Shoulds and the Paradox of Self-Motivation

I was coaching a physician recently who was struggling to start an exercise regimen. To protect her anonymity, I’ll call her Jamie.

Jamie had started and stopped exercising many times in the past but had never stuck with it. I could well understand this as she’s a mother of three with a busy career — her days are anything but quiet and full of free time.

Like many, Jamie had put on weight with her pregnancies and struggled to lose it. She also had a family history of diabetes and was worried about the extra weight increasing familial risk.

She’d tried everything from the Whole30 diet to Noom, from working out at her Y to shifting to an elliptical in her basement, and from having her husband push her to keep her accountable to app upon app, but nothing stuck. She just couldn’t get herself to stay motivated, no matter what she tried.

Like many others, Jamie didn’t know why she couldn’t do regular exercise. She just knew that she couldn’t. Having never gotten below an A- in her life, Jamie felt that, with exercise and self-care more generally, she was getting a big fat F.

So, Jamie and I got deep into discussion, and I asked her a few questions to help her understand what was getting in her way. I first asked her to share her thoughts on exercising. Here’s what she said:

  • I should get up at 5:15 every day and get on the elliptical.
  • I should be able to stick to my exercise routine.
  • I should be better at this.
  • I should be like other physician moms who figure out how to fit exercise into their busy lives.

Unfortunately, none of these thoughts improved her ability to sustain an exercise program. Something was still missing. 

Could it be that all these “shoulds” were actually getting in her way?

I’m wondering how you approach making a lifestyle change, developing a new habit, or getting some demanding task crossed off your to-do list. If you’re like me, Jamie, and many others, you may approach the issue by telling yourself that you should make the change. You should improve, you should become a kinder, more efficient, better person, you should just do whatever it is that you’re wanting to do. 

Unfortunately, all this “shoulding” may actually be stealing your motivation, rather than building it. As I discuss in my 2020 book, Everyday Resilience, these inner ‘should’ voices are ones we all have, yet without proper tools and skills, can really erode the inner resilience we all possess. At times, this voice of should can even become one that is punishing, harsh, and shaming, can’t it? It can even creep into our thinking around all kinds of things.

  • I should get out of bed early and get on the exercise bike.
  • I should be able to stick to my diet.
  • I should start meditating.
  • I should be nicer to my spouse.
  • I should be more patient.
  • I should get that work done.

Before you know it, all these shoulds then lead to a whole other level of self-judgment:  

  • What’s wrong with me not getting out of bed early and exercising?
  • Everyone else seems to be able to know how to manage their weight issues, but not me.
  • If I don’t get it together, I’m going to end up a fat diabetic sloth.
  • Why am I so unmotivated? What’s wrong with me that I don’t have the willpower everyone else has?
  • Why can’t I just suck it up and do better?

All of this begs the question: Have your shoulds motivated you? Have they helped you make the changes you want?

There’s a reason why so many of us can answer with a resounding ‘no.’ The fact is that telling ourselves that we should do something takes us away from the intrinsic or internal motivation that is what truly motivates us to do anything. The should takes us to an external source of motivation, one that is less likely to get the job done. The should leaves us trying to motivate ourselves because society says so or your parents told you to or how you think you should be doing something or other. It takes us away from what truly drives us in life — our desires, our passion, and what’s in it for us to take the action we want to take. We may believe that an external entity like money, keeping up appearances, or receiving praise from others will get us there, and they might for a brief while, but rarely in a sustainable way.

Let’s take a deeper dive into what it is that will truly provide the motivation you need. When you think about why all the shoulds actually erode our motivation, you can likely see the answer. After all, we humans tend to do things when there is something in it for us to do so. The old WIFM, or what’s in it for me, is an important truism.

The key is to make sure you’re aligning with your WIFM as opposed to the internalized voice of parents, teachers, and others which actually only serves to tap into our brain’s threat-defense system. Recall that this is the fight/flight/freeze system that our primitive brains developed to protect us from danger. Thank goodness our brains evolved in this way to ensure that our species rose up the evolutionary ladder! But in the modern world, this system is activated by threats of a psychological nature, ones that tell us we’re not good enough, smart enough, thin enough, or, in Jamie’s case, fit enough. And once the threat-defense system is activated, we’re operating in survival mode, small, withdrawn, fearful, and only focused on getting by. All too often, the result is procrastination, distraction, or avoidance.

