Help Patients Help Themselves

“This provides opportunities to help clients visualize what life can be like when the behavior changes,” Dr. Bartlett said.

It may seem that this motivational interviewing process would take too long for a single patient visit. However, Dr. Bartlett said, “In many cases, this can be part of an ongoing conversation that takes place over multiple clinic visits.”

Patient Should Do the Work

A motivated patient is more likely to make changes in health behavior, said copresenter Dr. Hewlett, whose work in England involves helping patients with arthritis cope with and manage their disease. First, a patient must have self-efficacy, which Dr. Hewlett described as the belief that one has the ability to carry out a task. Principles of self-efficacy include group-based role modeling and homework assignments.

“People learn better in groups, and group members become a credible source for persuasion,” Dr. Hewlett said.

As evidence, Dr. Hewlett presented the recently published results of a randomized, controlled clinical trial.¹ She and her colleagues showed that group cognitive behavioral therapy improves the ability of adults with rheumatoid arthritis to cope with fatigue.

Cognitive behavioral therapy, she explained, helps patients to understand the behaviors needing change and to identify the links between thoughts and feelings that drive behavior and increase the disease symptoms. This step is necessary before patients can set goals, another important component of self-efficacy. Patients should set their own goals for small, specific changes and should find solutions to any barriers to meeting the goals.

“It is crucial that the patient is the one doing the work,” Dr. Hewlett said. “The patient has to feel ownership in the goal.”

Understand Behaviors

For patients to better understand their current behaviors, Dr. Hewlett suggests they complete a daily activity chart for at least a week. With this tool, patients document their behaviors and symptoms for each hour of the day. Arthritic patients, for instance, may record when they sleep, when their energy and activity level is high or low, and when pain and fatigue cause them to “crash” and do nothing. Then the health professional can ask the patient what contributed to recorded patterns, such as sleeping during the day or “crashing” every evening. This process can help patients link behaviors with symptoms and help make changes that they can review in the following week’s activity chart, she said.