Module 3. How life gets in the way
Welcome back. How is the habit loop mapping going? Did you get a chance to try out the 3-step process that helps you step out of these old loops and into compassionate action? As a reminder. First, you take a deep breath and identify what loop you’re in. Second, take another breath, and name the loop. Take that third deep breath, and see if you can ground yourself with a reminder that you don’t have to take this on. Focus on the fact that they are suffering, instead of getting caught up in it. That’s it. Three steps and 3 breaths can make a big difference. Or maybe you only got a chance to start looking out for when you get caught in your patient’s story by noticing restlessness, being closed down, or worrying. Did this help you step out of the story and get more grounded in your own?
Here’s an example from a doctor who was pilot testing this program. They reported recognizing the following self-protection habit loop: “Yesterday, after looking at the name of a patient who is very demanding, I caught myself rooting for her not to come. Indeed, she did not [show up], and I caught my mind celebrating the fact".
A doctor described the following. “Just yesterday a patient came in who is very focused on her medical problem, naming it "inflammation". She was certain that THAT is what she has. It was challenging to not get lost in her narrative because unfortunately (medically) that was not correct. But she was absolutely suffering and I needed to ground myself. When I was able to move from "here we go again" in my mind to the fact that she is suffering and I need to ground myself with compassion for the challenge facing me and compassion for her, I could look at her and say, I know you are extremely uncomfortable and we will try to get to the bottom of this and that the problem you have been having is complex and needs a thoughtful approach with some educated trials (and possibly errors) to help us to avoid trying a quick fix that may not help you. Ultimately, my calm seemed to bring calm to the space -- and to her.”
Here’s one more example.
A doctor mapped out the following habit loop: Trigger- Friday afternoon, fear of being late for Dinner (again) which is pizza and movie night with the kids and my wife always telling me that I work too much and I am always late. Behavior- Rushing through patients and worrying. Result- Tightness, closed off, not connecting with my patients, totally out of the moment and stressed. I used the Mantra- "It is not about you", I labeled it Rushing, fear of being late and just sat with the fear a little while. It didn't feel good but felt some space and took the edge off. I realized rushing actually wasn't going to get me home faster and I sank into the last patient better, finished my end of patient call back tasks without rushing. I actually can't remember if I was late for dinner and seemed no one cared I think because I was present -rather than "on time" and frantic from being caught up in the fear/worry cycle.”
Today. like these examples, I’ll help you build on this grounding. We’ll first focus on a very common way that we get in our own way. I’ll also teach you a simple practice that can help you stay present with your patients, your colleagues and yourself. Let's get started.
One way that we get in our own way is by a phenomenon called thought intrusion. This is exactly what it sounds like, thoughts intruding. Let’s say that you’re in the middle of a patient interview, and a thought about your child who isn’t feeling well, or is having some trouble with their friends pops into your head. Or maybe you had a “misunderstanding” with your partner last night or before work, and it shows up in your mind, unannounced. Or you forgot to do something related to your last patient and your brain starts telling you that you’ve got to remember to do it. Whether the thought is regretting something about the past, or prodding you to worry or plan for the future, one thing is certain: it is keeping you from being present. Your patient is saying something, and no matter how hard you want to focus and hear what they are saying, your brain is crowded with these other thoughts, demanding your attention.
Worse yet, you feel embarrassed or guilty for asking your patient to repeat themselves–perhaps feeding the stereotype that doctors don’t do a great job of listening. Or you worry that you missed something important. And then these worry thoughts also fill up your head making it even harder to listen. Why is this the case? Well, similar to a computer that only has a certain amount of RAM -random access memory, your working memory can’t hold a lot of information at the same time. If your head is filled with these intrusive thoughts, it literally doesn’t have space for other information to get in.
This happens all the time, and not just in medicine. One study found that on average our minds wander a whopping 47% of the time when we’re awake. And that’s just the average person.
What have you tried to get those intrusive thoughts to stop? Forcing them out of your head? Willing yourself to listen to your patient, or your colleague or your spouse? How well does that work? I’ll spare you the details, but the bottom line from a neuroscience perspective is that willpower is more myth than muscle. But you probably already knew this from your own experience. Every time you’ve tried to resist that extra helping of dessert, or that extra drink that you knew you didn’t need, you know what I’m talking about. How about trying something different instead?
