Workshop Omgaan met persoonlijke doelen

Persoonlijke doelen geven richting en zin aan het leven. Het formuleren en nastreven van doelen vergroot betrokkenheid met de omgeving en het leven in het algemeen. Gezegdes en uitspraken zoals “Voor een schip dat niet weet waar het naartoe gaat, is geen enkele wind de goede” en “Het geheim van het mens-zijn is niet om te leven, maar om iets te hebben om voor te leven” laten dit uitstekend zien. Verder is het gevoel in staat te zijn doelen te bereiken en daarmee tot op zekere hoogte controle uit te oefenen over de omgeving verbonden met een positief zelfbeeld en positieve gevoelens. De perceptie van vooruitgang, dichter komen bij het doel, wordt als belonend en positief ervaren. Naast deze aangename functie van persoonlijke doelen kunnen ze soms ook behoorlijk lastig zijn, namelijk als het bereiken onwaarschijnlijker wordt en doelen ernstig bedreigd worden. Dit kan bijvoorbeeld door het optreden van een chronische ziekte of veranderingen in de levenssituatie gebeuren, waardoor het behalen van persoonlijke doelen moeilijker of onmogelijk wordt. Op basis van theorieën over doelmanagement zullen de deelnemers vertrouwd gemaakt worden met vier doelmanagement strategieën. We zullen U in deze workshop laten ervaren op welke manier men kan omgaan met bedreigde doelen, hoe men ook in moeilijke situaties doelmanagement kan toepassen en welke oefeningen men kan gebruiken om de op dat moment de beste strategie te kiezen

Exploring preferences for domain-specific goal management in patients with polyarthritis: what to do when an important goal becomes threatened?

Usually priorities in goal management—intended to minimize discrepancies between a given and desired situation—are studied as person characteristics, neglecting possible domain-specific aspects. However, people may make different decisions in different situations depending on the importance of the personal issues at stake. Aim of the present study therefore was to develop arthritis-related vignettes to examine domain-specific goal management and to explore patients’ preferences. Based on interviews and literature, situation-specific hypothetical stories were developed in which the main character encounters a problem with a valued goal due to arthritis. Thirty-one patients (61 % female, mean age 60 years) evaluated the face validity of the newly developed vignettes. Secondly, 262 patients (60 % female, mean age 63 years) were asked to come up with possible solutions for the problems with attaining a goal described in a subset of the vignettes. Goal management strategies within the responses and the preference for the various strategies were identified. The 11 developed vignettes in three domains were found to be face-valid. In 90 % of the responses, goal management strategies were identified (31 % goal maintenance, 29 % goal adjustment, 21 % goal disengagement, and 10 % goal re-engagement). Strategy preference was related to domains. Solutions containing goal disengagement were the least preferred. Using vignettes for measuring domain-specific goal management appears as valuable addition to the existing questionnaires. The vignettes can be used to study how patients with arthritis cope with threatened goals in specific domains from a patient’s perspective. Domain-specific strategy preference emphasizes the importance of a situation-specific instrument

A goal management intervention for polyarthritis patients: rationale and design of a randomized controlled trial

Background A health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention’s effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders’ analysis are planned. Methods/design The protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition. Discussion The purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of lif

Goal management strategies and successful adaptation to arthritis

Objective: Persons with polyarthritis often experience difficulties in attaining personal goals due to disease symptoms such as pain, fatigue and reduced mobility. This study examines the relationship of goal management strategies – goal maintenance, goal adjustment, goal disengagement, goal reengagement – with indicators of adaptation to polyarthritis, namely, depression, anxiety, purpose in life, positive affect, participation, and work participation. Methods: 305 patients diagnosed with polyarthritis participated in a questionnaire study (62% female, 29% employed, mean age: 62 years). Hierarchical multiple-regression-analyses were conducted to examine the relative importance of the goal management strategies for adaptation. Self-efficacy in relation to goal management was also studied. Results: For all adaptation indicators, the goal management strategies added substantial explained variance to the models (R2: .07–.27). Goal maintenance and goal adjustment were significant predictors of adaptation to polyarthritis. Self-efficacy partly mediated the influence of goal management strategies. Conclusion: Goal management strategies were found to be important predictors of successful adaptation to polyarthritis. Overall, adjusting goals to personal ability and circumstances and striving for goals proved to be the most beneficial strategies. Practice implications: Designing interventions that focus on the effective management of goals may help people to adapt to polyarthritis

The MOLGENIS toolkit: rapid prototyping of biosoftware at the push of a button

Peer reviewe

Living a good life with arthritis: managing personal goals to improve psychological health

