SOLVING THE PROBLEMS OF A CHRONIC ILLNESS:

6-Step Problem Solving

We all know how to solve problems. However, when you have a

chronic illness, you face problems most people do not. For
these complex and ongoing problems, systematic problem
solving skills are useful.

For example, you might be great at figuring out how to get to

the store when your car breaks down. But communicating problems with
family, your health care providers, your insurance company, or co-workers
may be more difficult problems to address.

Although interpersonal and major life problems are

more complex, and therefore more challenging, it is
possible to learn how to deal with them effectively.
Thats where problem solving training and practice
come in!

Balancing the demands of:

Family
Work
the Health care system
Self-management
Physical difficulties
Problem Solving
Social/Recreational activities

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 How can problem solving help with a chronic illness?
Studies have shown that problem solving training helps people with many
different chronic illnesses to improve health related outcomes. For
example, when people with chronic illnesses such as heart disease, stroke
and arthritis learned problem solving skills, they increased their level of
exercise, had fewer hospitalizations, reduced pain (and also use of pain
medication), and improved overall health status.*
*Lorig, K., Sobel, D., Stewart, A, and colleagues. (1999) Medical Care 37(1), pp. 5-14.

Whats the first step of

problem solving?

IDENTIFY THE PROBLEM

= Describe behaviors instead of labeling

In all the steps of problem solving, always describe things in terms of
observable behaviors. This helps you target some thing you can change.

A good behavioral description: My husband raises his voice and waves his
hands when telling me how he wants the checkbook organized. It makes
me nervous.
A not-so-good, labeling description: My husbands such a control freak
about everything, it drives me crazy!

Its not easy to discuss touchy issues in any relationship. If you are interested in
learning more about how to improve communication in your relationships and increase
your chances of making solutions win-win, the Assertive Communication module can
help you.

= Be aware that there may be more than one problem to solve. Often
there are many interrelated problems and after solving one problem youre
still having difficulty because the root problem was not addressed. Finding
the root problem can be difficult, but will speed your progress toward
solving it.

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 For example, the problem of having too much responsibility on a project
at work or home might be solved through communication and negotiation
with others who are involved, but the root problem of not being able to
say no to every project that comes your way might get you into the
same fix soon after the first problem was solved.

Another example: Susan wants to have more time to pursue her career
after spending three years at home taking care of the baby. Her
husband Jim would like for her to have her own career, but is worried
about finding good childcare and thinks it may not be financially
worthwhile for Susan to work full time. He also secretly wonders if she
will find him less interesting if she has her own life and acquaintances
outside the home. Susan senses Jims reluctance and, after mentioning
her desire to work once or twice, stops bringing it up. She begins to feel
she lacks the confidence to enter the workplace again and does not
explore her work options. She is afraid of bringing up the topic and
starting an argument because she is afraid of losing Jim. When they
have a small financial crisis, Susan angrily states that this would not have
happened if Jim had let her look for work.

In this scenario, several potential problems might be identified:

1) the difficulty in finding good childcare
2) Jim and Susans difficulty communicating to each other their true
feelings and concerns,
3) Susans lack of confidence about returning to work,
4) mismatched expectations between Jim and Susan about how long she
would delay her career,
5) Susans fear that she might lose her husband,
6) Jims fear that he might lose Susan if she re-enters the workplace.

Jim and Susan might initially identify the first problem (childcare) as the
most important one. If Jim and Susan are able to solve the problem, they
may still find that one month later they are arguing about Susans career. In
this case, mismatched expectations between the two of them might be
driving their arguments, and the childcare issue may simply be a related
problem.

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 SEEK OUT INFORMATION & SET GOALS
= To help insure youve defined the problem accurately, you should seek out
information from as many other people as possible. This will help you gain a
more objective view of the problem.

= Know your sourcesome people are very good at being objective, but
most people have a bias of some sort. Be aware that everyone you talk to
will have a different slant. Judge the input you get from others and do not
automatically discard ANY information, but dont just accept it at
face value, either.

