Stefan Elbers

153 Preventing relapse after successful treatment INTRODUCTION Interdisciplinarymultimodal pain therapy (IMPT) programs have been developed to address the complex multifaceted nature of chronic pain. Instead of directly treating the pain itself, IMPT programs offer a comprehensive approach to target mutually interacting cognitive, behavioral, emotional, biological, and social factors to improve daily life functioning and quality of life, irrespective of pain (Adams & Turk, 2015; Gatchel et al., 2014; Morley & Williams, 2015). Typically, these programs include an interdisciplinary team of at least three professionals from varying backgrounds that coordinate their therapeutic activities throughout the program in line with patient-centered goals and biopsychosocial treatment principles. Also, IMPT programs are generally provided within a single facility, and patients are actively engaged with their rehabilitation by means of exercises and tasks (Gatchel et al., 2014; Kaiser et al., 2017). Although IMPT programs are often considered treatment of choice for patients with chronic pain (Kamper et al., 2014), there are signs that a considerable proportion of patients are not able to maintain positive treatment outcomes over time (Morley, 2008; Morley et al., 2013; Turk & Rudy, 1991). This problem of relapse is not limited to IMPT; other behavioral treatments show similar trends for various patient groups, including patients following orthopedic rehabilitation (Reuter et al., 2009) and patients with chronic diseases (DiMatteo, 2004; Lee et al., 2013). These results indicate that the problem of relapse may transcend disease-specific treatment. One strategy that has been recommended to improve long-term effectiveness is to adjust the treatment program to specific individual patient characteristics, needs, and preferences (Miettinen et al., 2019; Noar et al., 2007). This tailoring is specifically relevant in the domain of IMPT because these types of treatment programs seldom target one type of behavior but a complex and patient-specific cluster of health behaviors, each associated with patient- specific personal and contextual factors (Steiner, 2012). Moreover, in the context of IMPT, the options to realistically simulate a patient’s natural environment within the boundaries of a treatment facility are limited, which may threaten effective generalization of newly learned behaviors to patient-specific meaningful contexts (Hollander et al., 2010). To provide patients and health care providers (HCPs) with tools that could prevent relapse after successful treatment, we initiated a research project to develop a relapse prevention intervention. In iterations over a period of 18 months, patients, HCPs, pain researchers, experts on behavior change. and designers participated in co-design activities to develop two relapse prevention strategies. These activities ranged from interviews with patients and HCPs to full-day cocreation sessions where ideas were developed into concrete prototypes. In the final phase of the project, the two most promising relapse prevention strategies were merged into a paper prototype intervention. This relapse prevention workbook