Psychological flexibility may be a key

Roisin Hegarty
Roisin Hegarty
University of Otago psychology PhD student Roisin Hegarty (pictured) has won the Otago Medical School Research Society’s Science Writing Competition with an essay on research about pain relief in arthritis.

Ms Hegarty won $500 for the essay, titled ‘‘Accepting the things we cannot change: a solution to the problem of fatigue in arthritis?’’Alice-Roza Eruera, of the university microbiology and immunology department, took the  $250 runner-up award with her  essay, ‘‘Parasites and People; a Malarious Relationship’’.

The competition asks entrants to explain ‘‘Why their research matters in a way that would interest a non-scientific audience’’, in a maximum of 800 words. Since the inaugural event in 2013, the winning articles have been published by the Otago Daily Times. The following is Ms Hegarty’s.

Accepting the things we cannot change a solution to the problem of fatigue in arthritis?

We're sitting in the breakfast nook at Abbie's house, when she says to me, ``I had for so long just assumed I'd be better, say by the time I was 30, and I had all these ideas of what my life would be like, and what I'd be doing, and where I'd be by now ... there's been a lot of grief associated with the fact of having to try and let go of those ideas''.

Abbie is 32 years old. She has fibromyalgia - a form of arthritis that causes chronic fatigue, pain, and a host of other debilitating symptoms.

``Just all my muscles, my teeth hurt, my hair hurts, if I go outside and there's a tiny little breeze, my skin hurts. It's just exhausting.''

For Abbie, a good day looks like this: Get up, shower, eat, run errands while she has energy, and maybe meet a friend for coffee, if there's any energy left to spare. On her bad days, she struggles to make herself a cup of tea.

I met Abbie when she came to a focus group I ran for my PhD research on the impact of fatigue in the lives of people with arthritis. Her story stuck out.

Abbie's fatigue was so severe she was unable to work.

Yes, she had better days, she said, but the unpredictability of her symptoms - never knowing when she would be able to function and when she wouldn't - made holding down a job an impossibility.

Approximately 50% of people with arthritis have fatigue that interferes with everyday life.

It isn't known why people with arthritis get fatigued.

But when people with arthritis are fatigued, they are more disabled, more likely to experience anxiety and depression, and are less satisfied with their lives. Disability is not entirely

a physical process - how people think, feel, and behave also play a part.

Sometimes, people's ideas about how things should be or how they should feel (for example,``I have to get rid of fatigue before I can do what matters'') are unhelpful.

When someone's focus narrows to finding a way to control their fatigue above all else, the things most important to them - spending quality time with friends and family, learning new skills or hobbies, contributing at work or in the community - fall by the wayside.

In my focus group research, I spoke with 21 people with arthritis about how fatigue affects their lives and whether they'd be interested in a psychological treatment approach that could help manage their fatigue.

The most common sentiment among the people most debilitated by fatigue was ``I'd be open and willing to trying anything''.

But what should they try?

Acceptance and Commitment Therapy (ACT) is a promising new therapeutic approach worth investigating.

The goal of ACT is to move people's focus away from trying to control their fatigue and move their focus towards living a more meaningful and satisfying life while experiencing fatigue.

ACT teaches a set of skills that help people disengage from the process of trying to change the unchangeable and turns their focus to what makes life worth living. ACT does this by helping people develop psychological flexibility - the ability to adapt or change one's behaviour to suit the situation.

Acceptance and Commitment Therapy takes the position that we all have things in our lives that we want to be different.

If we can change them, great.

But some problems can't be solved.

And if that's the case, we need to stop trying to change the unchangeable and focus on what matters most.

Before we ask whether ACT can help people with fatigue, it's important to understand whether the psychological process that ACT targets - psychological flexibility - is related to how disabled people with arthritis are by their fatigue.

My PhD research is the first step in understanding whether ACT could be useful for people with arthritis-related fatigue.

In my research, participants will complete a questionnaire measuring psychological flexibility, fatigue, and functioning every day for 10 days.

This will allow me to determine whether people with arthritis function better on days when they are more psychologically flexible.

My research can't cure fatigue - that's an unfortunate reality at this point in time - but it might be able to find out whether being more psychologically flexible is related to how disabled people are by their fatigue.

And if it is?

Then people like Abbie might not need to wait for a cure before they can start living a more meaningful life.

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