We know we should do ____, but instead we do ____

by Carolyn Thomas  ♥ @HeartSisters

I read this on the side of a Starbucks coffee cup. Seriously. It was written by Harvard psychologist Dr. Daniel Gilbert, who said:

“The fact that we can make disastrous decisions even as we foresee their consequences is the great unsolved mystery of human behaviour.

“When you hold your fate in your hands, why would you ever make a fist?”

Why, indeed?  Sometimes I think of Daniel Gilbert’s words when I make decisions of varying levels of potential disaster even when I know perfectly well that I will most definitely NOT like the consequences of doing so. 

These decisions can range from the mundane (“forgetting” to practice my ukulele before my weekly lesson) to the momentary (saying yes to that second helping of birthday cake) or the must-do (skipping exercise for the third day in a row because  . . .  oh, yeah, why DO I do that, anyway?)

Heart patients, like many living with other chronic disease diagnoses, face To Do lists that require YES or NO decisions all day long, day after day after relentless day: eat heart-healthy, get plenty of exercise, take all your meds, see your doctors, get enough sleep, lose weight, manage stress, blahblahblah . . .  Yet so often – especially when we are not feeling well – decisions to support such important tasks can falter by the wayside.

We know we should do  ____ (fill in the blank) but instead we do  ____ (fill in the blank!)

Here are just a few examples:

• heart disease survivors who decide not to sign up for/drop out of  cardiac rehabilitation even after their doctors’ referral
• survivors who decide to continue smoking despite knowing the very clear risks to their damaged hearts
• survivors who decide to stop taking their anti-platelet medications or blood pressure pills or other important meds their physicians have recommended for them
  

Now, I’m guessing that the heart patients who deliberately make these decisions are intelligent, functional humans who are capable of making many important decisions in life. They go to school, land jobs, raise children, drive cars, pay bills, do household repairs and make bank deposits. 

Yet they may consciously make poor heart health-related decisions as if they are utterly unaware of the consequences. (And remember that not making a decision is still a decision in itself).

It’s taken me a while, but I think I may finally get what’s going on here.

Let me offer a relatively minor comparison: my relationship with chocolate-covered almonds.

I fully realize that I should be able to eat a little treat of one or two delicious chocolate-covered almonds in one sitting like normal people do. But instead, once I start, I don’t seem to be able to stop.

The only solution to my impending risk of collapsing into a chocolate almond-induced sugar coma is this one: I cannot have them in the house. Period. Many people are apparently able to. I’ve learned, however, that I’m not one of them.

But why? Why? Why do I seem to have zero self-control when it comes to chocolate-covered almonds? Why is it so hard to walk past the bulk food aisle at Thrifty Foods where those gleaming almonds (in both milk and dark chocolate!) are calling out my name? And let’s face it, the bulk kind are not even the good kind . . .

But I can exhibit will power and self-discipline in other areas of life. I’ve managed to set and meet a variety of personal, academic, family and career goals. I spent 19 years as a distance runner, for example, and managed to conscientiously train precisely as required, rain or shine and whether I felt like it or not, for upcoming road races with my running group.

Yet when it comes to chocolate-covered almonds, I’m a goner.  Even as I’m wiping the tell-tale chocolate smear off my lips afterwards, I feel upset, ashamed and furious with myself.  I know that pigging out on chocolate almonds is NOT what I want to do, so why do I even start?

If Mahatma Ghandi (arguably the all-time poster boy of self-discipline) was correct when he wrote this. . .

“Your beliefs become your thoughts, your thoughts become your words, your words become your actions, your actions become your habits, your habits become your values, your values become your destiny.”*

. . .  then what does my little chocolate almond problem say about my very destiny on this earth?!?

As Dr. Dan Gilbert warns on that Starbucks cup, I can clearly foresee the consequences of  such a “disastrous decision” – yet there I go again.

