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[00:00:00] Hey guys, welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And from time to time, not infrequently, clients give us information to help other people, and this is exactly where this episode came from. We had a client who, I mean, a lot of unfortunate things had happened, none of which were her fault, but it kind of took the wind out of her sails, as happens sometimes.
And she sent me a video that really helped her, and she thought that it would help other people, and so that's exactly what this entire episode is about. The video itself is from Dr. Tracy Marks' YouTube video named "Setbacks versus Failure: Why Your Brain Gets Trapped in Negative Loops."
And if you don't know Dr. Tracy Marks, she's a psychiatrist who makes brain science content. So this episode, though, is particularly about setbacks. Even when they're not your fault, why do they hit as hard as they do? Why is it different than when you screw something up yourself? [00:01:00] And why it's totally normal sometimes when motivation doesn't just back, bounce back on command.
So we're gonna walk it through section by section of her video, because there's tons of useful, specific information in here, and we're definitely gonna link the video in the show notes, because you're probably gonna go... You're probably going to want to watch it in, in, in its entirety yourself.
Okay, so we're gonna start with section one, and this is the dopamine crash mechanism. So the core idea is your brain experiences a setback as a mismatch between what you expected and then what actually happened, and that mismatch causes a dopamine crash. That, that is not surprising. Dopamine is the motivation chemical.
It rises when you're working towards something and picturing the outcome. When a setback disrupts that outcome, dopamine drops, and that drop is what produces the flat, unmotivated, "What's even the point?" [00:02:00] feeling, right? Anyone relate? I know I've had that, like what? And so the key point from the video is that's not laziness or even a willpower problem.
It's actually the brain adjusting to a lost expected reward And the fix isn't pushing through it, it's actually giving your system time and support to reset. So here's an example, and actually I have a real-life example. My son who is trying to become legal with his driving turned 16 last week, and he had-- I mean, we prepared.
He, he's actually been driving for quite some time. He's a farm kid, so he's been driving all kinds of things for quite some time. And so I think there was maybe some overconfidence, but he really visualized passing his test on the first go. He was ready. He felt confident. The problem was that's not what happened.
He did not accumulate enough points to push him over the passing mark. He actually got too [00:03:00] many deductions and he did not pass. It was interesting to see him get out the car. The body language said it all. Like, I knew right away. And it, it was a physical manifestation of what I knew his brain was going through.
He visualized that o-outcome. He was very motivated. He's been looking for his 16th birthday, or he's been, he's been looking forward to the 16th birthday for probably at least two years. He, he would say back when he was eight and got his first dune buggy and got to drive that, and like we have, UTVs at the ranch.
And so he's been driving things q- for a long time. And man, when he got out, it was like a physical resemblance of what I believe that, that dopamine crash was. Like, he just-- Part of it was disbelief, but I could just see the heaviness in his shoulders, the facial expression. His whole body was s- was sinking.
And it was surprising to him. And Like he even asked, "Can I come back this afternoon?" Like, "If I could just [00:04:00] do one more try," you know? But you're right. The best case scenario was, and since we live near a small town, it's only offered on certain days, so there was kind of a forced, we have to wait for a week.
And so then that, in this last week would probably be that time where really his system needed time to recover. Of course, we practiced. We, you know, we did all the high yield points. We practiced in town, went through the route. But man, just the amount of time to give his system a reset and just get that confidence back behind the wheel, because he immediately told me when he got in the car, his words were, "I guess I can't drive."
Like, like he physically thought he had no skills to drive. And I'm like- Aw ... "I don't think that's what this whole experience is saying, son. We have evidence you can drive." But it was. It was. And so come a week later after driving and- manifesting and visualizing and praying and practicing and all the things.
