The older the illness, the smaller the first goal — what to take on first

"I've had this much treatment, so I should be better by now" — when you grow impatient in the face of a long-standing illness, recovery often slows down instead.

When I treat intractable conditions, rather than setting one big goal, I set small goals one at a time. Let me explain why I do it this way, and which one I tend to take on first.

Why start with small goals

A long-standing illness is built up in several layers. Beneath the hard symptom on the top layer, there are other problems piled up that prop it up. In this state, if you make "being completely cured" your only goal, you won't feel it even when you improve a little, and you'll tire easily.

Instead, if you take one thing that weighs heavily on your quality of life right now — for example, "not waking up at night from pain," or "getting through the morning hours" — and make that your goal, a small change becomes visible, and that becomes the strength for the next step.

One thing is worth setting straight here. Making the goal small does not mean the body mends faster. What the studies of goal-setting in rehabilitation have found sits mostly on the side of the sense that you can do this, and quality of life — and the evidence there is not firm. So a small goal is less a medicine than a waymarker that keeps you from losing the road. In a long-standing illness, having one or not turns out to matter a good deal.

Why I start with sleep

The small goal I most often take on first is sleep. There is a reason for it.

Sleep and pain pull each other along, but the pull is stronger one way. In studies that followed people over years, poor sleep predicted worse pain more clearly than pain predicted worse sleep. That is the reason to take hold of sleep first.

After that it is usually energy and digestion — the place where the materials for recovery come in. Long-stiffened problems generally move last.

But that sequence is the order I have met in my own consulting room, not a law that every body keeps. Which part moves first differs from person to person. So rather than fixing the order and pushing, I watch which side responds and move the next goal there.

We check the progress together

At each stage we go over what has improved and what has stayed the same. The longer someone has been ill, the harder it is for them to notice "a little improvement" on their own. Often a patient is doing this month what they could not do last month, and has no idea.

That is as far as anything can be said in the face of a long-standing illness. Finding together what is able to move first from where you are now, and walking those small goals one at a time. Walking that road with you is my role.

References

• Poor sleep predicted later pain more strongly and consistently than pain predicted later sleep disturbance (6 of 9 prospective studies) — The Journal of Pain, 2013
• Goal-setting in rehabilitation tended to improve self-efficacy and quality of life, but the evidence is of low quality and no improvement in physical activity measures was confirmed — Cochrane Database of Systematic Reviews, 2015

Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)