By Ann Langford (Integrated Diploma in Resilience and Wellness Coaching Skills)
Introduction: Why Arthritis?
In this assignment I explore how arthritis sufferers could benefit from health coaching. My primary motivation stems from arthritis’ growing prevalence with more than 1 in 5 afflicted in the UK. I am also motivated to have more helpful conversations with my Sisters who are both long-term sufferers and by my own genetic predisposition to the condition.
I want to gain a better understanding of arthritis as a health condition, find out which therapies beyond medical interventions can help and explore how talk-therapy might best assist in integrating care and maximising self-management. Whilst it is not my intention to be my Sisters’ Health Coach I do want to draw on learning gained to better reach and motivate them.
Arthritis: What is it?
With some 100 types of arthritis disorders identified, there are 3 major categories of arthritic condition: inflammatory arthritis, an auto-immune disorder, with rheumatoid arthritis (RA) being the best known; non-inflammatory arthritis, a degenerative disorder, with osteoarthritis (OA) the most common and; infection-caused arthritis. All arthritic disorders affect the joints and cause mild to very severe chronic pain which flares up or is constant. Depending on its category, arthritis can be accompanied by a variety of other symptoms which in some cases affect the entire body. Stiffness, swelling, fatigue, mobility limitations, deformity, anaemia, fever, depression are the most commonly associated symptoms.
Research shows that arthritis is regularly found among people who also suffer from one or more other conditions such as heart disease, diabetes, high blood pressure, obesity, anxiety and depression. How conditions might precede or cause one another varies. (Arthritis Foundation, Arthritis Care & Research). Even though arthritis affects people of all ages, in the UK, where some 10 million suffer, in excess of 80% have osteoarthritis and are aged 40+.
In addition to medical treatments it is widely accepted arthritis sufferers benefit from self-managing their conditions with dietary, exercise, and stress regulation interventions. A number of mind-body therapies are purported to also bring relief (Davis et al, 2006). When reviewing their helpfulness however only acupuncture, massage, yoga and tai chi were rated as the most effective in dealing with pain and disability in chronic pain conditions including RA and OA (Macfarlane et al, 2012).
In 2014, Manchester University Researchers found that brain and mindfulness-based talking therapies helped patients to better cope with chronic pain (Brown et al, 2014). Drawing on South African research Susan Blum (2017) contends that maximum coping efficacy is derived from a combination of behavioural changes and learning about pain-neuroscience, self-management strategies and stress management.
In my view there is enough evidence to contend that the quality of care enjoyed by arthritis sufferers can be maximised both by the adoption of proactive and holistic self-care and through person-centred, skill-focused talk-therapy to complement medicinal, physical and occupational therapies.
Which is the best talk therapy?
Arthritis is a Long Term Condition (LTC). Its symptoms and treatment have an occupational, social and emotional impact on its sufferers with anxiety, depression and arthritis frequently presenting together (Carrier, 2016). Research shows arthritis to be both exacerbated by and the cause of stress and depression and that patients suffering emotional impact are likely to find psychological interventions helpful (Arthritis Foundation). In common with the treatment of other LTCs, patient-empowerment and self-management are called for (Carrier, 2016, White, 2001).
A Cognitive Behavioural Therapy (CBT) approach with its focus on education and skill development and its effectiveness in dealing with stress and depression (Crane, 2009) appears particularly suited to the management of arthritis as sufferers stand to benefit physically and mentally from changing existing cognitions and behaviours and from introducing new ones (Sage et al, 2008).
CBT has proven efficacy in the management of many LTCs and most extensively of chronic pain (White, 2001). CBT is able to address both the medical and psychological problems associated with LTCs and focuses on patient self-management and the collaborative patient-carer relationship (Satterfield, 2017, White, 2001).
Other than sporadic, short-lived and research-driven initiatives there appear to be no established CBT assistance programmes. In addition to the perennial issue of resources: both private and public, there seem to be a number of factors which might explain this: there is a shortage of CBT professionals working in the LTC arena (White, 2001), arthritis sufferers may lose out against other LTC patients on the priority list; demand for psychological assistance is rising in line with the increase in LTC sufferers; research illustrating efficacy of CBT interventions in the short-term but leaving long-term results wanting (Carrier, 2016) and last but not least sufferers in pain tending to hold out for drug and medical interventions to end their troubles.