He practiced with a n- I mean, passed with a 97 out of 100 apparently, whatever, Officer Ward, and he [00:05:00] was elated. But that is amazing to see him come back from that and also recognize that it was probably the most beneficial that we had to wait a week in order to get back to the reset Yeah. I think, I think nowadays, and this is just anecdotal, but I've had a couple of teenage boys also not pass the first time.
I think they're not-- They're, they're very ready to fail kids that first time, and that's probably not a bad thing. Like, it's probably- Mm-hmm ... it's probably actually really good to help them be a little more humble and, and safe as they drive so that... We, we relate to that, so you can let him know he's not alone.
And I, I, I've heard from other parents that that is a thing. They, they're failing- Oh, yeah. I, I mean, he even Googled it, like, what's the passing rate in the Missouri Highway Patrol driving test, and it's only 50%. So I was like- Okay ... okay, there's probably [00:06:00] something to that. But just to highlight, it's not just disappointment.
There's truly a massive chemical drop that happens in your brain because- Yeah ... what it thought it was gonna get did not happen. Yeah, exactly. Yes. The sound effect that we use for that around here is womp, womp. Yeah. Exactly. A- and so that, drop, that dopamine drop af- can actually affect our executive function, and that's because two different brain regions are shifting.
That, the prefrontal cortex where we do our planning, make decisions, do emotional regulation it's suppressed under stress or under perceived failure, so it's not functioning quite as well. Might not be getting as much blood flow because the blood flow is going down to the limbic system and the amygdala, which is our threat detection system, and that is getting more activated.
And that part of our brain just isn't as [00:07:00] smart. It's not as evolved or as even human, and it doesn't distinguish between the subtleties of, " I missed a deadline," or, "I made one wrong turn," or, "I didn't stop quite long enough at the stop sign," versus, " I'm in real danger." And the result is we have that low dopamine, we have less executive function, less access to that best part of our brain, and a brain that is treating something that really is, in the scheme of things, not a huge setback, just kind of like an ordinary setback, it's treating it like a threat, which is why even small decisions then start feeling paralyzing in the aftermath of a setback.
So for example, say you sit down to answer just three simple emails and you can't make yourself pick which one to start with, or maybe you can't even make yourself open your inbox. It's not because emails are dangerous or [00:08:00] hard, but because the part of your brain that is weighing options and trying to make decisions is running on less power than usual, while that alarm system in the amygdala gets stuck in the high alert over something that's not even actually an emergency.
Yeah. So then she goes on to distinguish between a setback versus depression, 'cause we've just
acknowledged that there really is this massive crash of dopamine, and it takes the wind out of your sails, just like our client was experiencing. But she draws a distinction. So this feeling can feel like depression, but it typically isn't. the setback-related disruption is acute and it's situation specific.
So like Kendra's son could point to the fact that he didn't pass his driver's test. That's what's making him feel badly. Depression, though, involves longer-term changes in brain function. And that said, though, [00:09:00] she notes that unsupported setbacks can compound over time if they're not addressed, which is the argument for catching it early, recognizing what's going on rather ju- rather than just assuming it'll pass on your own.
So consider somebody who's feeling flat and unmotivated for two weeks after a specific event, like a rejection or a breakup or a loss or a bad diagnosis. You can still point to what caused it versus somebody that has felt this way for months with no specific trigger and it's affecting all parts of their life.
The same symptoms, it, like it looks similarly on the surface, but it's a different picture underneath, and that distinction matters for knowing whether this is something to ride out with self-care or something that it's time to go talk to a mental health professional. Yeah, and probably the most useful reframe in the video is a setback is external.
So you get-- you got sick, you know, someone let you down, life happened, you didn't pass your driver test, right? A failure is a [00:10:00] story that's internal. This is the one, "I didn't try hard enough. I'm the problem." Sounds like we're turning it inside and it's actually becoming an identity thing. And, and that can really be traumatic 'cause sometimes you can't get space from that.
