Today, I discuss a common and debilitating cognitive bias and emotional response that derails our patients (and sometimes ourselves) when trying to maintain positive life changes. Consider these questions:

  • A person engaging in intermittent fasting has notable success in losing weight and increasing their energy. They have been adhering to their schedule of only eating between 9am and 5pm for two months. Yesterday, however, they had a “slip” and ate a muffin before bed. Because of that slip, are they more or less likely to maintain their strict schedule today?
  • A person in recovery from alcoholism for six months had a drink at a friend’s birthday party yesterday. Are they more or less likely to drink today than the day before?
  • A person who dedicates themselves to writing at least a couple hundred words every day misses a day of writing yesterday after having written daily for months. Is this person more or less likely to miss a day of writing today?

The answer to all questions is that all three people are more likely to engage in their undesired behavior (drinking, eating outside the daily eating window, and not writing) following a slip, turning that one-time lapse into a relapse. Of course, some people after a slip can and will rededicate themselves to their goal and will be less likely to slip today than they were the day before their slip. This increased risk of relapse into undesired behaviors following a slip has several causes. For example, with alcohol, one cause is lowered impulse control during the time of intoxication.

Another mechanism relevant to all kinds of undesirable behavior is the cognitive bias of catastrophizing and negative filtering. After days, months, or years of maintaining desired behaviors and avoiding undesired behaviors, a lapse can flood a person with self-doubt, and a sense of uncertainty and peril. Not uncommonly a slip that comes after an extended period of desired behavior can lead to even greater self-doubt. That person realizes, anew, that the risk of relapse is never overcome, never a thing of the past, and always lying in wait, no matter how long they’ve been abstinent from undesired behaviors or engaging in desired behaviors. The thoughts of self-doubt, the realization of limited control, and the ever-present uncertainty, can further lead to thoughts and feelings of helplessness, hopelessness, and eventually, to an attitude of giving up. Thus, a slip is less dangerous in its direct effect than in its impact on cognitions (thoughts and beliefs) and consequently on emotions.

The danger of a lapse turning into a relapse is real but subject to intervention. Here are some ideas.

One Day at a Time

In recovery programs, a common aphorism is “One day at a time.” This motto effectively counteracts the cognitive bias of “just giving up” by continually reminding the at-risk person that each day requires a renewed commitment to one’s goal because each day brings its own risk of a lapse or relapse.

One day at a time forces a strong focus on today. This means not dwelling on yesterday’s regrets or tomorrow’s fears or, perhaps, fantasies of glory. Developing new adaptive behaviors is effortful and draining, and the best way to focus one’s limited supply of mental, emotional, and physical energy is to narrow the window of concern to today.

Of course, there are exceptions to the one-day-at-time attitude; life often requires a longer view. For example, for the intermittent faster it makes sense to develop a weekly meal plan because it provides a dietary framework for the week and decreases uncertainty and risk of a lapse or relapse. In this case, it is adaptive to extend the window of concern to encompass a week.

Another example is a person whose larger goal is to run a marathon. They spend months preparing through weight loss, improved diet, and training. In this case, the nature of the goal requires the window of concern to encompass the entire preparation period.

A third example is a person in recovery from addiction who will benefit from focusing on and planning for upcoming high-risk events, such as traveling on vacation, attending the wedding of a friend, or facing the mounting stress associated with preparing for a professional exam.

Thus, there is no predetermined “right” window of concern. But, once this concept – the window of concern – is articulated, it often becomes quickly evident what that window of concern should include and exclude.

Relapse Is a Process, Not an Event

Another useful aphorism from recovery programs is “a SLIP means Sobriety Lost Its Priority.” So, to continue to engage in one’s desired activities and avoid undesired ones, a person must set up their world to make success more likely than failure. Lapses and relapses are NOT due to an unexpected bolt of lightning. They grow out of engaging in various pre-relapse behaviors, including not planning for expected upcoming high-risk times.

  • A person engaged in intermittent fasting should not have muffins in the house. How did those muffins get there? They didn’t just walk in on their own. Perhaps that person’s significant other brought home leftover muffins from work, “to not waste them.” The person in training can and should have a conversation with their partner about not bringing random food into the house, which isn’t doing favors to either person.
  • A person in recovery from alcoholism probably began the process of relapse much before that first drink of their slip. Was that person attending meetings, did they have a sponsor, did they talk to their sponsor, and did they put in effort to anticipate and plan for events such as birthday parties in which drinks are served? Or did Sobriety Lose Its Priority?
  • The person who is dedicated to writing every day. What could they do to make what is often a lonely and effortful pursuit more likely to survive through the greater and lesser challenges of daily life? For example, questions writers can ask themselves are, “Do I have a larger goal that is more inherently motivating than ‘I’m going to write every day’?” and “What is the important message I need to share with the world?” Is that writer part of a writing community that can lend support, advice, and other resources? Does that writer have a deadline for the completion of their project?

Motivation Needs Life Goals and Not Only Process Goals

One lesson to maintaining one’s motivation through daily challenges is to view one’s daily activities through the lens of larger life goals and values. For example, why should a person in recovery from alcohol stay sober today? Perhaps because they want to set an example for their kids or to provide financially and emotionally for them. Or, perhaps, they want to sponsor other recovering addicts, to help others just as others have helped them. For the writer, it is appropriate to have a process goal of writing every day or producing a certain number of words each week, but it is not enough. It is equally important to view one’s daily behaviors as a path to flourishing, to realizing one’s core life vision or goal, and to being true to one’s values.

Until next time,

Dr. Jack

LanguageBrief

“Only in the darkness can you see the stars.” – Rev. Dr. Martin Luther King Jr.

“Fall seven times and stand up eight.” – Japanese proverb

“Turn your wounds into wisdom.” – Oprah Winfrey

“The only real mistake is the one from which we learn nothing.” – Henry Ford

“Your past mistakes are meant to guide you, not define you.” – Unknown