For true self-motivation, we can go to an important psychological theory. One of the most influential theories on human motivation, in fact, is self-determination theory, which originated from the work of psychologists Edward Deci and Richard Ryan, who published Self-Determination and Intrinsic Motivation in Human Behavior in 1985.

The SDT informs that we tend to be driven by a need to grow and gain fulfillment. One of the core assumptions behind the SDT is that developing mastery over challenges, learning, and growing is essential for our sense of self.

SDT also points to the fact that while we may be temporarily motivated by external rewards (money, prizes, societal messages, recognition or validation by others), internal sources of motivation fuel the most desire and commitment toward our goals. Also, tapping into our intrinsic desire to achieve a goal can be a powerful motivator and keep us going when external rewards aren’t enough. While the idea of intrinsic motivation may seem like a new concept, it’s something we’ve known about for quite some time. Many studies confirm the truth of SDT, bolstering the fact that intrinsically motivated people are more able to reach their goals – resulting in happier and healthier (and more motivated) people.

Tips to self-motivate

Reading this, you may be wondering: what’s the alternative?

SDT helps us understand the true ways we can motivate ourselves. What’s key is getting in touch with the “why” behind the change you want to make. That will take you to your WIFM and help you move forward toward your goal.

When I asked Jamie about her WIFM, she readily identified that exercising was important for her so she could avoid diabetes and have the longevity she wanted to be there for her family. Her WIFM also meant how good it felt to fit into some cool clothes she had worn before giving birth. Instead of beating herself up with a litany of shoulds, when she focused on what was truly in it for her, she felt more of a sense of ease about exercising. In our next coaching session, she proudly told me that she had stayed on her exercise program for the entire prior month, a first for her. Of course, it was still challenging to fit this into her busy days but now she was able to do so.

Since I’m all about pragmatic approaches, here are 5 tips to self-motivate and reach your goals.

    1) Pay attention to the voice of the shoulds. Honing this type of self-awareness is always the first step in effecting any change. And guess what? This type of self-awareness is also known as mindfulness. After all, mindfulness is about getting to know what is going on inside and around us. We pay mindful attention in a kind and friendly way, not by adding more “shoulds” onto the existing pile! Why is mindfulness so important? The simple answer is that it helps us to be more present and aware in our lives. And this can make a huge difference in how we feel and experience both ourselves as well as the world around us.

    2) Now that you’re aware of when the shoulds are present, broaden your awareness by noticing how you feel mentally and physically when you experience them. Do you feel uplifted and excited to move forward? Alternatively, perhaps you experience a sense of dis-ease, a downward sense of gravity that pulls you back toward the shoulds. Get in touch with how different the extrinsic and intrinsic motivation feels to you. Since the latter likely leaves you much more uplifted, this will also contribute to greater motivation.

    3) Now ask yourself: what is in it for me to make this change? What’s important about this? How will it help me? If it’s still unclear, try to identify the consequences of staying in the situation versus making a change. What will happen if you stay? What will happen if you change? Again, focus on what is important about this—not what other people might think or how they will react to your decision, but what’s in it for you. To enliven this, take a few moments to try on the desired state. Just like trying on a new sweater, notice what this will feel like for you. Notice how your body will feel. Perhaps there’s a sense of relief, a release of physical tension. You may also find that you’re feeling lighter, more energetic, or clear in your mind. Perhaps there’s a feeling of confidence, certainty, and freedom.

    4) Replace the should with “I want to because ___”. Fill in your reasons at the end of this sentence. Whenever your mind takes to a should, go back to this key sentence. Make it a mantra for what truly has meaning for you.

    5) Lastly and most importantly, be kind to yourself. Be patient with yourself. If you fall off your path, avoid the temptation to add more shoulds (and shame) to the situation. Remind yourself that establishing new patterns takes time and the willingness to keep starting anew. Remind yourself that you are an imperfect human amongst other imperfect humans.

    A little self-kindness and self-acceptance go a very long way.

