HEALTHY FAMILY REACTIONS TO ILLNESS: SETTING GOALS

How many times have you decided to change some negative habit, only to fail in your efforts after a brief period of progress? This New Year's resolution syndrome—setting lofty goals that prove to be unattainable by about January 31—probably has much to do with the fact that the month of February brings with it the highest number of hospitalizations for treatment of depression.
Positive copers do not set themselves up for failure by committing to broad, all-encompassing, vaguely stated goals. Rather, they orchestrate their rehabilitation in a way that promotes feelings of success and continued motivation. They do this by setting concrete goals that are realistic, specific, and measurable, and then they often participate as a team in pursuing the goals. For example, they avoid setting vague goals such as "I will start getting more exercise." Instead, they set very specific goals: "We will walk for thirty minutes four times this week." Positive copers write these goals down and state them in a way that allows them to measure their own progress in tangible terms. By being specific in your goal setting, you can create an aura of cooperation and appreciation of each other: "Look at this exercise journal—I'm really proud of us. We both stuck to our plan this week."
The preceding example implies a point worth stating directly: Healthy couples do tend to participate in most aspects of cardiac rehabilitation together. This is good for the marriage, and it is also good for the heart patient. Numerous research studies have clearly shown that when spouses participate in the life-style changes that are suggested in cardiac rehabilitation, heart patients comply with the recommendations more closely. Healthy couples adopt a spirit of healthy living that begins to organize their family life as they go through the cardiac rehabilitation process together.
This does not mean that they always exercise at the same time, eat exactly the same meals, or take the same medicines. Further, this certainly does not mean that spouses are responsible for their mates' rehabilitation. But it does mean that healthy couples make rehabilitation a marital affair. The spouse turns the crisis of the illness into an opportunity to modify his or her own health habits in needed ways. In the process, cooperation and intimacy grow in the marriage.
By being specific and realistic in your goals, you can also avoid becoming demoralized and demotivated during the course of rehabilitation. Like heart illness itself, many of the positive cardiovascular effects of healthy life-style choices are invisible. There are, of course, exceptions to this statement: you can see your blood pressure readings improve, your cholesterol count drop, or your exercise tests improve.
However, these readings do not necessarily continue to change in positive directions, no matter how hard you work at rehabilitation. After all, no one—heart patient or otherwise—progresses in a straight line toward perfect physical conditioning, no matter how great the effort. If these are the only yardsticks being used to measure your success, then you may lose the motivation you need to continue your lifestyle changes.
Participants in our rehabilitation program at Wake Forest University go through a predictable pattern of motivation of this sort. Patients are given a treadmill test upon entering the program and then again every three months. Good improvement in exercise capacity is typical between the entry testing and the first follow-up testing. Motivation during the three-month period after the second testing is therefore predictably high; those black-and-white numbers from the testing show that healing is happening.
Then the trouble begins. Indicators of increased physical conditioning often begin to level off with the third treadmill test. This is perfectly normal in the rehabilitation course. In fact, a large percentage of healthy recovering patients periodically show slight declines in indicators of cardiac functioning during repeated treadmill tests. Motivation becomes even more difficult to maintain when the heart patient's rehabilitation is interfered with by further medical complications. Repeated heart attacks, need for bypass or "balloon" surgery, or increased angina may occur despite diligent efforts to overcome the effects of the original illness. So how do you stay motivated even though those magic treadmill numbers or your own body may now be betraying your rehab efforts? Answer: Use tangible indicators of success in pursuing your rehabilitation goals.
Successfully recovering heart patients and their mates adopt the attitude that they will live—rather than die—with heart illness, and they accept that the illness will be part of the remaining years of their lives. They measure their rehabilitation progress in terms that are less dependent on medical scales and more easily tracked with honest self-monitoring. When they need a boost of motivation they ask themselves questions such as these:
Have I, indeed, exercised as regularly as I planned?
Have I made needed life-style changes like stopping smoking or limiting alcohol intake?
Am I eating a more heart-healthy diet?
Am I developing positive emotional and stress* management habits?
Am I following my doctors' orders about medications?
If you have done a reasonable (not perfect, but reasonable) job in these regards, then you deserve to pat yourself on the back with a tangible reward, regardless of what the treadmill, the blood analysis, or .my other medical test indicates. I do not mean to imply that these test results are unimportant. On the contrary, be realistic in dealing with the implications of such tests. It may be that you have to change your rehabilitation plan, based on the hard medical facts. The point is that positive copers motivate themselves by making note of what they are doing well and by rewarding themselves accordingly. Healthy couples help each other remain motivated throughout rehabilitation by giving nurturing and appreciative feedback to each other. Each takes note of what the other does that is right and good. They make lists of the many positive health care choices they make regularly, and they skip shaming and fussing about each other's imperfections.
Taking appropriate care of yourself is easier if you are supported in your efforts by caring attention from others. Healthy families seem to know this, and they treat each other in this spirit.
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