= Set goals for changing the problem. Be realistic.

Describe what you want and what you dont want. Also
consider what you would compromise on, that is, what would
be good enough.

BRAINSTORM
= Generate alternatives/potential solutions to the problem at hand.

= The most important thing is to generate as many potential solutions as

possible, the more the better.

= Dont forget to include any self-management strategies you think might

help you solve the problem.

= Reserve judgment. Dont judge or censor ANY ideas or prematurely

throw them out, no matter how wacky they seem at the time. Sometimes
wacky ideas help lead you to a better solution.

= Remember, others can share different perspectives and fresh ideasget

others involved in your brainstorming. They might come up with just the
idea you need.

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 CHOOSE A SOLUTION
= To help you do this, estimate the consequences of the
solution. Remember to think about the probable short-term
and long-term consequences, to you and important people in
your life.

= Do a cost-benefit estimation of each good potential

solution. Detail the pros and cons of each.

DESCRIBE THE PLAN

= Come up with a workable plan for putting the chosen solution into place.

= Find out what potential roadblocks there are to the

plan and ask yourself and others about ways to eliminate
those roadblocks.

= Find out who else should be involved and how to get

those people committed to the plan.

= Also ask What is the endpoint? How will I know when Ive reached a
satisfactory resolution?

= Put your plan in place, making sure to note problems with implementing it.

REVIEW AND REVISE

= Develop your own monitoring/rating system for the outcome.
Did it work like a perfect 10 or a 5?

= Always note what went well with the plan and what you feel good about
having accomplished. Even if it wasnt perfect, you probably made some
positive changes in your behavior that will help next time.

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 = Evaluate the differences between your expected outcomes
and the way it actually turned out.

= Use this information to help you plan for similar problems

the next time. Forewarned is forearmed.

= Problem solving is an ONGOING process, not a one-shot

deal. Big life problems probably wont get solved the first
time you use these steps. But with repeated attempts, you
can make changes each time that lead you closer to where youd like to be.

= It is a good idea to have a specified time and place to keep track of your
progress on a particular problem and to plan what you will do about it in the
future (Remember the Goal Setting module.). A weekly planning meeting is
a great place to do this.

Now lets put problem-solving into action!

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 SKILL: Problem Solving

Purpose: to help you more effectively handle complex problems

Goal:1) to break down large problems into solvable ones and 2) to spend less
time stuck on large problems

Use the homework sheet to help you through these steps.

Step 1: Identify the problem. Be aware that there may be more than one
problem.

Step 2: Seek out information and set goals. Get others input into the
situation and its potential causes. Set reasonable, achievable goals and make
sure that you have a fall back goal.

Step 3: Brainstorm. Think of potential solutions to the problem without

censoring any far-out ideas. If you can, get help from others.

Step 4: Choose a solution. Evaluate each idea you had by examining the
likely pros and cons of each. Choose the one you think holds the most
promise.

Step 5: Describe the plan. Be detailed, noting what potential problems you
might encounter and how to overcome these. Get important people involved
in putting the plan into place. Have a specific endpoint in mind and know how
you will evaluate how close you came to meeting it. Finally, put the plan into
action.

Step 6: Review and Revise. Note what went well and what did not go as
planned. Use this information to refine the plan the next time you attempt
it. Revise goals if necessary. Go through the process again until you are
satisfied with the outcome.