    In conclusion, changing and establishing new habits takes work. Motivating ourselves is something we all have to work toward. But if you want to reach your goals, you’ll motivate yourself by focusing on what’s in it for you to do so. This is the surefire way to build true, lasting, and successful change. With the right combination of factors, it’s more than possible to stay motivated and achieve any goal you may have. 

    Practice these 5 tips and you’ll free yourself from the tyranny of shoulds.  I can almost guarantee that you’ll soon be the one moving forward on whatever goal is truly important to you. The more you practice, the better you will become at creating exactly what it is you desire. And the better you get at creating your desired states, the more successful and happy you will be in life, in every possible way.

    It’s a VUCA Time in Healthcare

    I don’t have to tell you that these are complicated times in the world. The pandemic. Global warming. The war in Ukraine, and violence in many other parts of the globe. Inflation. Growing levels of inequity. The Great Resignation.

    In healthcare, in particular, these are very complicated times. The pandemic has brought to light many of the problems that were already brewing below the surface. Under resourcing. Shortages in staff. Negativity and discord. Burnout.

     It’s no surprise that the term VUCA is being used more and more to describe what’s occurring in healthcare. It’s a term that first arose in the military following the 9/11 attacks, and the same term is all too applicable to healthcare, everywhere on the globe.

    What Is VUCA

    We can think of VUCA as a big, tangled mess. A mess that is occurring in healthcare and elsewhere.

    V is for Volatility

    Upon an already stressed healthcare system, the pandemic brought with it many rapid and challenging changes in healthcare. Volatility is at bay in many ways but is most evident in the high levels of attrition and turnover we’re seeing — in physicians, nurses, technicians, therapists, and even in those who clean patient rooms.

    Indeed, a recent article in the Mayo Clinic Proceedings shed light on this issue. Looking at more than 20,000 respondents at 124 institutions, the study revealed that one in five physicians are planning on leaving their position in the next twelve months. For nurses, intent to leave was present in 40%. For advanced practice providers, 33%. This means a great deal of turmoil in hospitals and outpatient medical settings. It also raises questions about the sustainability of the entire enterprise.

    This “Great Resignation” in healthcare is something I was quoted in earlier this year in over half a dozen major news venues. While I was happy to be involved as an expert on the topic, I, like others in the field did not have a lot of tangible solutions to stem this tide.

    U is for Uncertainty

    With all this change, there is a massive sense of unpredictability and uncertainty about what will happen next.

    When will the pandemic end?

    What difficulty will come next?

    How will we do our jobs without adequate staff to support our efforts?

    What will the new normal be?

    C is for Complexity and Chaos

    The level of complexity in healthcare these days is almost inconceivable. So many moving parts. So much dissatisfaction and burnout. So much chaos. And the complexity and chaos have contributed to what can only be thought of as a giant vortex of negativity pulling all of healthcare into its hold.

    Additionally, there is so much change occurring that it has the makings of a dark joke:

    You work in a major urban area where you are in competition with the other major medical practice across town. You leave for a well-needed vacation on a Friday and return a week from Monday only to find that your health system has been acquired by your that practice. Guess what? Now you have to work side-by-side with the clinicians who were just 2 weeks ago, your biggest adversary.

    I hate to say it but, it can seem that, with all this VUCA, the joke may be on all of us in healthcare…

    A is for Ambiguity

    At the end of the day, we don’t know what all the changes in healthcare mean.

    What does all of this mean for my current situation?

    What does it mean for my future?

    If this continues, who will be left to take care of me and my loved ones?

    It is truly an ambiguous situation.

    Since many of us are experiencing a VUCA reality, it’s important to understand the impact it has.

    Certainly, a VUCA environment is both a disrupted and a disruptive one. It impacts all of us, doctors, nurses, technicians, therapists alike. Patients are certainly not spared. It can leave us:

    • Feeling unstable and ungrounded
    • Unsure of how to react to all the changes that are occurring
    • With lack of clarity on what our role is in a rapidly changing system
    • With reduced motivation to take actions that contribute to the greater good

    Most importantly, living and working in a VUCA environment can leave us fearful, reactive, and feeling out of control. This means that our limbic system is frequently activated, taking us into a fight/flight/freeze state. Unfortunately, in this state, we’re trapped in survival mode. And survival mode means that our world narrows, and that we are reduced to looking out for #1, ourselves. When we’re looking out for #1, we invariably have less left over to give to others. And yet, perhaps VUCA times require a greater degree of leaning into connection and shared community than ever.

