DTD 182
===
[00:00:00] This is the Drive Time debrief, episode 182.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. I'm Kendra. And today I was shocked to realize that we have not revisited one of the very principal tenets of what we teach. So we're gonna talk about it, we're gonna revisit it, it's thoughts, [00:01:00] beliefs, and how they shape your life in medicine, whether you realize it or not.
So let's talk about something called metacognition. That's a word that maybe you've never heard of. Or maybe if you had Psych 101, you'd heard of it, but it's been decades. So what metacognition is, is literally thinking about your thinking and becoming aware of your own thinking, and then deciding what to do about that.
Once you are aware of it, it turns out that you are not your thoughts, and that is such a wild concept because I just assumed I'm somebody who ruminates on thoughts all the time. Like, that's just me, but that isn't me. That's what my brain is offering up. I am the watcher of those things. So you also are not your thoughts, you're the watcher of them.
And how can we know this? Because sometimes you get a song stuck in your head. That's not you. That's just what's happening in your brain and you're watching it happen in front of you. So that little tiny shift, which is not a tiny shift, [00:02:00] it's kind of mind blowing, stepping outside of your head and starting to observe what's going on in your head can change everything.
Yeah, so this is how it works. Circumstances are neutral. The circumstance itself doesn't create feelings by themselves. It's your thought about the circumstance that sparks the feeling. This feeling drives an action. And the action is how you get results. This is how you have the results that are in your life.
And if you have goals, then this is how you're gonna create the results that you want. Your brain's setup actually proves this. We call it the primitive brain or the back of the brain, whatever you wanna say, but it reacts and the cortex interprets it. So there's always a thought in between. Even if it's super fast, there's a thought.
So you have a circumstance or a situation. And between that and the feeling, it's lightning fast, but it happens. And sometimes it feels like it's out of control. But [00:03:00] just like Amanda said, we can start to be aware and actually be the observer of what thought is coming. And if we don't appreciate or don't like it or don't get the results we want, we can actually change that.
So here's an example. Any parents out there, if your kid gets a less than average score like a D, one parent might be like, oh my gosh, this is so embarrassing. My kid got a D in the class. Another parent thought: Oh my gosh. My kid usually gets A's, is he depressed? Is he being bullied? Is he checking out in life?
Like, totally go the other direction. And a third might say it's not a big deal. D's are D's, they won't end up in a van down by the river. No worries. But this is the thing, it's the same circumstance. A kid gets a D in a class or whatever. But that was three different thoughts and three different feelings.
So another example, your spouse forgets something on the [00:04:00] grocery list, right? I mean, anybody have a significant other that gets extremely distracted at the grocery store and comes back with like three bags of Halloween candy and no eggs or no milk. Okay, well, someone could think, wow, they don't care about me at all 'cause I really needed these things off my list, or.
Oh, wow. They remembered everything else. That's great. We won't be short on Halloween candy, or you're amused. Whatever it is. It's the same circumstance, but it's different thoughts. Even in medicine, a patient can show up to the ER or the office for the 20th time with belly pain. You can think, oh my gosh, not again, and feel frustrated.
Or you could say, Hmm. This is the 20th time this patient showed up. Am I missing something? And get curious. Either way you're gonna get results, but just remembering or realizing that we actually do have more control over this and the results that we get and all we have to do is understand that [00:05:00] the power of metacognition is that the circumstance never changes, but it's a way that you're thinking about your thinking.
It's a way that you want to experience the situation, and then the empowerment comes 'cause you get to choose. So this week, try it. Try catching yourself in the moment and asking, what's driving this feeling? Just noticing it is actually a win and deserves celebration.
Yeah. And I know for me, for a long time, I really had a hundred percent belief that everything I thought was true. And that was a big wake up call to realize, oh, and also helped me understand why other people didn't think the same way I did about every single thing. I mean, really.
Yes. Really. It's wild. Now I know not all my thoughts are true, and maybe all of yours are, maybe not. So once you start noticing your thoughts, the next step is realizing which ones have turned into [00:06:00] beliefs. And that's kind of what I was describing being there where it's like, of course all this stuff is true.
Beliefs don't come out of nowhere. They come when we think something over and over again, and we have tens of thousands of thoughts every day. Probably about 95% of them don't make it into our full conscious thought, but a lot of it is just kind of under the surface there. Each one is like a little dirt road in the brain or even a path through the woods.
If we repeat it enough times and keep going down that path and going down that thought over and over again, that path in the woods turns into a trail. It turns into a little hiking trail with signs. It turns into a road and eventually a superhighway. When we think it enough, that is when we're talking about neuroplasticity, that's what we're talking about is shifting neural networks by [00:07:00] changing our thoughts. Amanda has shared many times her love for Taco Bell back in the day and didn't really matter if she was hungry or not. She left shift, she deserved that. Was it a burrito you would get? Mm-hmm. What was it? Just any of them, sometimes it'd be the special, whatever, but I knew I deserved it.
Mm-hmm. That's great. I just went through whatever I had just gone through. I deserved this. Yes, absolutely. And I would argue you did deserve it, and you also deserved any good things, including having health. Good health, not with the Taco Bell every day. That's what I do like about coaching is that it could be true, but what's the result of it? Right.
