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Table 1 Major therapeutic elements of the stepped care approach of BRIA (Bridging Intervention in Anesthesiology); Kerper et al., Effects of an innovative psychotherapy program for surgical patients - Bridging Intervention in Anesthesiology: A randomized controlled trial. Anesthesiology 2015;123:148-59 [6]

From: Readiness to change and therapy outcomes of an innovative psychotherapy program for surgical patients: results from a randomized controlled trial

Step I: Computer assisted psychosocial self-assessment and brief written computerized advice (BWA) for all patients

Components

 • Multiple-choice questions that can be answered by use of mouse, without requiring any input from keyboard

 • Duration: Approximately 25 min per patient

 • Items: Standardized psychological screening tests and single items concerning psychological distress, as well as social, lifestyle and psychological factors related to mental health and psychosocial therapy

Objective

 • To offer computerized tailored BWA to all participants of the screening

Topics of BWA

 • For patients without clinically significant psychological distress: Positive feedback of screening test results indicating healthy lifestyle

 • For patients with clinically significant psychological distress: Detailed, individually tailored feedback of test results indicating psychological distress; if required suggestions concerning therapy and behavior changes

 • Domains: Depression, anxiety, general psychological distress, substance use problems (alcohol, illicit drugs, tobacco), well-being, quality of life, other health factors like weight, sleep and physical exercise

Step II: BRIA psychotherapy sessions for patients with comorbid mental disorders

Components

 • Inpatient therapy sessions during hospital stay, outpatient sessions after discharge

 • Bedside visits and sessions in therapy rooms

 • Duration up to 50 min per session

 • Outpatient BRIA sessions up to 3 months postoperatively, booster sessions up to 6 months postoperatively

Objectives

 • To motivate patients with mental disorders and support them in participating in subsequent psychosocial health care options

 • To initiate the improvement of patients’ psychological symptoms and well-being

Topics of therapy sessions

 • Detailed psychological assessment and clarification of diagnoses of mental disorders according to ICD-10

 • Development of therapeutic alliance and activation of resources

 • MI to enhance motivation for therapy participation and behavior change

 • Emotional relief and individually oriented crisis interventions

 • Introduction of relaxation and stress management techniques

 • Guided discovery of reciprocal relationships between behavior, cognition, emotion and medical conditions

 • Elaboration of a biopsychosocial model of disease and health

 • Introduction to the concept of coping and problem skills training

 • Information on psychosocial mental health care options and teaching of skills how to apply for programs of psychosocial health care