    So, what can you do? 

    Let’s Look At 4 Ways To Overcome Uncertainty

    While the challenges of a VUCA world can seem inescapable and insurmountable, there are a number of steps you can take to manage yourself so you still show up in ways that you feel good about. So you can look back and feel proud about yourself and your actions.

    A mindful approach can help you hold steady amidst these challenging times. Here are 4 mindfulness strategies you can employ.

    1. Embrace uncertainty

    When you stop and think about it, uncertainty and change are the only things that are certain. Impermanence is one of the basic laws of our world.

    After all, everything changes. Our relationships change. Our kids grow up and change. Our bodies age and change. Our environments change. Our planet changes.

    All too often, however, we forget this basic truth. We somehow expect things to be predictable and stable.

    The problem is that this expectation sets us up for difficulty. It leaves us struggling unnecessarily when something shifts. It adds a layer of suffering above and beyond that caused by all the VUCA around us.

    What I’m getting at is that we have a choice. We can meet uncertainty with reactivity or we can meet it with mindful understanding.

    More than meditating on a remote mountainside, mindfulness helps us have the calm, steadiness, and clarity we need to work constructively with all the change and uncertainty.

    At the same time, while we can find ourselves resisting change, we can remind ourselves that it does not have to mean something bad! Just take a moment right now to think of all the difficulties you have faced in your life and work that are now resolved and far behind you. This can help you see how change has actually been quite the positive.

    1. Respond to complexity with compassion

    Even knowing that change is the only thing that is certain, it can still be difficult to weather. Living in such a VUCA time is difficult. You deserve compassion for managing all the challenges.

    With mindful awareness, we can bring ourselves compassion for what we’re going through. There is increasing evidence that self-compassion is a powerful antidote to stress and even burnout. From where I sit, I think that it is actually one of the most powerful medicinals available to us.

    Managing the Vortex of Fear

    Vortex-of-fear

    Uncertainty can elicit a deep sense of fear and ill ease. Fear, like all emotions, has its place. We need to recognize this feeling and take time to tend to it. When fear becomes the major driver, however, it can take us to a dark place. Fight or flight is vital when we need to take rapid and immediate action for safety or for survival. When we don’t, fear can be paralyzing, leaving us feeling powerless, hopeless, and stuck. Fear breeds hostility, rigidity, and takes us to a place of reactivity as opposed to one of thoughtful and mindful activity. When we’re in fear, we move out of compassion for ourselves and for others.

    To stay grounded and focused, we need to assess. What’s being triggered? Is it my safety and security? My sense of well-being? In this moment, am I facing a real threat? Or is my fear related to something that hasn’t even occurred, and may or may not occur in the future? This discernment is critical so that you can mobilize resources to cope with whatever it is that’s right in front of you, and build reserve to face future challenges as they unfold.

    Check in with yourself right now. How resourceful are you when you’re in a place of fear? When you look back on decisions you’ve made based on fear, do you believe that you’ve made the best decision? Have you seen others make wise decisions? Now ask yourself the following question: when you’re at your best, are you letting fear steer your course or are you able to notice your fear, center yourself, and move forward from a constructive place? What would be different if your focus shifted from fear to calm and equanimity?

    Once you’ve righted yourself, you can decide what action is the right next step. In the face of fear, small actions are best. You can set a daily intention to tune in to yourself and notice when fear is nipping at your heels.

    Gandhi said “The enemy is fear. We think it is hate; but, it is fear.” His words ring true in the current political environment. Managing one’s fear could never be more important. Like anything, this requires practice. It’s well worth it, though, so that we can live with a sense of peace and contentment. So we can make decisions that we don’t later regret. So we can mobilize resources to be our best with all people we meet.

    Please leave your comments and suggestions below so others can learn from your experience.