If it's giving you results that you don't want, there is the cutest resident that is on like blowing up on TikTok right now. She's adorable and she is like, there is no one who treats themselves better than me. I treat myself better than anyone on when I'm on call days, I [00:08:00] give myself all the treats and I'm like, I think that's how it started for me.
Flash forward 30 years and suddenly everything is a reason to deserve this. Mm-hmm. Yeah. Yeah. I can appreciate her celebration though. I mean, she's celebrating. Absolutely. It's the cutest thing, celebrating herself. I'm gonna try to get her on the podcast. Hopefully. I would love it. Yeah, so that's, you know, these are just examples of thinking a thought over and over again. I deserve that Taco Bell. I deserve it. So I'm gonna get it. And Taco Bell itself isn't evil, but the question is, is that thought serving you? My particular variety of it was I'm getting off at 2:00 AM, I can have all the kids' Halloween candy I want and I'm gonna watch House Hunters and Yeah.
And me too. Sure. Absolutely. We deserve whatever we want after dealing with what we deal with at work. And it didn't help me. It didn't help my life be better. If it felt good in the moment, but [00:09:00] long term, I'd have all the candy hangover for the next day. Not enough sleep. Mm-hmm. Yeah. Is it? So is it creating the result that we actually want?
If so, great. If not, then we can start moving into some of that neuroplasticity we were talking about. Some beliefs are things that we inherit. It's not just stuff that we come up with ourselves. Sometimes it's been given to us and we've received, we call this toxic programming that we may have gotten in our training.
Not everyone, but some of us did. We rehearse these thoughts so much, like suck it up buttercup, that it really creates problems for us. Sometimes when we're kids, our parents may have given us some beliefs that are healthy or not. I know some parents, bless their hearts, are trying to motivate their kids and say harsh things to them.
Like, you'll never amount [00:10:00] to anything. Oh. Like that stuff gets burned in a kid's brain and they create a belief out of it 'cause they can't stop thinking about what their parents said to them. Some of 'em are good things, like you are smart, you can do anything and your hard work is going to pay off. Those things, yeah. If we think about those and believe those and apply that to our lives, that can really create good results for us. Other ones, maybe not so much like you're responsible for everyone else's happiness. That might not be something that was explicitly told to us, and it's something that a lot of us picked up because we over-function and we get stuff done, and so we can make everyone happy.
Right. Except no, that sets us up for a lot of sadness and burnout later on. Some illogical beliefs that we might develop as kids, like your parents' [00:11:00] fights are somehow your fault. As adults, it's our job to revisit those and decide if these thoughts still belong with us, and if they're creating results that we want.
There's some tools we use to examine our beliefs. Byron Katie, we've talked about her multiple different times in previous podcasts, she is a modern day philosopher and she has four questions she asks about thoughts. The first one is, is it true? The second question is, can you absolutely know it's true?
The third one is, how do you react when you believe that thought? Are you being the best version of you when you believe that thought? And fourth is, who would you be without that thought? So take Amanda's Taco Bell example, the thought being, I deserve this. Is it true? Definitely, definitely true. But who would you be without it?
Maybe, maybe [00:12:00] healthier, maybe happier, maybe get a little more sleep and not have a Taco Bell hangover. There are other stories, lots in literature that you can find and some inspirational true stories. One I really love, it's from a book called The Hiding Place, and it's a woman named Corrie ten Boom. She and her family got put in concentration camps during World War II for helping Jewish people escape the Nazis.
[Background conversation removed]
So their family was put in concentration camps for helping [00:13:00] Jewish people escape the Nazis. And Corrie, of course, was experiencing this as the absolute horror that it was. And her sister had this moment where she became grateful for fleas because the fleas kept the guards out of their room 'cause there were so many fleas. And I was like, whoa. I have never forgotten that story because it's such a powerful example of how shifting our thoughts can change the way we experience things. So if someone can find an empowering thought in that setting, then I can probably find it in my house or at work or when I'm frustrated in traffic or frustrated in a grocery store aisle, things like that. There is another thought from one of our, from the coach who trained Amanda and me, Brooke Castillo. She said, no one can take your dignity, hope, self love or joy without your permission, and [00:14:00] that it's sometimes hard to believe, but that is true and it can shift you out of feeling powerless and into a place where you can take charge of your own happiness.
Beliefs are not fixed. We do not have to keep the same beliefs forever. I've changed a lot of beliefs in my life and you know, I think it's normal for people to switch political beliefs or religious beliefs or beliefs about what vegetable they like the most or what beverage they like to drink.
Even the beliefs that we have about ourselves, about our families, about what we're capable of. These are beliefs that can be shifted if they're not helping us have the best life that we can have. They're just well-practiced thoughts. So we just invite you to look at your own beliefs and say, do I want to keep rehearsing this one?
Is this making [00:15:00] me feel good? Is this making me better and stronger? And if it's not, maybe it's time to start a new script. Absolutely. And I like how you're saying that too, because when you're a child and you're picking up these belief systems, you don't really have a choice and they probably served you and they probably helped your survival at that time.