Let’s say you have an intrusive thought, you start worrying about something. That worry thought can gain momentum. One worry thought can lead to another, which leads to another. On and on. The more worrisome that thought stream gets, the more the momentum builds. That’s where the phrase “train of thought” comes from. One thought leads to the next and to the next and to the next. Most of us get carried away on this or that thought train without even noticing it. The more emotional charge the thoughts have, the more these thouhts grab your attention and takes you for a ride –full steam ahead! That train can take you far away from the present moment before you even notice that you’re on it. You can’t just grab the brake lever making the train screech to a stop so that you can get off. The harder you try to push or pull those thoughts out of your head, the more your brain fights back and keeps going.
Let’s use some science to help you work with your brain instead of trying to fight against it. There’s a phenomenon in physics called the observer effect. Basically when scientists try to observe the characteristics of really small particles, like electrons, they have to hit them with other really small particles, like photons.The physicists noticed that by hitting electrons with photons, it was affecting the electrons’ momentum and as a result their observations. They called this the observer effect. By observing, they were affecting the results. This is also true in the quantum realm of the mind, in this case behavioral neuroscience.
Here’s how it works: you can simply observe a worry thought by labeling it as a “worry thought.” You can observe a planning thought by simply naming it: “planning.” You can do this with any thought. By naming or noting it, you are using the power of the observer effect. This works because you can’t name or note a thought and be identified with it at the same time. In order to label the thought, you have to have some distance from it. You have to have some perspective. Naming the thought gives you that perspective.
Instead of trying to stop your thought train, you can use the observer effect in your brain. You can simply observe thoughts, and by observing you will do more to reduce your intrusive thoughts’ momentum than by trying to push them away or derail them to some other way. This helps you keep your balance and not get knocked down by those thoughts whizzing around in your head. And by practicing this observe and label response, you can learn to step off the train, one thought at a time.
That’s right, you don’t have to believe everything you think. When you observe your thoughts, you can choose to get on the thought train or not. If you notice habitual thought patterns, you might already know where they will take you if you get on that train, and this awareness can help you decide whether that’s a train you want to get on board or not.
Here’s how to put this into practice. We’ll call it noting as a shorthand because you are noting what thought arises from moment to moment. If an intrusive thought pops into your head, you note it. You can keep this really simple, by noting to yourself “thinking” or “intrusive thought” or coming with the label that works for you. No matter how many times it comes up, simply note it. Once you get the hang of it, you can start noting specific thought patterns. This is similar to giving your empathy protection habit loops nicknames, like I talked about in the last modules. For example, if you tend to worry a lot and notice a worry thought come up, note it as “worrying.” If you plan a lot, note those thoughts as “planning.” And so on. You can even extend the noting practice to noting emotions and body sensations. Each time you note an emotion, the same observer effect helps you gain some perspective. Noting fear. for examle, helps you be able to not get lost on the worry train as fear heads out of the station and starts moving into the future. That’s what worry is after all: fear of the future.
Now notice the difference–in your own experience–between carried away by an emotion or thought train and simply observing the emotions and thoughts as they come up. Notice how observing helps you be less identified with thoughts and emotions, giving you a wider lens and greater perspective. Having perspective builds on what you learned in the last module: it opens you up so that you can see more than what is right in front of you, or what is taking you for a ride, so you can step off the train and get on board with being fully present with your patients or whoever you're with. That’s right, noting your emotions and intrusive thoughts helps you stay grounded so that you can be present not just when you are listening to your patients, but in other parts of your life as well. It helps you be present with your colleagues and it helps you to be present with co-workers. It helps you be present with family members. It helps you be present with yourself.
So try putting this into action today. See how many thought trains you can identify. See what happens when they take you for a ride, and how the practice of noting thoughts or naming them can help you step off the train, and onto solid ground. When you notice an intrusive thought pop up, don’t sweat it. Simply note it.
Onward! We'll see you in the next module.
References:
Killingsworth, M. A., & Gilbert, D. T. (2010). A wandering mind is an unhappy mind. In Science (Vol. 330, Issue 6006, p. 932). https://doi.org/10.1126/science.1192439