Living Well with a Long-Term Health Condition: 5. Problem Solving

Why this leaflet?

This resource is intended for people who are living with, or have recently been diagnosed with, a long-term health condition. Living with a long-term condition can bring challenges. Problem solving can sometimes help working out these challenges. You may need to adapt advice in this leaflet slightly to suit your own health and personal needs. If you have concerns about anything or how to adapt things to your own particular needs, please ask your GP or your health care professional. This booklet contains lots of information and advice. You might find it helpful to read it in small chunks, or with a family member or friend.

Facing problems

Problems, setbacks, and dilemmas are an everyday part of life. Everyone can struggle with these from time to time. Like many others, you may be facing a mix of small day-to-day problems as well as life’s big challenges. No matter how big or small the issue, it is always useful to have ways of facing these problems and managing them as best as possible. Sometimes it isn’t about solving the problem but about finding the best possible way to cope with a situation so that you can minimise the stress it might cause.

Problems can come up in lots of different areas of your life. They may be related to money worries, health (our own or others), relationships, friendships, work, or study. They may be about a missed train, a leaky roof, a puncture, or a missing set of keys.

Problems and long-term conditions

People with health problems may face problems specifically related to their condition alongside day-to-day problems.

Long-term health conditions can add an extra set of challenges. You may struggle with arranging hospital appointments around childcare and work, managing flare ups of your symptoms, dealing with fatigue or pain, making big or small decisions about your treatment, worries about the condition itself, managing relationships with health care professionals and communicating with others about your condition, to list just a few. The variety and number of problems someone living with a long-term health condition may face might test the coping and problem-solving skills they currently have.

It can be helpful to use a problem-solving cycle to help find a new way of coping with some of these challenges, especially when the best strategy isn’t obvious.

Common effects of problems

Here are some common examples of how living with unresolved problems can affect you physically and emotionally.

The way you think:

Spending a lot of time focused on the problem.
Chewing it over in your mind a lot.
Thoughts about the problem popping into your mind when you don’t want them to.
Imagining the worst-case scenario.

The way you feel:

Anxious, tense, panicky and uneasy.
Feeling ‘dread’ when you think about the problem.
Feeling ‘fed up’, ‘not bothered’ or indifferent, particularly if it has been going on for a long time.
Feeling angry and resentful – ‘why me?’

Your body:

Tense muscles, aches and pains.
Fatigue.
Poor sleep and disrupted appetite.
Flare ups of symptoms affected by stress.

The things you might find happening:

Avoid thinking about the problem OR chew it over constantly in your mind.
Avoid tackling the problem by staying busy with other things.
Use alcohol, drugs, tobacco or nicotine or food to try to feel better.
Keep on trying the same solution, even if it has not worked in the past.
Spend a lot of time surfing the internet, trying to get second opinions, requesting more medical tests.

Why you might be struggling

It is understandable that people with health problems struggle with the demands of their conditions which can be unpredictable, uncomfortable and draining. However, many people with health problems feel bad about themselves because they are struggling or have not been able to overcome the problems they face.

You may recognise thoughts like ‘I should have sorted this by now’, ‘I should have got over this by now’ or ‘I wouldn’t have this problem if I was strong enough or determined enough’. Usually, these unhelpful thoughts are overly harsh and unlikely to be true.

You have probably tried lots of things to help yourself already and showed great determination and effort. We often know how to solve or deal with ‘easy problems’, but bigger problems can be more difficult to tackle. If your problems cannot be easily solved with the problem-solving and coping skills you currently have, it might be useful to try some new ideas.

The problem-solving cycle

Some difficult problems need a structured approach to solving them. Below are an important series of steps which can help you tackle problems in an effective way. Each step is an important one. Try not to skip steps along the way!

Step 1. Define Your Problem

What exactly is it you up against? Try to complete this sentence:

‘The problem I am facing is____________________.’