There's a pretty good reason probably why that became embedded. But a lot of times the things that got us through our childhood aren't what will get us to the next level. And so that's when we have the option to start to use our metacognition, become aware of the programming that's going on in the subconscious, like the things that are running, you know, humming in the background all day long.
To then look at them critically like that is holding me back. That might not even be true. That might be true, but it's not gonna get me to where I wanna go. And [00:16:00] this equally true thought is much more useful for me to get me to the next level. So once you've spotted those thoughts and beliefs, how do you start to change them? Well, the first thing is that it's gonna be a little uncomfortable. Your brain, human brains do not like cognitive dissonance, which is where beliefs aren't matching up with reality, or one belief is in direct conflict with another belief that you have. Brains like everything to match up and just be nice and clean and pretty with a bow on top.
And that's not how reality is sometimes. So changing your beliefs can start with a little bit of stress, but it's still worth it. You can either change your reality to make it line up with your beliefs. That takes a lot of effort and sometimes it's not possible. Or you can also opt to change your belief to something that's more useful for you. That's always on the table. So here's how I like to explain it. Treat new thoughts like a gym workout because of neuroplasticity. You can, if you go on YouTube, you [00:17:00] can see a new synapse form, you can Google, like new synapses forming with neurons and it's amazing. Like they send out little dendrites, some don't attach, but then every once in a while, one does attach and it starts really thin and really weak. But then over time they strengthen. That's what you can do with your thoughts. So it's like doing a, like for instance, you don't go to the gym and do one bicep curl and just walk out of there expecting to be ripped. I would say that, but I'm pretty sure I have done that before where I thought one workout was just gonna change everything. Well, back to reality. It's the same with thoughts. Like you do have to put the reps in to strengthen, just like Laura had explained before.
It's a gravel road, it's a dirt road, then a gravel road, then maybe chip and seal, then maybe asphalt, then maybe multiple lanes. That's how you create this superhighway, and it takes patience and it takes time and nothing's broken if it doesn't happen [00:18:00] immediately. You've done one bicep curl. It's gonna be okay.
So start to pick a thought that you wanna believe, then to make it lay down even faster, let yourself feel the feeling. Some people feel the world is an unsafe place. That is a belief that probably served them at some point. It's a belief that is probably very available and makes a lot of sense for people.
But how does it make you feel? And what if there's a lot of good in the world? What does that feel like, that feeling? Let yourself feel that so that you can start to generate, you know, multiple bicep curls, multiple reps, and start to lay that down. Hold that feeling in your body, not your head. Dr., how do you feel? Well, I thought that this was stupid. That's not a feeling. Feel it in your body. I'm talking to myself. Hold it for 10 to 20 seconds and then repeat it. Feeling the feeling helps and then repeating it several times a day. It's just like going to the gym. Neuroscience backs this up, Dr. Caroline Leaf's research shows it takes about 63 [00:19:00] days or three 21-day cycles for a new pathway to really stick. That's how long it takes to turn a dirt road into a default superhighway. So Bob Ross is an example. Who doesn't love Bob Ross? But it turns out he used to be a pretty stern, tough Army sergeant.
I can't even imagine that. But he went from that into a guy who turned every little mistake into a happy little accident. He literally rewired his identity. Even in the hard stuff, we've all reframed painful experiences. Laura has shared before in podcasts how her dad's alcoholism, although tragic and probably didn't wish that it was that way if she got to choose.
But it did build resilience and empathy in her, and that's a reframe that has helped her and shaped her life. And for comic relief, I always picture myself when I deserve my Taco Bell for showing up and getting paid at work, even if it is chaotic, telling that to Corrie ten Boom's sister, who was ridden [00:20:00] with fleas, how I deserve a burrito. Not exactly the same level of hardship.
Yeah, so quick note, this is not about toxic positivity. You don't wanna lie to yourself 'cause your body knows. Mm-hmm. But many times there are equally true thoughts, one of which gets you closer to the result that you want. So do not paste a smiley face over unresolved pain. That can be something that it really is time to go to a therapist or EMDR or something to process, not just cover it up and, you know, slap a layer of glitter on top of it. That's not what we're talking about. That's how you get heart disease and autoimmune diseases. Don't do that. Yeah. And give yourself grace through this process. You're gonna have old automatic thoughts pop up. It makes sense. That's been rehearsed over and over again.
That's normal. The idea is just to keep practicing awareness, number one, and then just keep practicing just like the reps at the gym.
Oh yeah, I think that's the end of mine.
Well, that's it for [00:21:00] today's episode. Friends, if you found this conversation helpful, the best way to support us is by leaving a review. It helps other physicians find the podcast and moves us up on the list. And we'd also love to hear from you. So if you've had experiences with thoughts you wanna keep, maybe ones you wanna dump and everything in between, please give us a shout at [email protected] and always don't forget, follow us on the socials at The Whole Physician. We'd love to connect with you there. So thank you for spending time with us today and until next time, you are whole. You are a gift to medicine and the work you do matters.
[00:22:00]
