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Table 1 Content of the Fear of Recurrence Therapy (FORT) intervention sessions

From: Protocol of a randomized controlled trial of the fear of recurrence therapy (FORT) intervention for women with breast or gynecological cancer

Session number

Description

1.

- Self-introduction by each participant, with a focus on their experience with fear of cancer recurrence.

- Introduce major heading of the Fear of Recurrence Therapy (FORT) from the six sessions.

- Introduce the automatic thought, behavior, and consequence therapy model and the fear of cancer recurrence model (FCRM).

- Introduce notions of cognitive restructuring and how to identify FCR triggers.

- Teach and practice progressive muscle relaxation.

 Homework: Practice progressive muscle relaxation daily. Complete thought journal and challenge maladaptive thinking about the fear of cancer recurrence.

2.

- Prepare questions for nurse specialist, who provides education about general cancer screening guidelines and signs of recurrence in Session 3.

- Help participants deal with the fact that uncertainty can never be eliminated.

- Discuss ways of regaining a sense of control using Wheel of Life exercise.

- Teach calming self-talk. Provide participants with relaxation CD audio and instruct them to use calming self-talk phrases with their relaxation CD when appropriate.

 Homework: Listen to CD every day. Practice calming self-talk. Complete thought journal and challenge maladaptive thinking about the fear of cancer recurrence. Prepare questions for the specialist nurse visit in Session 3.

3.

- Visit from nurse specialist.

- Increase tolerance for uncertainty by discussing acceptable levels of worry.

- Challenge faulty beliefs about benefits of worry.

- Decrease maladaptive coping strategies.

- Teach and practice guided imagery.

 Homework: Practice guided imagery daily. Continue challenging faulty beliefs about benefits of worry. Complete thought journal, adding a column for behaviors to monitor coping strategies that participants are adopting.

4.

- Provide psycho-education about worry and the need for exposure to worst fears.

- Promote emotion expression and confront specific fears that underlie fear of cancer recurrence.

- Write down worst-fear scenario.

- Teach and practice mindfulness using a body scan through breathing exercise.

 Homework: Read worst-fear scenario every day and then do a self-care activity. Practice mindfulness exercises daily.

5.

- Review exposure to worst fear scenario exercise.

- Discuss ways of coping with some of the feared outcomes.

- Promote expression of demoralization feelings.

- Encourage participants to re-engage with important life goals, people or activities they may have given up.

- Discuss what meanings the future and planning now have for them.

- Teach and practice mindfulness using eating meditation (Raisin meditation).

 Homework: Challenge their worst fear scenarios into more likely realistic ones. Write down goals and priorities for the future.

6.

- Review all content covered.

- Discuss future goals.

- Set new priorities.

- Promote saying good-bye to the group and provide closure.