Stefan Elbers

162 Chapter 6 Patients reported mixed experiences relating to the role of the health care provider regarding the workbook. Active involvement was considered useful as it facilitated the transition from the workbook to treatment and vice versa. Patients who did not actively discuss the workbook with their HCPs believed that more involvement would have led to better outcomes. As a minimum, they recommended an HCP-led introduction where the use of the workbook would be explained. Acceptability of the Workbook Content Patients and HCPs reflected on what potential action mechanisms were involved and which behavioral outcomes were targeted. Participants reported that the use of Insight Cards helped to create a moment of reflection on important experiences. Also, rereading the experiences provided a better understanding of important treatment concepts. For VBG, patients indicated that it contributed to pacing of activities, planning meaningful goals, and anticipating the effort needed to attain the goals. One patient who used the VBG strategy to plan a long journey in advance commented. A positive experience is ... Normally it is just persisting, no matter what. I will do this now. But here, if you aim for greater things, you will need to work towards it. I have seen that clearly now. [P8] Patients reported a shift from active use during treatment to passive use (as a work of reference) posttreatment. I have not actively used the workbook after treatment, but I am glad that it is available as a reference book. [P17] During active use, VBG especially was considered time-consuming, which hindered regular use for some patients. In the posttreatment phase, one patient reported that reading the workbook content helped him counter an impending relapse. Participants made multiple suggestions for new components to the prototype intervention such as additional reading material on pain education, a specific section that describes the possibility of relapse, and the option of prioritizing the most important Insight Cards. Participants further suggested discussing the workbook with peers during group meetings and made specific suggestions should the workbook be developed into a digital app, such as adding informative video clips and a digital avatar that could interact with the patient. Participants reported that the workbook contributed to facilitating the pursuit of meaningful goals, providing a structure to the treatment process, pacing activities, monitoring progress, and revealing the most important milestones during the program.