    Top 5 Benefits of Mindfulness

    benefits-of-mindfulness-for-doctors

    Top 5 Benefits of Mindfulness for Healthcare Providers

    Modern conversation is dominated by discussion of the benefits of mindfulness in the healthcare industry. The implications are that not only can “being in the present moment” help us feel more in control of our days, lives, even careers but, it can help us take better care of our patients as well. Unfortunately, we are constantly distracted by email, social media, text messages, or, just as easily, by our own thoughts.

    As a physician coach, I’ve seen first-hand how mindfulness can can have a major positive impact on physicians and other healthcare professionals. A popular misconception about mindfulness is that it is equal to spirituality, that it is the ability to completely clear our mind of all thoughts, or worse, an unequivocal detachment from life and the world around you. Instead mindfulness is simply complete awarenessbeing present with what’s going on in one’s life with kind awareness, questioning thoughts and assumptions, replacing judgement with compassion, and moving beyond preconceptions. In the healthcare industry, we become so focused on what needs to be done that we forget to simply be.

    So how can mindfulness help physicians and other healthcare providers in general? Here are 5 benefits:

    1. Mindfulness helps doctors achieve calm

    Often our minds spin wildly, jumping from thought to thought. The swirl of thoughts can be like the torrent of a waterfall. We try to focus on a task and our mind goes to an argument we had that morning, a recent text, or how guilty we feel for eating those 3 additional scoops of ice cream last night. When we aren’t ruminating about the past, we fixate on a concern about the future, and anxieties and worries take hold. Even if there are no current stressors, our thoughts can take us into a downward spiral driving fear, rumination, and distress.

    Mindfulness helps us realize that thoughts are simply thoughts, not reality.

    Instead of being swept away by the waterfall, we learn to watch it from the comfort of the water bank. Creating some distance from our thoughts frees us from being trapped by them and allows us to access a natural calm and ease.

    2. Mindfulness can help physicians improve their relationships

    Despite being physically present with loved ones, it’s easy for our minds to be elsewhere. Often we stew about a meeting we have to plan for or replay a tense conversation with our boss, missing what’s in front of us. Mentally living in another moment, we can see our partner or children as the annoying distraction. We find ourselves impatient and short-tempered.

    When we’re in the present moment, we detach from past experiences and future worries and give our full attention to those we’re interacting with. Drifting from the now is inevitable, but we can note this and gently return to the present. We all know how good it feels to interact with someone fully invested in us at that moment, and others immediately sense when we’re fully there with them. Staying in the present, we often find that it’s easier for others to join us there.

    3. Living in the present allows for a broader perspective

    When we’re in the mindless mode, we develop tunnel vision. We become stuck in a fixed reality that we have assumed to be true. Watching the world through this clouded lens, we have difficulty simply seeing and appreciating what is. Often times the way we see a problem can, in fact, be our problem, and part of being mindful is being open to challenging our own assumptions. One of the cornerstones of mindfulness is a quality of open awareness and curiosity. When we become inquisitive about a problem and question our assumptions, we see options that were previously outside of our field of view.

    In addition, by shifting our focus to the present moment the magnitude of our problems begin to shrink. Right here, right now, it’s likely that our needs are being met, our health is manageable, and we can meet the challenges we face.

    4. Mindfulness can help healthcare workers be more ressourceful

    What if you could focus on what is rather than how you think things should be? Releasing expectations about your situation allows you to take action from where you actually stand. If you know what you’re facing, as opposed to an altered version of it, it’s likely that you’ll have more clarity. You’ll be able to see what the real constraints are and where there are openings for change. And all that energy that you’re putting into wishing things were different can be harnessed to take action with what actually is.

    When you stay in the present moment, there is more available to you to come to a solution. You can then respond wisely and in a fully informed manner, rather than reacting blindly. You develop the superpower of conscious clarity. Watch this light animation of Dan Harris explaining how practicing mindfulness can be a superpower.

    In this video, I explain what mindfulness is and how it can be applied to help physicians achieve their highest potential and lift them out of the detrimental cycle that can lead to burnout.

    5. Mindfulness helps foster confidence and creativity

    When we focus on what’s actually going on right now, we shed comparisons with others, harsh judgments about ourselves, and our analysis of our circumstances. All of these thoughts sap our natural creativity, and besides being overly-critical, they are rarely accurate.