You can't differentiate that in the moment. So the same event, but the brain uncomfortable with uncertainty will often default to the second interpretation. And if you repeat it enough, that turns into actually learned helplessness. You just stop trying because your brain has decided that effort doesn't matter, or maybe the payoff from the effort doesn't equate the results, right?
And so her point was that most setbacks were never about personal inadequacy. They were disruption. Nervous system lost its rhythm. Executive system got overwhelmed. Brain defaulted to protective mode. So see, all of [00:11:00] these are very objective. This is not failure. This is actually a physiologic stress response.
So, for example, you applied and matched, right? To get into a program. You didn't land the-- maybe your first choice or maybe your second choice or the place you wanted to be. That's a setback. That's a fact. It was a setback. The failure story shows up right after, and it's usually uninvited like, "Oh, I guess I'm just not good enough for that spot, that residency, that program."
Same event, but only one of those two sentences is actually true, and it's not the second one. Shocker Yeah. And then comes the rumination loop. Oh, doctors, we are so good at ruminating. It's like- Yeah ... our favorite little thing our brains do. It's our hidden talent. It's one of them. And beating ourselves up.
She then-- she covers the, the default mode network, which is the part of the brain that's active when we're not focused on anything [00:12:00] specific, like if we're like if we're just daydreaming or, or if we're ruminating. And she says after a setback, it starts getting loud, like asking questions, "Why did this happen?
What's wrong with me?" And it, it gets creative and starts pulling in all the past dis- disappointments to make it even more spicy and interesting to reinforce the current, the current mood or the current I don't know, rut. And her point in explaining this is that people don't usually actually get stuck in the setback itself.
They get stuck in like that whole glob of junk that, that came with it, that narrative that builds around it afterwards. So, for example, maybe someone's lying awake replaying whatever today's disappointment was, and somewhere in there the brain also drags up the time this happened in residency and that other time from years [00:13:00] ago that, you know, this can come up a lot in interpersonal reaction, like interpersonal situations where like, how can they, you know, how can they understand me this way?
Or like what, you know, how do, how does this keep happening? Or, and then that other time from years ago, and none of it is actually relevant today or tonight But the brain treats them as, like, supporting evidence for either this always happens to me or often I'm a just terrible person. That comes up for doctors more than, more than we might realize, and it sh- we don't use should a whole lot, but that's why I'm gonna just say it should not.
Yeah. But, like, even when you don't identify as, like, a victim mentality- Mm-hmm ... this is why it can happen anyway. Like, none of us- Yeah ... wants to be in victim mode, and yet this makes brain sense why- Yeah ... why it can still happen when a setback happens to you. So, let's start to work our [00:14:00] way out of it. The first tool that she mentions is behavioral activation.
So guess what? You're not gonna feel motivated, and it doesn't matter. That's why action first, then motivation can build from the- there. The instinct is to wait to feel motivated before doing anything, but that's not how real life works. Motivation follows after you get started, not the reverse. It is always, with any sort of...
I, I hope nobody else there, out there is a procrastinator, but I am a recovering procrastinator, and it's always the getting started that's the hardest step. So here's the deal. Start with a small structured task, like just do one email or walk around the block, something that's very easy that your brain can't really argue with.
Give yourself a sense of a tiny accomplishment just to start nudging that dopamine system back into gear, because she deflated just now, right? So when you're in [00:15:00] overwhelm, you always start with, like, the easiest things first. That's not how you should do your day-to-day when you're feeling great. You should start with the hardest thing first.
But when you have just had a setback and there's no wind in your sails, then pick something super easy. Just get going. So she uses in the video the analogy of jumper cables on a dead car battery. Small actions aren't the full recharge, it's just enough to get things turning over again. So an example might be everybody's inbox is a problem, right?
Especially, God bless you all, you primary care doctors out there. I can't even imagine the amount- Oh gosh ... the sheer volume of messages and- Mm-mm ... charts, secure chats, and everything else. So yeah, you're not gonna feel like tackling the whole inbox. but instead of waiting to feel ready, you just make a deal with yourself to respond to exactly one, one message.
