Stefan Elbers

155 Preventing relapse after successful treatment rehabilitation program if they had severe or dominant psychiatric conditions, were unable to speak Dutch, were involved in ongoing legal procedures, or insisted on obtaining additional somatic diagnostic procedures. An additional criterion for location Maastricht was that patients needed to experience pain-related fear of performing certain activities in daily life that could be challenged in an in vivo exposure procedure. In this study, all patients who participated in the IMPT were eligible for inclusion. Treatment The outpatient IMPT programs at both locations varied in dose and content but had a similar biopsychosocial perspective and included pain neuroscience education as well as cognitive behavioral approaches to improve physical functioning and health-related quality of life. At minimum, the treatment staff consisted of a physiatrist, physical therapist, and psychologist but could also include a social worker and occupational therapist. Both programs required active patient involvement and included regular interdisciplinary team meetings to discuss the patient’s progress. The treatment program inHoensbroek contained multiple intervention components, including but not limited to graded activity, acceptance and commitment therapy, learning to pace (work-related activities) and set realistic goals under supervision of an occupational therapist, and functional exercise therapy such as swimming or walking under supervision of a physiotherapist. After an initial treatment phase of 3 weeks (5 days per week), a patient-specific program was created that matched dose and content with individual needs. On average, the total program was 12 weeks. The center provided accommodations for patients who were unable to commute to the center on a daily base. Location Maastricht primarily provided exposure in vivo treatment (Bowen et al., 2009; den Hollander et al., 2016; Hollander et al., 2010). At minimum, the program was 2 weeks with 2 treatment sessions per week but could be extended up to 10 weeks depending on the complexity of the case. A typical treatment program contained 20 hours of treatment and consisted of medical education by a physiatrist (that no harm or additional injury could be inflicted by performing activities) and behavioral experiments led by a physical or occupational therapist and psychologist (half of the sessions were led by both HCPs). Materials We developed two strategies to prevent relapse after successful treatment: Insight Cards and Value-Based Goal Setting (VBG). Insight Cards consisted of a set of cards on which patients could write down their most meaningful rehabilitation experiences, ideas, and milestones (Supplement 1). The upper half of the card provided space for the insights, and the bottom half was reserved for a related environmental cue such as a picture or a quote. The collection of these cards allowed HCPs to ensure the intervention was received