Ires Ghielen

129 BEWARE: Study protocol of the pilot RCT Experimental condition: body awareness training (BEWARE) The experimental intervention is delivered by professionals from the fields of psychology, physical therapy and psychiatry. The BEWARE training is mainly based on the principles of ACT [34]. The goal of this training is to acquire and apply adequate coping strategies with wearing-off, and live a valuable life despite the presence of wearing-off symptoms. Psycho-education about PD and wearing-off is discussed by the psychiatrist. The psychologist explains and trains the concepts of body awareness, cognitive defusion, valued living and applies imaginary exposure, in ACT therapy known as FEEL (Feeling Experiences Enriches Living) exercises [34]. During the imaginary exposure, patients are asked to imagine a real-life situation that easily triggers wearing-off. The patients practice with experiencing and daring to allow the feelings that are triggered by the ‘off’ during this imaginary exposure. The patients are encouraged to gradually take part in activities that they previously avoided because of the (anticipation of) wearing-off. The psychological exercises are alternated by physical exercises that are performed by the physical therapist. These exercises include movement strategies and moving on rhythmic music which helps the patients to relieve stress after the imaginary exposure. To generalize the intended effect, the patients are given homework assignments, such as body awareness exercises and planning value-based committed actions in daily life. Control condition: treatment as usual (TAU) The patients in the control group receive treatment as usual based on the current KNGF guidelines for physical therapy in patients with PD [35]. As in the experimental condition, patients are taught movement strategies. Outcome measures Primary outcome measure The primary outcome measure is self-efficacy, assessed with the 10 item General Self Efficacy Scale (GSES) [36]. Self-efficacy is defined as the extent or strength of one’s belief in one’s own ability to complete tasks and reach goals, in other words; a person’s belief in his or her ability to succeed in a particular situation [37]. In this questionnaire, patients are asked to rate specific statements on a scale from 1 to 4 (1 = not at all true, 2 = hardly true, 3 = moderately true, 4 = exactly true). 7