Table 1 Content of telephone-delivered cognitive behavioural therapy sessions
Session number | Treatment outline |
|---|---|
1 | Engagement and preparation  Discuss the patient’s experience of post-stroke fatigue  Explain symptoms and potential mechanisms of post-stroke fatigue  Emphasise that maintaining factors are potentially reversible  Explain how to use a diary to monitor daily activities, rest and sleep |
2 | Balancing daily activities, rest and sleep  Review diaries the patient has been keeping to determine current levels of activity, rest and sleep  Discuss strategies to improve sleep patterns  Set SMART goals to increase daily activities and improve sleep  Agree on an initial plan to balance activity levels, rest and sleep |
3 | Increasing daily activities in graded increments  Review the patient’s diary and discuss progress with the initial plan  Discuss new goals to be achieved in the coming weeks (including decreasing the amount of rest)  Agree on a weekly plan to work towards new goals |
4 | Improving emotions and thoughts  Discuss the ‘3-area model’ to explain the links between thoughts, emotions and behaviour  Discuss the unhelpful thoughts and emotions that might occur in response to fatigue  Introduce thought challenging sheets |
5 | Dealing with difficulties in making progress  Identify common ‘blocks’ and setbacks in making progress  Discuss any problems the patient has experienced and agree with the patient solutions (patient taking active role) |
6 | Preparing for the future  Check patient’s understanding of the intervention and discuss their progress  Encourage the patient to suggest new future targets and a plan for working towards them  Ask patient to fill out treatment evaluation forms |
Booster (4 mo after starting intervention) | Review of overall progress  Evaluate the patient’s progress since session 6  Help the patient solve any outstanding problems  Review the patient’s understanding of treatment rationale and skills  Discuss further targets and plans |