Defining the problem clearly like this can help you focus on one thing rather than being distracted by several issues which might be better managed separately. You may find that in trying to define your problem you discover there are several parts to it which are better managed one at a time. It is also always better to try to put something into words. This can also make it feel more manageable and helps to take the emotion out, which can get in the way.

Prioritise

If you have several problems, write a list. Choose two or three problems from the list and order them from least important to most important. Put a circle around the one you have chosen to work on.

If you find your mind wandering to the other problems, gently remind yourself that for now you are focusing on just one problem at a time.

Ask yourself

Is this a problem I can do something about, or is it outside my control? Some problems cannot be solved by individuals, despite their best efforts. For example: public transport being on time, the weather, or the choices and behaviours of other people may be outside your control.

If you believe that there is something you can do about the problem you face, continue following the steps below. If the problem looks like it is outside of your control at the moment look at the sections later in this resource ‘What if the problem is outside of my control’.

Step 2. Brainstorm

List as many possible solutions to the problem as you can. Write down everything from the simplest to the far fetched and funny. This will help you to start thinking flexibly and considering lots of different options.

For example, if the problem is ‘I need to get to the hospital but there are engineering works on the train line I need’ you might generate the following:

Walk 5 miles to get there
Hire a limo or a helicopter
Take a taxi
Check for rail replacement buses
Cancel and reschedule the appointment
See if there is an alternative train route
Ask a neighbour for a lift maybe in return for some babysitting later.

Of course, some of these options are not practical or possible but sometimes thinking widely about ways to solve a problem can help you find a solution you might not have thought of before. Think of it like a funnel – think of all of the possible solutions, review them and filter out solutions that might not work, and you may be left with one very helpful solution! If you turn the funnel the other way up and there is only room for one possible solution, it can be demoralising and frustrating when that doesn’t work.

Step 3. Choose one

Take a step back and review the solutions you have come up with. Which one do you believe will help you to move closer to solving the problem?

Step 4. Make a plan

Decide when, where, and how you will carry out the solution you have chosen. Try to be as detailed as possible. Write it down and put it somewhere you can see it. The more specific you are with this plan the more helpful it will be for you to see how your plan and your solution is going.

Beware of jumping ahead or getting side-tracked!

It is common to start off enthusiastically with these steps and then get distracted by other things. To give yourself the best chance of success put a reminder in your phone or tell someone you trust what you plan to do.

Also, it is common to unintentionally skip some steps and jump into doing things. Try not to fall into this trap. The steps are an important tool for helping you approach problems effectively and for helping you learn from what went well and what did not work so well.

Now do it!

Step 5. Review how it went

Did it go to plan? Did it move you closer to solving the problem? If it did not go to plan, perhaps you can break the solution down into smaller more manageable parts or go back to the list to choose another option.

Is the Problem Solved? If not try these steps again.

If it’s solved, great, congratulations – you can see how searching for new solutions and learning new ways of coping and problem-solving can help. If your solution isn’t going to work, go through these steps again. Keep positive and persevere.

Problem solving steps summary

What is the problem(s)?
- Prioritise a problem
- Is there something you can do about this problem?
Brainstorm solutions
Choose one solution
Make a plan
- Remember not to get side-tracked or jump ahead
- Now do it!
Review

Trouble shooting

The steps above might sound simple and straightforward. But what if you get stuck? What if it is very difficult to get closer to solving the problem? Below are some suggestions to help you with the problem-solving steps.

What has worked before? Have you faced this problem before? If so, what have you tried in the past? Did it work? If it worked then, can you try it again now? Perhaps you have not faced this problem before but have faced other similar dilemmas. Are there any skills or strategies you have used then that you could use now?

What have you tried before that has not worked? You may have tried things in the past that turned out to be unhelpful or maybe only worked in the short term. If your experience tells you that these solutions have not worked in the past, perhaps they are unlikely to work now. Try not to re-use old problem-solving strategies that have not helped.

Take a different perspective. If a friend was in a similar situation, what might you advise them to do?

