Table 2 Summary of the contents of Iconic Therapy and Structured Support Therapy programmes

Iconic therapy + treatment as usual^b

Module 1: Understanding the problem, motivating and acquiring some basic coping skills.

Session 1

Content:

- Presentation.

- Explicative model of pathology: visual understanding of the problem origins and perpetuation as an enduring vicious cycle (the sinking, the blinding and the flight icons)

- Education to recognize patient’s affective reactions (the map icon).

Objectives:

Understanding that it is possible to develop healthier alternatives to replace dysfunctional patterns of thinking, feeling and behaving (to be learnt and trained during the length of the therapy).

Session 2

Content:

- Therapeutic model elaboration: emotional self-regulation techniques (the key phrase and the cooling off time icons).

- Basic skills training: decision making and self-improvement techniques to manage remorse after hurting another (the corsage of alternatives, the telephone and the zig-zag icons).

Objectives:

Acquiring new learning experiences and general self-management skills to control inappropriate emotional responses.

Module 2: Intimacy and empathy.

Session 3

Content:

- Interpersonal problems solution: expressing criticism to reach an agreement (the sacks attack and the translator icons).

- Practical examples and role-playing in groups.

Objectives:

Experiencing self-effectiveness when sharing experiences in interpersonal relationships.

Session 4

Content:

- Interpersonal problems: accepting criticism and getting distance from negative relationships (the black grain, the glass wall and the rock wall icons).

- Practical examples and role-playing.

Objectives:

Sharing experiences of interpersonal relationships in groups.

Session 5

Content:

Negative emotions and cognition management:

- Hostility (the mountain icon)

- Inhibition (the pen icon)

- High expectations from others (the bouquet of flowers icon)

- Cognitive filters (the coloured sunglasses icon)

- External attribution (the tower of books icon)

- Practical examples and exercises.

Objectives:

Detecting and changing negative ways of perceiving and interpreting other people or events.

Practicing motivated behaviors, reflecting intentions and desires.

Module 3: Self-esteem and identity.

Session 6

Content:

- Personality trait optimization (the river icon).

- Others comparison avoidance (the coloured bars icon).

- Overcoming the need to receive a torrent of affection (the self-disqualification pitfall icon).

- Mimetization vs reaching a genuine position (the mimetization and the positioning icons).

Objectives:

Gaining a more stable sense of self and personal security.

Session 7

Content:

- Sense of Emptiness (the Matryoshka dolls icon).

- Negative vs positive behavioral tendencies (the positives and negatives icon).

- Prejudices avoidance (the Mozart icon).

Objectives:

Gaining a more stable sense of self and personal security.

Session 8

Content:

- Emotional balance clues (the table icon).

- Personal dependence avoidance (the flag icon).

- Uselessness of complaining about past experiences and how to take advantages of them (the web and the embankment phrase icons).

- Practical review by sharing practical uses of the icons on group.

Objectives:

Reaching independent self-advise on daily situations.

Module 4: Self-direction.

Session 9

Content:

- Liberty vs impulse slavery: reconceptualization (the bypass road icon).

- Goals setting (the range icon).

Objectives:

Strengthening impulsiveness and risk-taking control.

Session 10

Content:

- Adversity as an impulse towards the goal (the sailboat icon).

- Values and prosocial standards to guide our decisions (the compass icon).

- Practical exercises of people finding their own concretes and vital goals.

Objectives:

Instigating normative ethical behaviour.

Final review (Session 11):

Relapse prevention. Workshop reviewing learned strategies and post-treatment evaluation.

Sixth month review (Session 12):

Relapse prevention. Workshop reviewing learnt strategies.

Twelveth month review (Session 13):

Relapse prevention. Workshop reviewing learnt strategies and 12-month follow-up evaluation.

Structured support therapy + treatment as usual^c

Session 1: Social relationships.

Content:

- Presentation.

- Video and debate. May friends or acquaintances turn into relatives for you? / What is the importance of having a friend to stand by? / Is it possible to find a friend on the internet?.

Objectives:

Participants interacting with other participants of similar characteristics in a casual and secure environment.

Session 2: Risks on the internet.

Content:

Video and debate. What do you use social websites for? selfies, finding partners, photos, risks, problems.

Objectives: Participants interacting with other participants of similar characteristics in a casual and secure environment.

Session 3: Emotional instability and impulse control.

Content:

- Information about the role of emotion regulation and emotional instability (coordinate axis) in emotional disorders.

- Impulsivity definition. The turtle technique (detect the emotion, stop, hide and breathe in the shell, go out and think of a solution).

Objectives:

Debating about the given topics and sharing strategies to deal with them.

Session 4: Emotional regulation and jacobson relaxation technique.

Content:

- Role-playing: The therapist reads a short story and the participants play a role simulating different attitudes towards the story (distracted, aggressive or interested). The rest of the participants try to detect name, intensity and coping skills to deal with shown emotions.

- Soft music and Jacobson relaxation technique.

Objectives:

Session 5: Social skills.

Content:

- Defining empathy and assertiveness.

- Role-playing “the assertiveness umbrella”: the participant with the umbrella is required to express his complaints in front of the rest of the group.

Objectives: Learn to detect internal and external social skills.

Session 6: Social skills ii.

Content:

- Role-playing. The participants are invited to introduce themselves, ask the therapists questions, maintain a conversation with their closer partner or express, in his/her opinion, the best characteristic of the partner on the left.

Objectives:

Increasing assertive behavior in a secure environment.

Session 7: Self-image and communicational styles.

Content:

- Defining identity and self-image by thinking of an admired person (famous, family or friends) and detecting similar traits within themselves.

- Defining communicational styles: passive, aggressive, assertive.

- Videos with examples of people with different communicational styles.

Objectives: Learning to detect their own and other’s necessities.

Session 8: Mindfulness.

Content:

- A specialized volunteer psychologist delivers a mindfulness session lying on the floor, with raisins to be consumed by the therapist and participants as a shared contemplative experience.

Objectives:

Enhancing stress tolerance and contemplation capacity.

Session 9: Self-esteem.

Content:

- Defining self-esteem and main personal characteristics: each participant writes his or her 5 main characteristics on an anonymous paper and gives it to the therapist, who reads them all. When there is a negative characteristic, the therapist tries to explain its usefulness and the way to make it positive.

Objectives:

Improving self-awareness.

Session 10: Self-esteem ii.

Content:

- Self-esteem: participants are incited to exercise their body, trust in their qualities and use them, don’t look for other’s approval, take perspective and accept their problem.

- Self- realization: bearing in mind their best qualities, participants are invited to think of an activity they are motivated for as well as different ways to keep in touch with it.

Objectives: Improving the self-esteem.

Session 11: Relapse prevention. Reviewing the strategies learned across the program and contents and post treatment evaluation.

Sixth month review (Session 12):

Relapse prevention. Workshop reviewing learnt strategies.

Twelveth month review (Session 13):

Relapse prevention. Workshop reviewing learnt strategies and 12-month follow-up evaluation.