    When we live in the present moment, our attention is focused on what we’re experiencing and instead of getting caught up in negative self-talk; we can simply note it and move on. We leave rigid ways of understanding our experience behind. This flexibility clears room for new thoughts and ideas, and the results are often a rush of creativity.

    Integrating mindfulness practices into our lives provides a multitude of benefits: we spend more time in the here and now, we experience less anxiety and more calm, and we enjoy deeper and more meaningful relationships. We reduce the tendency toward tunnel vision and see more options and choices, and this helps us feel less trapped by our circumstances. And we remove barriers that stifle our creativity and confidence.

    It’s easy to get absorbed in our email, phones, and the most recent text message. Just as easily we get lost in our own internal thoughts. When you find yourself distracted, worried, or anxious, take a few minutes to bring your attention to your breath. It’s a sure-fire way to access the present moment.

    Learn How to Be Mindful Within the Present

    If you’d like to learn practical tricks to develop more mindfulness and develop greater balance, download my free guide From Burnout to Balance: 10 Steps You Can Take Today. In this guide, you’ll be given 10 tools to better manage the most common afflictions physicians are faced with today from shedding guilt, to overcoming the Imposter Syndrome and make time to reenergize. 

    Download the leading healthcare guide to reduce physician burnout.

    Gain the balance you need to:

    • Reclaim your purpose
    • Maximize efficiency
    • Lead with strength and calm

    Enter your email and receive the free guide directly in your inbox 

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    Comparison: The Thief of Joy

    comparions-physician-burnout

    How much time do you spend on mental comparisons? Looking on Facebook and thinking everyone else has better relationships and is much happier than you?  Thinking that everyone in your peer group is smarter than you? Or fretting about how much fitter, thinner, smarter, or more successful you were at a different point in your life? Much of our stress, frustration, disappointment, guilt, and regret is the result of comparing ourselves to preconceived ideas about how we should be acting, how we should be looking, and how our personal successes are perceived by others. Theodore Roosevelt once said that comparison is the thief of joy. Indeed, comparisons often keep us in a mental hamster wheel of self-doubt and lack of confidence. To combat physician burnout, it is critical to decrease the tendency toward comparisons.

    But comparison allows me to improve my performance

    You may believe that comparisons keep you on your toes. Let’s test this out. Think about any times you’ve compared yourself to someone else in the past week. Did the comparison help you feel good about yourself and your circumstances or did it send you into a spiral of self-critical thoughts? Did you feel energized and optimistic about your circumstances or did you feel defeated, inadequate, and that your life would be forever deficient?

    Like advertisements, comparisons hold us in the belief that if we only had product or service X, we’d be happier, feel and look younger, and be the king or queen of our world. While it’s always good to work toward life improvement, comparisons typically leave you unable to focus on the satisfaction inherent in your current circumstances. Comparisons push your focus onto either the past or the future, or simply what’s wrong with the present. Comparisons keep you from being content and perhaps more able to accept what is. Right now.

    How to stop comparing yourself to others

    As a physician coach, here are four steps I teach to overcome the pull to comparisons:

    1. Start tuning in to your own thought processes. Simply begin noticing when you are going into comparison-oriented thinking. Try not to judge yourself. Jot these instances down so you can begin to see how often this occurs.
    2. Once you’ve noticed that you’re making a comparison, name it to yourself. Say to yourself “there I go comparing myself again.” Doing this begins to create a distance between the comparison you’re focusing on and the reality of the situation. Having that distance and separation is vital in having choice and control over your own thoughts.
    3. Now ask yourself: What is the cost of this thought process? What would I gain if I spent less time on these mental comparisons? Journal about these questions.
    4. Now for the challenge. When you find yourself making a comparison and coming up short, push yourself to think of at least three ways you, your circumstances, your thoughts, and your actions are right and adequate just as they are. Your mind will call you back to the land of comparison and self-criticism. Your job in this step is to exert equal and opposite force in the other direction! Definitely take notes here.

    These steps take a lot of practice. What you will gain, though, is the ability to see your own strengths and accomplishments. You’ll find yourself experiencing more calm and a stronger sense of your own self-worth. Harkening the words of Theodore Roosevelt, you may even find yourself experiencing more joy.