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Goal Setting for Managing Rheumatoid Arthritis Fatigue: A Qualitative Exploration

Cliss, Alena; Morris, Marianne; Ambler, Nicholas; Knops, Beverly; Hammond, Alison; Almeida, Celia; Hewlett, Sarah


Alena Cliss

Marianne Morris

Nicholas Ambler

Beverly Knops

Celia Almeida

Sarah Hewlett


Background: Cognitive behavioural therapy (CBT) addresses the links between thoughts, feelings and behaviours and often uses goal setting to facilitate behaviour change. Some studies suggest that goal setting improves health-related behaviours in long-term conditions, therefore this was explored in a randomized controlled trial of CBT for the self-management of RA fatigue.
Methods: Groups of 4–6 patients attended a 7-session CBT course for managing RA fatigue. Goal setting was discussed in groups of 2 or 3 for 30–45 min facilitated by the clinical psychologist or occupational therapist. At each session the clinicians documented the agreed goals and detailed any clinician-observed and patient-reported outcomes. These records were analysed using inductive thematic analysis by two independent researchers.
Results: Data were available for analysis from 25 RA patients (8 male), with a mean age of 59.86 yrs (range 29–77), 13.41 yrs disease duration (1-38) and baseline fatigue VAS 5.84 (0.5–9.9). Patients set 74 goals, with 83% achieved successfully. The goals addressed desires to change lifestyle behaviours, including exercise uptake, weight management, sleep hygiene, energy balance and pacing. Analysis identified cognitive and behavioural goals under two main themes:
Managing the impact of RA fatigue: Patients reported the need to reduce stress and anxiety, to be able to complete activities of daily living despite the demands of their RA. For example, one patient set a goal to reduce her time commitments, which she achieved using a cognitive approach of restructuring irrational beliefs about assertiveness (EC03). Another (D04) aimed to re-build his social network, which he achieved through a behavioural strategy of returning to a dominoes group that he had previously abandoned due to his RA fatigue.
Maintaining relationships with self and others: This underpinned managing the impact of RA fatigue and included increasing self-confidence and self-esteem and improving communication with partners and families. One patient aimed to re-build intimacy in a personal relationship (A08). She achieved this through the behavioural means of initiating physical contact with her husband to communicate her own needs. Another patient aimed to reduce her stress and anxiety, which she achieved using a cognitive strategy of noting negative thoughts and reflecting on coping strategies (A11). Progress over the course showed not only the successful adoption of self management strategies, but increasing confidence, self esteem and sense of control, suggesting greater adjustment to RA.
Conclusions: Weekly negotiated goal setting within a CBT programme enables patients with RA fatigue to make changes in their daily life. Through a sense of achievement and empowerment, along with a shift in cognitions and behaviours, patients adopted a more active and adaptive coping style. Goal setting could be a useful tool in the self-management of RA fatigue.


Cliss, A., Morris, M., Ambler, N., Knops, B., Hammond, A., Almeida, C., & Hewlett, S. (2010). Goal Setting for Managing Rheumatoid Arthritis Fatigue: A Qualitative Exploration. Rheumatology,

Journal Article Type Article
Publication Date 2010
Deposit Date Oct 23, 2023
Journal Rheumatology
Print ISSN 1462-0324
Publisher Oxford University Press
Peer Reviewed Peer Reviewed