This investigation evaluated the efficacy of relaxation training and cognitive therapy separately and in combination in enhancing the coping skills of patients during epidural steroid injections. Subjects consisted of 80 back pain patients. They were randomly assigned to four groups to receive either relaxation training, cognitive therapy, relaxation and cognitive therapy, or attention control treatment. All subjects were provided preparatory information describing the procedure for the epidural injection and typical physical sensations experienced by patients undergoing the procedure. Relaxation training consisted of Jacobsonian progressive relaxation instructions which were modelled by the trainer. Cognitive therapy consisted of instructions and a work sheet designed to assist subjects in designing positive (rational) self statements concerning the injection procedure. Attention control procedures involved instructions and written exercises of equal duration to the relaxation and cognitive treatments but containing no instructions for the control of anxiety and pain. The three experimental groups exhibited significantly fewer "ae1f-distress" verbalizations during the injection. On other dependent measures, namely, the remaining catagories of pain verbalizations, gross body movements, heart rate, and independent ratings of anxiety there were no significant differences among experimental and control groups. Results are discussed in terms of spontaneous use of coping skills, habituation, individual differences …