subjects were asked to complete coping cards to
describe their maladaptive thoughts and adaptive coping thoughts. The groups were
used to explain the role of fear, depression, anger and irrational thoughts in pain.
Pleasant activity scheduling. The subjects were encouraged to use distraction tech-
niques to reduce depression and pain perception. They were encouraged to shift
their focus from those activities they could no longer perform to those that they
could enjoy. Activity goals were scheduled and pleasant activities were reinforced at
subsequent groups.300 HEALTH PSYCHOLOGY