Table 1

Cognitive behavioural therapy intervention topics for each session plus supporting materials

Week1st HourSupport materials2nd Hour
1

  • a) Course purpose and expectations—Why are we here?

  • b) Establish ground rules

    Commitment, confidentiality, homework

  • c) Validate your fatigue—share and discuss

    Fatigue experiences (differentiate from flare)

    Self-management strategies and struggles to change

H: Arthritis Research UK booklets
H: Setting our course (groups' ideas)		Energy management

  • Boom and bust behaviour

  • Rewards/pitfalls of boom and bust

  • Prioritise, balance, pace, plan

  • Barriers to pacing, choices


H: Achieving a balance
H: Activity cycling
T: Energy management diaries
2

  • a) What are your priorities for change in your life?

    What are your drainers and energisers?

  • b) Self-sabotage in the course—How might you do that?

T: Wheel of life (priority areas)
H: Best ways of self-sabotage		Goal setting (in groups of 3–4)

  • Individual short-/long-term goals

  • Use peer group for ideas

  • Contracting

3Sleep and rest

  • How much do we need? Quality vs quantity

  • Sleep hygiene strategies for individual patients

H: Getting a better night's sleep
T: Sleep diary (if needed)		Goal-setting review, new goals
4Stress and relaxation

  • Personal stressors, physiological reactions to stress

  • Relaxation rationale and techniques

H: Effects of stress
H: Relaxation practice guide
T: Relaxation CD		Goal-setting review, new goals
5Assertiveness

  • Passive, manipulative, assertive? Which are you?

  • Other people's reactions to these?

  • Communicating your needs

M: Cartoon examples
H: Saying ‘No’		Goal-setting review, new goals
6Reviewing our self-help toolkit, course consolidation

  • What have you learnt? Review each topic


Dealing with setbacks—what might you do?

  • Negative self-talk, automatic thoughts and rumination

M: Islands:

  • Desert island now=passive

  • Mainland=unrealistic 100% health

  • Adaptive coping island=realistic (good life despite rheumatoid arthritis)


M: Fatigue pit: falling in, digging out
H: The pit and tools to dig yourself out
H: Coping with setbacks		Goal-setting review, new goals
7Review past 8 weeks and all topics

  • How did you get on?

  • How did you/will you deal with setbacks?

  • Goal follow-up

  • H, handouts; M, metaphor; T, tools.