Two heads are better than one. Ask a friend or family member to help you come up with possible solutions.

Accept help. Maybe this is a problem that cannot be easily solved alone. Many people with health problems worry about being a burden on others and work hard to be independent. However, perhaps asking others for help is part of the solution. Try to imagine how you would feel about being asked for help by a friend or family member who was struggling. Would you see them as a burden and begrudge giving help or would you be glad to have a helping role from time to time?

Be a detective. You may not have all the information you need to solve the problem or to come up with new solutions. Try asking your healthcare professionals for more information about the health dilemma you face. If possible, go to your consultation with specific questions written down to help you use the time well.

If you choose to use the internet, stick to websites that are likely to have accurate and helpful information. NHS Choices is usually a good place to start. Beware of general browsing of the internet for information about your condition as many websites contain information which may not be accurate and may exaggerate benefits or risks. There is also a danger that if you look at too many websites you will get conflicting information which can be very confusing.

“Are we there yet?” Perhaps, despite your efforts, the problem is not yet solved. You have not ‘arrived’ at your destination. Maybe you are feeling disheartened and fed up. If this happens, review what you have tried and ask yourself “Has this got me closer to solving the problem?”. You may not be ‘there yet’, but you may be moving in the right direction on the right road. If your experience tells you that you are moving in the right direction, keep going!

Learn from your attempts. You might try a solution that doesn’t work out. Try not to get disheartened. Instead, try to learn from this. It is as important to know what doesn’t work as to know what does.

Give credit where credit is due. Acknowledge your effort and persistence and note your successes, however small. Remember that living with health problems is not always easy and that there will be setbacks. Try not to let setbacks overshadow your good work.

Is it worth it? Solving problems is challenging. It can be very demanding of time and energy. Sometimes getting wrapped up in solving a problem can mean losing touch with other things that are important in your life. Take a moment to ask yourself what does it cost you to solve this problem (e.g., time with family, time spent doing pleasurable activities) and is the outcome you are looking for worth it?

Your answer may be ‘Yes, it is worth it’. However, you might decide to accept the problem as it is, without trying to solve it, and find other ways to live a more meaningful life for now, perhaps returning to the problem later.

Take a step back. If your efforts have not produced the results you wanted, despite all your best efforts, ask yourself the following question again “Is this something I can do something about, or it is out of my control?”. If you realised that the problem might be beyond your control, read on for ideas about how to cope with problems we cannot control. If your experience tells you there is more you can do, continue using the problem-solving steps.

Problems you can’t control

Sometimes it is clear from the start that the problem you are trying to solve is outside of your control and you cannot have much of a direct effect on a situation or the outcome. In these situations, trying to solve something you can’t actually do much about is like ‘beating your head against a brick wall’. It can be painful and frustrating to try to change things you can’t actually do much about!

Perhaps it is external factors you cannot control, like economic or political changes, which have made it difficult to solve the problem. Or perhaps at this point in time you don’t have the resources you need to solve the problem (e.g., time, money, energy). These things are not your fault and are not under your control, so try not to fall into the trap of being too hard on yourself.

You may be having thoughts like ‘I’m not working hard enough’ or ‘I’m not persistent enough’ or ‘I’m hopeless, I ought to be able to cope with this’. These kinds of thoughts can make you feel bad, can be unhelpful, and are often unlikely to be true.

If you are battling problems that you can’t change it can be helpful to take a step back and think about what else you might be able to do to make day to day life easier.

Living with problems you can’t control

Even if the problems you face are not within your control, there are still things you can do and there is hope. These strategies will not make the problem go away. Instead, they will help you to be less bothered by the problem and aim to help you live a rich and meaningful life, even though the problems are still there.

Acknowledge your situation

Try to acknowledge that, for now, you cannot change the situation you are in. This is not always easy.

Stopping looking for a solution can be very difficult.

