Effects of Combining Cognitive Behavioral Therapy with Bilateral Upper Limb Training in Stroke Patients: A Randomized Controlled Trial

Table 1

Cognitive behavioral therapy.

Stage	Session	Topic	Contents
Initiation	1–3	(i) Introduction to the program and education	(i) Program overview; (ii) Information on stroke and hand coordination & education on the use of the hemiplegic upper limb; (iii) Education on cognitive behavioral therapy
Development	4–6	(i) To have a positive mindset and build self-confidence	(i) To read positive phrases regarding acceptance; (ii) To read poems describing feelings and to highlight favorite words and sentences; (iii) To read positive phrases regarding courage and to choose and write down favorite phrases
	7	(i) To learn how to reduce tension by relaxation through breathing	(i) To learn the behavioral techniques of relaxation and breathing; ⟶ From session 7 onwards, the relaxation and breathing techniques are practiced at each session
	8	(i) To energize behavior	(i) To record the activity performed at each hour and to evaluate the sense of joy and accomplishment together; ⟶ From session 8 onwards, weekly activities are planned together
	9–12	(i) To turn negative thoughts into positive thoughts	(i) To read an autobiography of someone with stroke experience and to make a note of thoughts and resolutions; (ii) To draw one’s own body while pushing away any negative feelings from the body; (iii) To recall a pleasing moment of the day and to record details and the positive feeling of the moment; (iv) To think of a pleasant activity and actually perform the activity
	13–17	(i) To improve self-esteem and remember to have a positive mindset	(i) To identify a cognitive distortion and find a solution on one’s own; (ii) To think of something, one is good at and to write down the thoughts and feelings related to it; (iii) To read a negative story and recall the meaning of the story; (iv) To remind oneself how valuable he or she is; (v) To write a word of advice to another patients with stroke
Termination	18–20	(i) Completion of the program and making a resolution to have a happy life	(i) To learn how to respond to a negative situation; (ii) To write about the feelings one had throughout the program; (iii) To make a resolution towards one’s positive life ahead