Personal and coaching experience informs us that maintaining behaviour change and adherence in both its broadest and medical sense: following health advice, are not automatic and can be challenging. LTC sufferers’ resilience and self-efficacy is regularly and extensively tested: it is implicit to their condition. American Health Psychologists’ clinical trials have demonstrated that extended-care programs, skills training and social support are the most promising approaches in promoting long-term adherence (Middleton, 2013).
It seems to me that supplementing the CBT Psychologists pool with Health Coaches and coaching- trained Physical and Occupational Therapists may serve arthritis and other LTC sufferers well. The goal of the coaching would be for patient-clients to take the lead in managing their own conditions and to become knowledgeable and skilled. Skills and knowledge gained by clients will bring about greater confidence which might further contribute to their health and self-care. Coaching success would be measured through assessing self-management and activation levels. (Laurel, 2011; Rogers & Maini, 2016).
It is my view that for arthritis coaching to be long-term effective it will need maintenance. Whilst the regularity of interactions between coach and client may reduce as the coaching relationship develops it is my contention that the Coach, or coaching assistance should be a permanent feature of the care plan.
What to take away for own practice?
Both my Sisters could do more to manage their conditions. Their quality of life and that of many other sufferers could be improved and their pain experiences lessened with a more integrative care methodology and better informed self-care and management.
It is my view CBT style coaching capitalising on the brain’s neuroplasticity and changing behaviour through better thinking might best achieve this in tandem with physical and occupational therapies.
I am reminded however that changed behaviours might not materialise and that when they do, they may not necessarily reduce physical complaints or be long-term maintained. My mission as a Sister and a Coach, more than anything else, is to be present with an open heart, to be compassionate and help keep feelings of overwhelm and helplessness at bay (Santorelli,1999).
- Alexander, L. (2011), How to Incorporate Wellness Coaching into Your Therapeutic Practice, London: Singing Dragon.
- Brown C.A., El-Deredy W. and Jones A.K. (2014), When the brain expects pain: common neural responses to pain anticipation are related to clinical pain and distress in fibromyalgia and osteoarthritis, European Journal of Neuroscience, 39(4), pp. 663-672.
- Blum, S. (2017), Healing Arthritis, Your 3-step Guide to Conquering Arthritis Naturally, London: Orion Spring.
- Carrier, J. (2016) 2 Ed., Managing Long-term Conditions and Chronic Illness in Primary Care, Abingdon and New York: Routledge.
- Crane R. (2009), Mindfulness-Based Cognitive Therapy, London and New York: Routledge.
- Davis, M., Eshelman, E. R., and McKay, M. (2008) 6 Ed., The Relaxation and Stress Reduction Workbook, Oakland, CA, US: New Harbinger Publications.
- Macfarlane, G. J., et al, (2012), A systematic review of evidence for the effectiveness of practitioner-based complementary and alternative therapies in the management of rheumatic diseases: rheumatoid arthritis, Rheumatology 51: pp 1707-1713.
- Middleton, K.R., Anton, S.D., Perri, M.G., (2013) Long-Term Adherence to Health Behavior Change, American Journal of Lifestyle Medicine: 7(6): pp395–404.
- Prochaska, J.O., Norcross,J.C. and DiClemente, C.C. (1994), Changing for Good, New York: Avon Books.
- Rogers, J. and Maini, A. (2016), Coaching For Health: Why It Works And How To Do It, Maidenhead: Open University Press.
- Sage, N., Sowden, M., Chorlton, E., Edeleanu, A., (2008), CBT for Chronic Illness and Palliative Care: A Workbook and Toolkit, Chichester : John Wiley & Sons.
- Santorelli, S. (1999), Heal Thy Self: Lessons on Mindfulness in Medicine, New York: Bell Tower.
- Satterfield, J.M. (2017), Cognitive Behavioral Therapy: Techniques for Retraining Your Brain, Audiobook and Course Guidebook, Chantilly, Virginia (US): The Great Courses, The Teaching Company.
- White, C.A. (2001), Cognitive Behaviour Therapy for Chronic Medical Problems: A Guide to Assessment and Treatment in Practice, Chichester: John Wiley & Sons.
 In October 2017 Arthritis Care and Arthritis Research merged to form Versus Arthritis.