Cognitive Behavioural Therapy to Optimize Post-Operative Recovery Trial

Inclusion Criteria: * Adult men or women aged 18 years and older. * Presenting to fracture clinic within 2-12 weeks following an acute open or closed fracture of the appendicular skeleton. Patients with multiple fractures may be included. * Fracture treated operatively with internal fixation. * Willing to participate in CBT. * Language skills and cognitive ability required to participate in CBT (in the judgement of site research personnel). * Consistent access to a smart phone and/or tablet that is capable of running the CBT provider's application. * Provision of informed consent. Exclusion Criteria: * Fragility fracture. * Stress fracture. * Concomitant injury which, in the opinion of the attending surgeon, is likely to impair function for as long as or longer than the patient's extremity fracture. * Among patients who are fully weightbearing, those not experiencing any pain in the fracture region. * Active psychosis. * Active suicidality. * Active substance use disorder that, in the judgement of the treating surgeon, would interfere in the patient's ability to partake in the CBT and/or the trial. * Already participating in, or planning to, start other psychological treatments (including CBT) within the duration of the study (12 months). * Anticipated problems, in the judgement of study personnel, with the patient participating in CBT intervention and/or returning for follow-up. * Incarceration. * Currently enrolled in a study that does not permit co-enrolment in other trials. * Previously enrolled in the COPE trial. * Other reason to exclude the patient, as approved by the Methods Centre.