Examining the efficacy and acceptability of an internet-delivered pain management program for endometriosis

The Endometriosis Pain Course is an internet-delivered self-management program. It is a psychological treatment based on cognitive behaviour therapy (CBT) principles adapted to address the impacts of endometriosis-associated symptoms and difficulties, such as chronic pain, on women's daily functioning and wellbeing. The course consists of: (a) Five lessons released via the eCentreClinic participant portal over an 8-week period. Each lesson is delivered individually and covers a different topic and introduces 1-2 core CBT skills designed to promote self-management, psychological wellbeing and quality of life. Lesson 1 (released in week 1) provides an introduction and overview of the course, psychoeducation on chronic pain, the pain system, and emotional wellbeing. Participants are encouraged to identify their symptoms (e.g., unhelpful thinking styles, physical symptoms, unhelpful coping strategies) as a home-based exercise. Lesson 2 (released in week 2) provides psychoeducation on unhelpful thinking, particularly as it relates to chronic pain and introduces cognitive challenging skills. Participants are encouraged to practise thought challenging in the following two weeks. Lesson 3 (released in week 4) covers behavioural activation and relaxation strategies to manage mood and anxiety symptoms, and participants are provided with the resources to undertake activity scheduling as a home-based task. Lesson 4 (released in week 5) introduces activity pacing to manage symptoms such as pain and fatigue, and graded exposure to manage anxiety and avoidance. Participants are encouraged to attempt activity pacing and/or graded exposure tasks as a home-based task. Lesson 5 (released in week 7) provides information and strategies relating to relapse prevention. Participants are given materials to develop their own relapse prevention plan and to help with goal-setting for the future. The duration of each lesson is approximately 20-30 minutes. Lessons are completed in weeks 1,2,4,5 and 7. Participants can view lessons via the eCentreClinic's online platform or download them as PDF files. Lessons are are accompanied by worksheets (called DIY guides) which can be downloaded and/or printed as PDF files. Participants are encouraged to engage with the home-based exercises at a frequency and duration that is helpful for them, though a suggested time commitment of at least 30 minutes each week is encouraged. (b) Additional Resources developed specifically for this intervention. These resources provide information about common problems people struggle with, and guidance on how to manage these, such as redirecting attention from pain, managing sleep, working with health professionals etc. (c) Automatic emails that help guide people through the course. Examples of these e-mails include: reminders when new lessons are available, congratulatory messages once a lesson has been completed, brief messages that reinforce the core concepts of the lessons and e-mails inviting contact and encouraging engagement if a participant has not logged in for a while. Participants will have the option of accessing support from a Clinical Psychologist who will be available during the 8 weeks to discuss concepts, answer questions and promote and encourage skills practise. Participants will have the opportunity to schedule regular phone calls with the Clinical Psychologist during the first few weeks of the Course. Participants can also contact the Clinical Psychologist via email and through the secure private messaging system accessed via their participant log in on the eCentreClinic website. The Clinical Psychologist is nationally registered and employed by Macquarie University. They will be provided with training and supervision from a senior psychologist to ensure competence and safety in their practice. Adherence with the intervention is monitored via the study's secure web platform, which records information such as the number of participant log-ins, lesson completions, time spent completing each lesson and number of downloads of additional resources.