Behavioural Activation for Chronic Pain

The intervention will consist of Behavioural Activation Treatment (BAT) and Behavioural Relaxation Training (BRT). The intervention program will consist of 10 weekly, 1-hour sessions. The treatment protocol will be adapted from the Behavioural Activation Treatment for Depression- Revised (BATD-R) manual. BATD-R will consist of psychoeducation for chronic pain, daily monitoring of activities, selection and graded hierarchy of activities and goals based on individual values, and contacting other individuals. Homework tasks are given at the end of each session. These homework tasks will include a daily monitoring of activity level, completing a Life Areas, Values, and Activity Inventory (selecting important life areas and values and selecting corresponding activities), and towards later sessions daily monitoring with activity planning. BRT is comprised of ten postures and activities that are characteristic and can be observed in a relaxed person. The participant is guided through each of the ten postures and activities by demonstration, modelling, and correction by the therapist as to how the relaxed posture should feel and look. Once the participant has acquired these ten postures, the therapist observes how relaxed the participant is and can also provide feedback. Observations continue to be made over successive training periods to gauge progress in acquiring relaxed behaviours. BRT will be included in the 10 weekly 1 hour sessions along with BATD-R. Homework will consist of 20 minutes of relaxation per day. The homework will require the participant to practice each of the 10 postures at a convenient time in their day. The therapist will be trained to deliver BRT. To ensure accuracy, independent observers will observe and report the same events during training to ensure reliable observation of BRT. The observers should attain an agreement of 85% or better on the Behavioural Relaxation Scale. The therapist will be periodically assessed for maintenance of skills. The intervention will be provided by a post-graduate Master's student who will receive weekly supervision from a registered clinical psychologist who has been in practice for 16 years, has a behaviour therapy background, and experience in delivering Behavioural Activation therapy. Sessions will be video recorded and 30% of videotaped sessions will be assessed for their adherence to session checklists. Observer agreement of the Behavioural Relaxation Scale will also be periodically assessed with the help of a volunteer to perform the relaxed behaviours.