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 SKILL: Problem Solving
(Sample)
Step 1: Identify the Problem
1-2 factual sentences describing the root issue
What is it that you want to change?
What do you want to be different?
Step 2: Seek Information and set Goal
Ask for help from others in defining the issue(s)
Clearly define the goal you want to achieve
Step 3: Brainstorm
Think of as many potential solutions as possible
Can you use any of your self-management skills (tracking,
deep breathing, goal setting, problem solving) to improve
the situation?
Step 4: Choose a Solution
Examine the pros and cons of each potential solution
Choose one you think is most likely to succeed
Step 5: Describe the Plan
Detail each step of the plan and how they fit together
Step 6: Review and Revise
Evaluate how the plan went and
Go back and revise the problem solving process again
until the situation is acceptable to you.
UMHS 2003, Dr. D. A. Williams and Dr. M. Carey
Think of a problem you could begin to change this week.
Ask: What is the specific problem? What is not going the way I
would like? What is going wrong? I am not in regular contact with old
friends because I get caught up in the demands of work and family. I
am not setting aside time specifically for old friends.
Ask: What do I want to be different? How do I want it to look in the
end? What is my fall back goal? I want to e-mail, telephone, or write
letters to at least one old friend a week.
Ask: What can I do to change the situation? What do others think
may be potential solutions? I could schedule a time every Saturday
morning to contact friends; I could ask them to contact me; I could go
buy nice stationary to encourage me to write; I could buy a cheaper
long distance phone plan; I could buy plane tickets to visit friends; I
could invent a Star-Trek teleporter to whisk me away to visit a friend
Ask: What are the advantages and disadvantages of each potential
solution? Which one holds the most promise? The disadvantage of
writing is that it takes a long time and is easy to avoidadvantage is
that people like to get letters and might respond; the disadvantage of
phoning is that it costs moneythe advantage is that I like talking to
friends and would be more likely to do it. I think phoning would be best.
Ask: How can I make this solution work? What has to happen for
this to work? 1) I need to call around during tomorrows lunch break to
find good long distance plans 2) schedule every Sat.at 10am for calling
3) write notes on the refrigerator and bedroom mirror to remind me 4)
tell the friend in advance so theyll be there when I call
Ask: What went well? What didnt go as planned? And what do I want to do
differently next time? I had a great conversation with my friend! But I
need to make sure I set a timer when Im talking so that I dont spend
more on my phone bill than I can afford!!
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 Lets Summarize

Problem solving steps can help you break down and begin to solve complex,
thorny problems.

Always use descriptions of behaviors or observable events to describe

problems.

In order to solve a problem you must:

1. Identify it as a problem.
2. Target one particular aspect of the problem.
3. Seek out information on the potential causes of the problem.
4. Brainstorm with others to generate potential solutions.
5. Select a solution you think is workable.
6. Put the plan in to action, including all the small details that are important
for success.
7. Review the success of your attempt. Identify what went well and what
didnt go as planned.
8. Revise the plan and keep going through these steps until you have arrived
at a successful stopping point.

Keep tryingeven the most difficult problems can be improved if you

dont give up!

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 SKILL: Problem Solving Think of a problem you could begin to change this week.

Step 1: Identify the Problem

Ask: What is the specific problem? What is not going the way I
1-2 factual sentences describing the root issue
would like? What is going wrong?
What is it that you want to change?
What do you want to be different?

Step 2: Seek Information and set Goal Ask: What do I want to be different? How do I want it to look in the
Ask for help from others in defining the issue(s) end? What is my fall back goal?
Clearly define the goal you want to achieve

Step 3: Brainstorm
Ask: What can I do to change the situation? What do others think
Think of as many potential solutions as possible
may be potential solutions?
Can you use any of your self-management skills (tracking,
deep breathing, goal setting, problem solving) to improve
the situation?
Ask: What are the advantages and disadvantages of each potential
Step 4: Choose a Solution
solution? Which one holds the most promise?
Examine the pros and cons of each potential solution
Choose one you think is most likely to succeed

Step 5: Describe the Plan Ask: How can I make this solution work? What has to happen for
Detail each step of the plan and how they fit together this to work?

Step 6: Review and Revise

Evaluate how the plan went and
Ask: What went well? What didnt go as planned? And what do I want to do
Go back and revise the problem solving process again differently next time?
until the situation is acceptable to you.

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