It turns out that we tend to prioritize our behaviour decisions based on a number of factors – including how we’re feeling, how much else is going on in life, and even our cognitive biases.  This is especially important if you’re a patient living with a chronic illness diagnosis like heart disease.

For example, I’ve written previously (here and here) about Dr. Victor Montori and his Mayo Clinic-based team working on the innovative concept called Minimally Disruptive Medicine. They explain how a patient’s “burden of treatment” can so often get in the way of following a doctor’s basic orders. As Dr. Montori explains:

“A patient’s education level, literacy, state of depression, pain, fatigue, social connectivity and supports, financial status – all of these affect a patient’s capacity to do the work.

“The workload can simply exceed capacity to cope.”

NOTE:   Are you living with a chronic or debilitating illness?  Take this Burden of Treatment survey. But first go back to reading the rest of this post, please!

Behavioural scientists sometimes blame poor decisions on what they call “present bias”.  This causes us to pay attention to what is happening right now, but not to worry too much about consequences in the future, and which makes it so effortless to pop a fistful of chocolate-covered almonds before even pondering the longterm consequences of that decision.

As Professor Dan Ariely from Duke University in North Carolina told a BBC interviewer earlier this year, this is one of our most important cognitive biases:

“Present bias is what causes things like overeating and smoking and texting while driving and having unprotected sex.”

Not only is my destiny being impacted by this clear cognitive bias of mine around chocolate-covered almonds, but Dutch researchers recently announced that I’d actually be a whole lot happier overall if only I’d embrace the  benefits of what’s known as “trait self-control” (TSC).(1)

Calling TSC “the trade-off between relishing immediate gratifications and achieving longterm goals”, they further explained:

“Research has consistently shown higher TSC to be associated with more positive outcomes in life such as higher academic achievement, better health, more interpersonal success and less maladaptive adjustments (Tangney et al., 2004). 

“Indeed, while having to forego an immediate pleasure for a distant, longterm goal, people with high TSC are much more successful in managing competing goals by favoring the one with the most virtuous outcome, which in turn leads to greater life satisfaction.”

Translation: saying NO to that chocolate covered almond (“forgoing immediate pleasure”) will apparently promote my overall happiness and greater life satisfaction (“most virtuous outcome!”).

But Jonah Lehrer, author of the book, How We Decide, also wrote about this in the Wall Street Journal. Here’s what he had to say:

“Most of us assume that self-control is largely a character issue, and that we would follow through if only we had a bit more discipline.

” But research suggests that willpower itself is inherently limited, and that it fails in large part because our brains weren’t built for success. Willpower, like a bicep, can only exert itself so long before it gives out; it’s an extremely limited mental resource in decision-making.

“Willpower is so weak, and the prefrontal cortex is so overtaxed, that all it takes is a few extra bits of information before the brain starts to give in to temptation.

“This helps explain why, after a long day at the office, we’re more likely to decide to indulge in a pint of ice cream, or eat one too many slices of leftover pizza.

“A tired brain, preoccupied with its problems, is going to struggle to resist what it wants, even when what it wants isn’t what we need.”

Which of course begs the obvious question: maybe if I take more naps to rest my tired prefrontal cortex, will it help me in deciding to ignore that siren call of the chocolate-covered almond?  

♥  

P.S.  I just want to point out that I have not had a chocolate-covered almond since June 7, 2014.

* as quoted in Hope in the Age of Anxiety by authors Anthony Scioli and Henry Biller. Oxford University Press, 2009.

(1) Tracy Cheung et al. Why are people with high self-control happier? The effect of trait self-control on happiness as mediated by regulatory focus. Personality and Social Psychology, 5, 722. July 8, 2014.

Illustration: Boston Globe

Q:  What has helped you do more of ___ instead of doing ___?

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.See also:

• Six steps to stop emotional eating
• How to stare down that plate of chocolate chip cookies
• Confessions of a non-compliant patient
• Living with the “burden of treatment”
• Mindless eating: 8 reasons women eat when we’re not even hungry

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