I have a goal, a goal to reduce my social media time. Why? Cause it can make me miserable! It distracts me from more important things and it can engage me in conversations that are just… well… pointless! That’s a whole heap of productive time, lost! Anyway that’s my problem, my own personal issue and something that I need to acknowledge for my own personal growth. More on this later.
You may have noticed I highlighted miserable in that first paragraph. I wanted to bring your attention to my skepticism about SMART goals. I think they are really not that SMART for working with people living with pain. SMART goals actually came from business and were adopted into the healthcare model. According to Mcpherson, Kayes, & Kersten, (2014) The S part (Specific) and the M part (Measurable) of the SMART acronym appear to be the only aspects that are particularly relevant to the healthcare setting, questioning the validity behind the other aspects as to whether they may even be harmful.
It would seem that SMART goals are useful (particularly the S and M parts) for simple task completion however the problem of adherence to goals comes into question and as such people living with pain (in my experience) have difficulties sticking to goals. This is through no fault of their own. It’s just that perhaps it is due to the lack MEANING?
This leads me onto the acronym MEANING. The idea behind MEANING is to apply a more comprehensive approach to meaningful goals. Self-regulatory theory and theory of intentional action control are two approaches that are proposed to address the ART part of the SMART acronym.
Self-regulatory theory proposes a connection between goal progress/failure and mood, motivation and sense of self. Therefore goals become more about the individual rather than just a thing that someone should set out to achieve in a relevant and timely manner, which in actual fact what the person wants could be none of those things.
Theory of intentional action aims to channel a persons intentions into behavioural action through the use of an action-coping plan. The use of an if-then (or perhaps when-then) plan attempts to bridge the intention-implmentation gap. This means that you can accommodate for things that might get in the way of planning and carrying out the goal-related activity. For example:
‘If I have a flare up and am unable to go for my planned 20 minute walk then I will attempt some mindfulness and walk around my house 5 times.’
Now I understand that some will be reading this and say, “whatever mate, I can’t walk whilst I’m having a flare up” This maybe true, however getting up and going to the toilet, or making lunch etc, still means you are moving around your home, adding a little bit more in is encouraging positive physiological responses in your body and recognising that encourages achievement – flexible persistence!
I like the idea of if-then plans as it embraces the concept of flexibly persisting – this ability to cope whilst performing an action and working towards future planning.
So on to MEANING itself. The acronym stands for:
M – Meaning – What is of value or important to the person
E – Engage – Establish rapport, connection, trust and collaborative communication
A – Anchor – sub goals for what is most important or of value to the person
N – Negotiate – Levels of progress towards attainment
I – Intention/implementation gap – specific steps taken to bridge the I/I gap (if-then plans)
N – New goals – Goal setting & goal striving as ongoing rather than a means to an end
G – Goals as behaviour change – Goals are an active intervention that impacts on people’s actions, mood, motivation and sense of self.
MEANING does appear lengthy, yet it has been suggested by Mcpherson, Kayes, & Kersten, (2014) that 1) it can identify what is of value and meaningful to the person and can also help the clinician reflect on their own behaviour, 2) help with strategies to maintain motivation in goal progress and enhance a positive sense of self, and 3) help to bridge the gap between implementation and intention.
So earlier I mentioned how I am miserable about social media and I aim to change my relationship with it, well the final example of goals is something that I stumbled upon in a podcast recently (here) and flips goal setting on its head!
VAPID stands for:
Vague – The goal is unclear, and the steps you need to take to achieve the goal are unclear.
Amorphous – The goal doesn’t have a finish line or any sense of achievement.
Pie in the sky – It’s too ambitious.
Irrelevant – The goal isn’t actually linked to what we really value and care about.
Delayed – There’s no time frame. It can happen any time.
VAPID was developed by a psychologist Dr Randy Patterson, Author of How to Be Miserable: 40 Strategies You Are Already Using. Now the idea behind VAPID goals is to enhance your misery, where SMART goals would be setting a means to achieving your goals. What’s the point of that?! And how is that relevant to persistent pain?! I hear you all cry!
Well, VAPID could be used as a means of critically analysing whether the goal you set yourself or with your clinician is actually of value or meaningful to you. The other way is to use VAPID as means to analysing how miserable you already are as a result of pain. Now just bear with me on this!
Let’s say you are miserable because of pain and in order to learn to live well with pain you had to be even more miserable than you are now. So you are asked to make a list of things that would make you feel miserable about living with pain. Such as it’s restrictive or socially isolating, you can’t exercise or do your vacuuming.
The idea behind this is two-fold. 1) if you do feel more miserable as a result of identifying what makes you feel miserable it allows you to identify that you have some control over your mood. This may not seem useful but the idea is that if you have a little bit of control you may be able to get a little bit more. 2) The things on the list may already be what you are doing, so change doesn’t mean taking on anything new or increasing your time limit, it means stopping what you are already doing, to a degree. This is symbolic of the boom bust cycle. In order to get through your vacuuming you do the entire house, you might feel content in the short term but in the long term your sensitivity goes up, you do less, you hurt more, you vacuum less, you feel more miserable.
Vague – You just have to Vacuum
Amorphous – Ok i’ve vacuumed, now what?
Pie in the sky – Doing the whole house, is that fair?
Irrelevant – Do I even like vacuuming?
Delayed – I have to do it, but do I need to all in one go?
VAPID can help you identify what makes you feel miserable. This doesn’t mean you stop however it may help you to ease back and build up slowly so that you can direct your focus onto aspects of your life that hold more value and are meaningful to you.
So, there you have it, I hope this blogpost has given you a few ideas (patient or clinician) to think beyond or outside of the SMART goals box and of course I’m always open to healthy critique.
Thanks for having a read
Mcpherson, K. M., Kayes, N. M., & Kersten, P. (2014). MEANING as a smarter approach to goals in rehabilitation. Rehabilitation Goal …, (2014). Retrieved from https://books.google.co.nz/books?hl=en&lr=&id=yvLRBQAAQBAJ&oi=fnd&pg=PA105&dq=inlevack+rehabilitation+palliative+OR+terminal+OR+stroke&ots=Tb1Md7Epe5&sig=M-_gCeZbsgs5hGpf8VyhtXJHLRs
Paterson, R. (2016). How to Be Miserable: 40 Strategies You Already Use. New Harbinger Publications Inc.