Table 1 Intervention techniques used in the Group CBT treatment

SESSION 1

▪ Participants discuss experiences of breast cancer, HF/NS, and personal goals for treatment

28, 6

▪ Provide information about physiology of HF/NS and the role of thoughts, feelings and behaviours

1

▪ Discuss triggers of HF/NS and ways to modify them

28, 8

▪ Introduction to full body relaxation

21, 26

HOMEWORK:

▪ Monitor and modify triggers of HF/NS

▪ Practice full body relaxation

9, 26

SESSION 2

▪ Participants feedback on homework from previous session, with group support and problem solving of difficulties and focus on positives

19, 28, 29, 8, 18

▪ Provide information on stress and discuss its impacts on HF/NS

36, 1, 2

▪ Provide examples of cognitive and behavioural stress management techniques

36, 21

▪ Participants create a specific stress goal to enhance wellbeing

7

▪ Introduce paced breathing to relaxation

21, 26

HOMEWORK as before plus:

▪ Implement stress goal

7

▪ Practice paced breathing

9, 26

SESSION 3

▪ Participants feed back on homework from previous sessions, as above

19, 28, 29, 8, 18

▪ Discuss cognitive, emotional and behavioural reactions to HF/NS and generate more helpful responses

8

▪ Participants try out some cognitive and behavioural strategies for managing HF/NS

26

▪ Introduce use of paced breathing and cognitive strategies at onset of HF/NS to reduce impact of flush

21, 26

HOMEWORK as before plus:

▪ Monitor thoughts, feelings and behavioural reactions to HF/NS, practice more helpful reactions

17, 26

▪ Practice paced breathing at the onset of a HF/NS

9, 26

▪ Complete a sleep diary for a week

17

SESSION 4

▪ Participants feedback on homework from previous sessions as above

19, 28, 29, 8, 18

▪ Provide information on sleep and discuss sleep diaries

1, 2

▪ Discuss behavioural strategies for improving sleep quality

21

▪ Participants create an action plan to implement two sleep goals

7

▪ Practice relaxation and paced breathing

21, 26

HOMEWORK as before plus:

▪ Implement sleep goals

24

SESSION 5

▪ Participants feedback on homework from previous session as above

19, 28, 29, 8, 18

▪ Provide information on thoughts and sleep

1

▪ Provide tips on managing cognitive and emotional reactions to sleep difficulties

21

▪ Create action plan to change thinking and behaviour when having sleep difficulties

7

▪ Practice Relaxation and Paced breathing

21, 26

HOMEWORK as before plus:

▪ Implement second set of sleep goals

7

SESSION 6

▪ Participants feedback on homework from previous sessions as above

19, 28, 29, 8, 18

▪ Discuss overall progress and write a therapy blueprint by identifying helpful strategies, potential barriers or setbacks, ways of spotting setbacks and overcoming them, and a maintenance plan for future goals relating to the treatment

35, 16, 17

▪ Group discussion of managing uncertainty and future plans, and symptoms in the context of breast cancer

29, 28

▪ Practice Relaxation and Paced breathing

21, 26

▪ Goodbye and how to access help in the future

29