Remember, acknowledging your situation is not the same as ‘giving up’ or ‘liking’ or ‘wanting’ the problem in your life. Instead, it is about letting go of the struggle you have with the problem. You can do this by making room for it in your life and allowing it to be there, instead of trying to get rid of it.

Acknowledging the problem is a bit like having an unwanted, loud guest at a party. You don’t have to like them, but you may have to offer them a seat!

Manage your thoughts and feelings with mindfulness

Once you decide to accept your problem and begin to let go of the struggle with the problem, you will naturally have different thoughts and feelings that come up. You might have thoughts like “I’ll be stuck with this awful problem forever” and feeling angry, frustrated, and sad. This is a normal reaction.

Many people fall into the trap of trying to push these thoughts and feelings away. However, this just makes them come back even stronger. For example, try NOT to think of a Pink Elephant right now. How did you do? Did you manage to keep the image out of your mind? If you are like most other people, probably not!

Instead of trying to push difficult thoughts and feelings away, you can learn new ways of being less caught up in your thoughts and feelings and eventually less bothered by them. One way of doing this is to practice mindfulness.

Mindfulness is about paying attention in a particular way. It invites you to take a curious and non-judgemental attitude towards whatever you are experiencing in the ‘here and now’. Try these simple steps:

Focus first on your breath. Pay attention to the natural rhythm of your breath. Notice the rise and fall of your chest and stomach. Notice how the breath feels coming in and out of your nose. Pay attention to any changes in your breath. Don’t be concerned if you notice your mind has wandered off. This is normal. Just gently bring it back to the breath.
Notice thoughts, feelings and sensations that come up and try to grab your attention. This is normal. Instead of pushing them away, or judging them as bad or a nuisance, just observe them, as if they were leaves on a stream or cars driving by outside. Then bring your attention gently back to the breath.

As you become more skilled at using mindfulness, it can help you be less bothered by difficult or painful thoughts and feelings about the problem. You will learn to observe them and notice them without getting caught up in a struggle with them.

Being mindful of your experiences is a very different way of paying attention and it takes practice. There are many good books and CDs about mindfulness and about how to apply it to your everyday life if you think this approach might be helpful for you and you would like to learn more.

Do what matters to you

Even though you may not be able to solve some problems in your life there are still ways of living a full and vibrant life. Focus on things you can control that make your life better.

Ask yourself the following questions:

What do I really value in life?
What gives me pleasure?
What gives me satisfaction?
What gives me meaning?
How often do I do the things that connect me with my values?
How often do I do the things that give me pleasure, satisfaction, and have meaning?

Perhaps, like many people you have lost touch with the things that are really important to you in life. It is possible that you have been working so hard at trying to solve a particular problem that the things that really matter have been neglected.

Write down the things in life you really value and think about what you would be doing if you were living a life that fitted with these values. For example, if you value being a good parent, you might decide to spend more time with your children. If you value health and well-being, you might make changes to your weekly shop, cutting down on fatty food or alcohol. If you value humour, you might meet with friends who make you laugh.

Now, plan for when and how you are going to do things that fit with your values. You can use the problem-solving steps if you get stuck.

Solve the solvable

Even though you may be faced with a big problem that is outside your control, this does not mean you have no control over your life and other problems. Continue to take on other challenges that are solvable, starting with manageable tasks, and give yourself credit when you succeed.

Next steps

Plan a time to use the ideas in this leaflet
Share the ideas with someone who can support you
If you have tried the ideas in this leaflet and you have not seen any improvements, talk to your healthcare professional about getting further support.

King’s Patient Advice and Liaison Service (PALS)

This is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. The PALS office is located on the ground floor of the Hambleden Wing, near the main entrance on Bessemer – staff will be happy to direct you.

You can find their website here.

Tel: 020 3299 3601 Fax: 020 3299 3626 Email: kch-tr.pals@nhs.net

Providing feedback

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Originally written by Dr Jane Hutton, Consultant Clinical Psychologist.

Revised by Dr Clare Cooper, Psychologist for the IMPARTS programme, February 2023.

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