A holistic approach to future thinking

 

Carolyn Berryman’s area of research interest is strongly focused on chronic pain. Here, Carolyn looks at what transformative research means and the implications for creativity and innovation in the collaborative landscape.

As a researcher, I feel it is important to reflect on what it means to do ‘transformative research’—something all researchers would aspire to, I think. I make no claims to be a transformative researcher yet, but I have taken active steps to promote that possibility.

Transformative research can be defined as research that forever changes the way of looking at a problem or applying a technique. Yet, when what we know about the world is put into question in a way that challenges our current conceptualisation, we can feel provoked and anxious—not giddy with joy.

Using qualities of critical reflection at this point, we can examine our beliefs and choose to grow and develop, and expand our perspectives.

These qualities of self- reflection, personal development and metacognition are at the heart of doing transformative research, indeed at the very heart of self-transformation.

Well, how do you come to new ways of looking at things?

One way is to embrace other ways of knowing such as trusting your gut instinct. That doesn’t sound right for a scientific researcher, but applied to situations such as who to collaborate with, how to choose a mentor, and finding a work situation that is a balance between stability and the ‘edge of chaos’ (Boal & Schulz 2007) can be driven by gut instincts.

On my journey I have sought out collaborators, workplaces and mentors who challenge my view, tell stories of how it is in their world and who create space for us to develop different questions and hopefully new answers.

These leaders are often future visionaries who might, for example, take my recently developed skill in non-invasive brain stimulation and apply it in a way that is completely unexpected. Or they may feel challenged by the questions that come from my naïve knowledge of their area and together we venture down a new path.

The cost of this approach is time and as my (woeful) publication record will attest, I have been enjoying these explorations way too much.

New ways of looking at problems also come from engaging with experts in the field and listening deeply to them. By this I mean the consumers of our therapeutic services.

My area of research interest is strongly focused on chronic pain, and the experts in chronic pain are the people with it. Their expertise is often brought home to me when we collect data from people with fibromyalgia and complex regional pain syndrome as they report and display their multiplicity of dysregulated systems. We collect the full story in the one session, uninterrupted, because this was often an unrealistic expectation in clinical work, where the story would emerge over several sessions and the activities during the intervening time were difficult to account for.

By facilitating their story telling and not expecting a linear relationship between the story and what emerges as signs and symptoms, I have found myself generating new insights into the disorders, and finding new questions to ask, such as does interoception modulate multisensory integration of pain and movement in fibromyalgia?

Because you need to be tossed out of your ‘stasis’ to view things differently, one of the most challenging aspects of any transformative undertaking is getting comfortable with uncertainty.

An example might illustrate this better: it relates to the very first piece of original research I undertook—a systematic review that examined the evidence for working memory deficits in people with chronic pain (Berryman et al 2013).

To complete the review in a systematic manner required us to define what working memory was, and if you have ever ventured into the neuropsychological literature you will know that it is plagued by conceptual fuzziness (both real and perceived), and it took many long months of uncertainty and indecision—and several expert opinions—to decide on a definition that would be well accepted.

I found that I quite liked ‘sitting with uncertainty’ on the ‘edge of chaos’ and I have sought it out ever since—again at a cost of time. The outcome of that publication, though, has been wonderful, with a citation rate three times larger than is usual for that journal, and it answered my clinical question as to whether there were alterations in the way people with chronic pain process information (yes).

I am most interested in basic mechanisms because they are the fundamental building blocks of behaviour that can be investigated non-invasively and in vivo.

I am especially interested in whether the degree of cortical neuroplasticity that a person exhibits is related to their response to stimuli, in particular pain.

My hypothesis is that normal plasticity mechanisms allow a person to adapt to current demands, repair and recover, but that an over- or under-response may serve to compound the pathological consequences of an insult or injury.

Changes that we can see at cortical level using sophisticated imaging such as transcranial magnetic stimulation combined with electroencephalography may be the first in a series of neural circuit dysfunctions that underpin a maladaptive response.

I have run my first experiment investigating this, but as yet, have not presented my findings at any conference.

In order to explore the breadth of possibilities of these research outcomes, I have been developing future thinking and the imagination of what might be.

Grant applications are looking for this and there is stress associated with trying to find the right words to articulate what you’re thinking. Being able to imagine differences in thinking or behaviour can be developed by guided reflection, but this implicitly requires the person to possess some imagination to begin with.

The guided reflection needs a conceptual understanding of how you currently think and then you start to imagine how you could think differently (Curtis & Cerni 2015). Seeing your own thinking or ‘metacognition’ is a bit of a buzz word in education circles at the moment.

We all have different capacities within and for metacognition, and a helpful way of thinking about the insightful moments when they occur has been framed into ‘knowing when to be creative, knowing when thinking needs to shift focus and knowing the limits of one’s own creative capacity and how to extend that through others’ (Middlebrook 2015).

Creativity and innovation are key elements of the transformative research landscape and are necessary in order to produce a new or continue a competitive edge over other research groups, and thus be attractive to funders.

There seems to be a fashion attached to this churn and at the moment, basic research as I do is off the boil, with concerning consequences.

Transformative research rarely occurs in isolation. We do need collaborations across silos, environments and subjects in order to view things differently. We also need time to establish the parameters of our outcomes such that the results might be predictable in patient populations and effect sizes grown to clinical effectiveness.

Because of the variability that comes with being human, having a condition, interacting with a health professional, being influenced by your family, peers, the state of the world in general, at the moment I can’t predict how that will happen, but I am off to have a chat with the lead scientist on the Hadron collider—surely he will have some interesting ways to account for variability in the data.

>> Email inmotion@australian.physio for references.

Since completing her PhD, APA Pain Physiotherapist and APA Musculoskeletal Physiotherapist Carolyn Berryman has been a NHMRC Early Career Fellow at the University of Adelaide, where she is using non-invasive brain stimulation techniques to investigate neuroplastic changes in the brain in people with persistent pain. In a career spanning 30 years, Carolyn has worked on undergraduate and postgraduate physiotherapy programs as a musculoskeletal clinical tutor and pain sciences lecturer at the University of South Australia, run her own physiotherapy practice (18 years), and given more than 20 public and professional presentations.

 

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