This thesis focused on the role that goal-based coping plays for the psychological adaptation of people with arthritis. People with polyarthritis experience elevated levels of distress and lower levels of wellbeing compared with the general population [1-3]. These results have a negative effect on disease symptoms and treatment adherence which influences people’s quality of life [4-6]. Effective use of goal-based coping is considered to increase adaptation to a chronic disease and lead to a higher level of psychological health [7-10]. In this thesis, goal-based coping was studied in its role as a facilitator of adjustment and as a starting point for the support of persons with arthritis. This thesis was divided into two parts to address the following research questions: Part I: What is the relationship between goal management and psychological adaptation to arthritis? Part II: What is the effect of a goal management programme on the psychological health of people with arthritis and mild depressive symptoms? In Part I, the relationship between four goal management strategies and five outcomes of psychological health were explored and a domain-specific measurement instrument for goal management was presented. In Part II, the development and effect of a goal management programme for persons with arthritis and mild depressive symptoms was discussed. Also, key components of the programme from the participants’ perspective and its fidelity were evaluated. In this general discussion, the main findings with regard to the research questions are summarized. Subsequently, the theoretical and methodological considerations of this thesis are explored and finally, recommendations for research and practice are given

The longitudinal relation between patterns of goal management and psychological health in people with arthritis: The need for adaptive flexibility

Objectives Due to their disease, patients with polyarthritis face the task of reconciling their threatened personal goals with their capabilities. Previous cross-sectional research on patients with chronic disease related higher levels of goal management strategies to lower levels of distress and higher levels of well-being. This study was the first to focus longitudinally on goal management patterns that combined strategies originating from different goal management theories. Our first study objective was to identify patterns that consisted of various strategies of goal management among patients with polyarthritis. Subsequently, the cross-sectional and longitudinal relationships between these patterns and the psychological health of the patients were studied. Methods A longitudinal questionnaire study with three measurements of goal management and psychological health was conducted among 331 patients with polyarthritis. Stability of goal management over time was analysed with ANOVAs. Patterns were identified using cluster analysis at baseline, based on the following strategies: Goal maintenance, goal adjustment, goal disengagement, and goal reengagement. Longitudinal relationships between the patterns and psychological health (specifically: Depression, anxiety, purpose in life, positive affect, and social participation) were analysed using a generalized estimating equations analysis. Results Three goal management patterns were found: ‘Moderate engagement’, ‘Broad goal management repertoire’, and ‘Holding on’. Patients with the ‘Broad goal management repertoire’ pattern had the highest level of psychological health. The ‘Holding on’ pattern was identified as the most unfavourable in terms of psychological health. Over time, stable differences in levels of psychological health between the patterns were found. Conclusions This study was the first to reveal patterns of several goal management strategies and their longitudinal relationship to psychological health. Psychosocial support for arthritis patients with lower psychological health should focus on helping patients to become familiar with a broad range of goal management strategies when dealing with threatened goals

A goal management intervention for patients with polyarthritis and elevated levels of depressive symptoms: a quasiexperimental study

Purpose: Goal was to establish whether an intervention that aims to increase goal management competencies is effective in decreasing elevated levels of depressive symptoms and increasing well-being in patients with polyarthritis. Materials and methods: Eighty-five persons with polyarthritis and elevated levels of depressive symptoms participated in the goal management intervention consisting of six group-based meetings. A quasi-experimental design with baseline measurement, follow-up at 6 months and a reference group of 151 patients from an observational study was applied. Primary outcome was depression; secondary outcomes were anxiety, purpose in life, positive affect, satisfaction with participation, goal management strategies, and arthritis self-efficacy. A linear mixed model procedure was applied to evaluate changes in outcomes. Results: No improvement was found for depressive symptoms and no changes were found for the secondary outcomes, except for positive affect that improved in the intervention group. This increase was mediated by an increase in goal adjustment. Furthermore, goal maintenance decreased and self-efficacy for other symptoms increased in the intervention group. Conclusion: This study indicates that interventions designed to aid patients with arthritis with goal management skills are potentially helpful for increasing positive affect, although further studies are needed.Implications for rehabilitation People with polyarthritis have to manage their disease in combination with possibly conflicting roles and personal goals, resulting in an ongoing process of finding equilibrium in a constantly changing situation. Based on a person-focused view, the program Right on Target focused on coping with threatened activities and life goals due to arthritis. The program consisted of six group-based meetings led by a trained nurse and a personal trajectory wherein participants were stimulated to try out various behavioral options related to an own threatened activity in concordance with their personal goals. The program seemed effective in increasing flexible goal adjustment and self-efficacy and participants experienced more positive affect directly after the program and at 6-month follow-up