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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
 • 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
 • 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
 • 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
 • 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