Lesson 1Session 5: Mindfulness and interoceptive exposure — body scan, focused attention, tolerating visceral sensationsTeaches mindfulness skills to observe sensations without judgment and reduce reactivity. Covers body scan, focused attention, and interoceptive exposure to GI sensations, emphasizing willingness, curiosity, and safety parameters for local practice.
Introducing mindfulness for GI symptomsGuided body scan for visceral awarenessBreath and anchor focused attentionPlanning interoceptive exposure exercisesManaging distress during exposure practiceIntegrating mindfulness into daily routinesLesson 2Overall format decisions: recommended number of sessions, session length, group vs individual delivery, mixed/online adaptations and rationaleOutlines key format decisions for GI Resilience Training, including recommended dose, session length, and delivery mode. Explains how to adapt for online, hybrid, and group formats while preserving fidelity and safety in Sierra Leone clinics.
Recommended total number of sessionsStandard session length and pacingCriteria for group versus individual formatHybrid and telehealth delivery adaptationsMaintaining treatment fidelity across formatsLesson 3Session 1: Assessment, psychoeducation, and collaborative formulation — goals, intake tasks, and baseline measuresCovers intake procedures, rapport building, and risk screening. Guides clinicians in gathering GI, medical, and psychosocial history, delivering psychoeducation, and co-creating a shared biopsychosocial formulation and treatment plan.
Pre-session screening and referral pathwaysStructured GI and medical history takingAssessing avoidance, disability, and riskPsychoeducation on gut–brain interactionDeveloping a shared case formulationSetting goals and initial home practiceLesson 4Session 7: Sleep, lifestyle, and behavioral activation — sleep hygiene, activity scheduling, pacing to reduce avoidanceAddresses sleep, physical activity, and daily routines dat influence GI symptoms and resilience. Covers sleep hygiene, graded activity scheduling, pacing strategies, and reducing avoidance-driven rest dat maintains disability.
Assessing sleep patterns and fatigueTeaching core sleep hygiene practicesDesigning graded activity schedulesPacing strategies for symptom flaresReducing avoidance and safety restMonitoring lifestyle changes over timeLesson 5Session 6: Emotion regulation and acceptance strategies — ACT exercises, values clarification, urge surfingIntegrates emotion regulation and acceptance-based strategies tailored to GI distress. Uses ACT-informed exercises, values clarification, and urge surfing to help patients act in line with values despite discomfort and urges.
Psychoeducation on emotions and urgesValues clarification and life domainsACT defusion and acceptance exercisesUrge surfing for symptom-driven behaviorsBuilding personalized coping menusAssigning values-based action tasksLesson 6Session 3: Cognitive patterns and cognitive restructuring — identifying catastrophic thoughts, thought records and behavioral experimentsFocuses on identifying catastrophic interpretations of GI sensations and related safety behaviors. Teaches cognitive restructuring, thought records, and behavioral experiments to test predictions and reduce symptom-related anxiety.
Mapping common GI-related thinking trapsLinking thoughts, emotions, and behaviorsUsing structured thought record worksheetsDesigning behavioral experiments safelyResponding to stuck or rigid cognitionsHomework review and refinementLesson 7Session 4: Exposure to feared foods and situations — graded exposure principles, hierarchy creation, in-session exposuresIntroduces graded exposure to feared foods, places, and bodily sensations. Guides hierarchy development, in-session exposure planning, and debriefing to reduce avoidance, safety behaviors, and catastrophic expectations.
Functional assessment of avoidance patternsBuilding individualized exposure hierarchiesPreparing patients for exposure rationaleConducting in-session food exposuresConducting situational and activity exposuresProcessing learning and updating beliefsLesson 8Session 8: Relapse prevention, maintenance plan, and discharge — personalized coping plan, booster scheduling, community resourcesGuides consolidation of gains, relapse prevention, and discharge planning. Includes personalized coping plans, early warning signs, booster options, and linkage to medical, psychological, and community supports.
Reviewing progress and remaining barriersIdentifying personal relapse triggersCreating written coping and action plansPlanning booster and follow-up contactsCoordinating with medical providersConnecting to peer and community resourcesLesson 9Session 2: Stress–gut cycle and short-term skills — diaphragmatic breathing protocol and symptom/food diary setupExplains di stress–gut feedback loop and how arousal worsens GI symptoms. Teaches diaphragmatic breathing, brief relaxation skills, and introduces symptom and food diaries to track triggers, patterns, and early treatment gains.
Teaching the gut–brain interaction modelExplaining the stress–symptom feedback loopDiaphragmatic breathing teaching protocolIntroducing brief in-the-moment calm skillsDesigning symptom and food monitoring toolsAssigning home practice and troubleshootingLesson 10Adaptations for severity and comorbidity: stepped adjustments, extended modules for comorbid anxiety/depression, safety planning for severe avoidanceDetails how to tailor di protocol for varying symptom severity, comorbid anxiety or depression, and complex risk. Covers stepped-care adjustments, extended modules, and structured safety planning for severe avoidance.
Stratifying patients by severity levelStepped-care and dose adjustmentsIntegrating anxiety and depression modulesCoordinating with prescribing cliniciansSafety planning for severe avoidanceMonitoring risk and escalation pathways
