Fatigue is a common and severe problem for many patients with arthritis. It has a significant impact on all aspects of their lives, including not only doing daily tasks, but consequences on their relationships, family life and work. However, despite its frequency and severity (often worse than pain), research shows that patients feel that the rheumatology team does not offer support for managing fatigue and that they struggle to manage it alone. Further, research shows that nurses do not know what support to offer. A systematic review of trials, suggests some evidence for exercise interventions and for psycho-social interventions, including cognitive behavioural therapy (CBT).
CBT is an approach that examines the links between thoughts, feelings and behaviours and how these may be influencing symptoms. For example, someone who continues to work overtime in the office, despite severe fatigue from arthritis, may be driven by thoughts that must always do everything perfectly, underpinned by feelings of anxiety that their colleagues will think less of them if they go home on time. Thus their behaviour and hence their fatigue, is partly driven by their thoughts and feelings, and they are unlikely to reduce their working hours just because a health professional tells them this is what they must do.
People are best convinced by their own arguments, therefore the aim of CBT is to structure the discussion in such a way that the patient can work out the answers to the questions about their behaviour themselves (Socratic questioning). With help, patients can work out what thoughts and feelings drive their behaviours, and then they can be helped toward challenging those thoughts and feelings (and eventually the behaviours).
In addition to Socratic questioning, CBT incorporates other techniques such as the use of daily diaries to help people understand their own behaviour patterns, trying experiments to make changes, helping people understand choices they are making and options available, and the use of peers to help them learn, as well as goal-setting (covered by another speaker).
This presentation will examine how health care professionals might use a cognitive behavioural approach in their clinical practice when supporting patients with fatigue. It will provide useful tips that professionals might like to try out in clinic. The evidence-base will be from a published RCT of fatigue self-management.
Disclosure of Interest None Declared