Not because it's particularly even urgent anywhere, it's just because we're trying to hook up the jumper cables. Mm-hmm. I love that [00:16:00] analogy. Yeah, that's a good, that's a good one. You can definitely see that in just, just gotta get it started. Just I need- Just go ... I need a little electric- You want, go. Yeah
to get, to get jumped here. So tool number two she calls micro goals. So once again, we're shrinking the goal down so it doesn't trigger that threat response or that, that going back to that sense of overwhelm. If the actual goal is start exercising again, right? The micro goal might just be putting on your workout clothes, like putting your socks and shoes by the bed, whatever.
Success is measured by starting, not by finishing, and each micro goal completed is a small proof of concept. You're telling your brain you actually can still do stuff, right? So maybe instead of the inbox and you're in academia, you have a goal of getting back to writing a grant proposal or something that seems [00:17:00] huge, right?
That just seems like a lot of work. The micro goal isn't finishing the whole draft, it's actually turning on your computer, opening the document, write a para- write one sentence, write a whole bunch of ideas, right, that are just coming out of your brain. ' Cause if more happens after that, great. There's motivation, right?
That dopamine gets lit up. But if not, your one micro goal was still met, so that still counts. Yep. And one trick is just to set the goal so ridiculously low- Mm-hmm ... that you would just laugh to not do it. Like, maybe even just write two words. Like, then you, you're overcoming the activation energy to start and, and your brain really is gonna have a hard time saying, "I can't write two words."
Mm-hmm. Another tool she offers is dopamine reset habits. Just we all know that scrolling social media indefinitely is probably not great for [00:18:00] us. It actually messes with our dopamine system. And so when we get those quick dopamine hits from scrolling or maybe eating junk food, those are really short-lived and they're not going to restore real motivation.
What's actually gonna work is something new. Like try something new, even something small. Movement, even five minutes, even one minute. One BJ Fogg, who wrote "Tiny Habits," his little habit for exercise was to do two push-ups every time he went to go to the bathroom. And I'm just thinking, I hope he works from home 'cause I would not wanna be doing push-ups outs- outs- outside the public bathroom.
But- The ER floor. No, that's my OCD saying. Yeah, no. But just something tiny. Connect, for connection, maybe a call to a friend or, or even just a text if that feels too much. she notes that social bonding is one of the strongest dopamine [00:19:00] boosters available. And completion, finishing something small in one sitting.
And one thing that I use with clients a lot is just the idea of dopamine hacking. we can even just imagine what it feels like to finish something and get some dopamine going. It's amazing how that can help us motivate to start, say, tackling our giant pile of backlog charts. Just imagine what it would feel like to have a couple of those done.
So here are some more examples. So novelty could be driving home a different way than usual, just kinda wake your brain up a little bit. Movement could be five minutes of stretching before bed, or I have one client, we're like, "Let's just do one yoga pose before bed." Because then you can... are still identifying as an exerciser and you can add onto it later.
But it's so much better than doing nothing. Connection could be just a text to a friend instead of scrolling past their name on Instagram. Completion could be [00:20:00] finally unloading the dishwasher that's been sitting done since this morning. And if you're hesitant to do that, maybe time it sometime to see how long it takes.
It takes me about four minutes to empty the dishwasher, so that's something I can usually make myself do. None of this fixes the setback that we had that made these things hard to do, and all of this helps nudge the brain chemistry back towards the baseline Yeah. So we wanna start to use structure in a positive way and not weaponizing it.
So it matters because rebuilding structure becomes a predictable daily anchor, and that reduces the number of decisions that the brain has to make. That, whenever you're, the wind has been taken out of your sails, helps things stay calmer and things are automated that way. So her caveat is important.
Don't weaponize structure with s- with harsh self-talk, like, "Get it together, no excuses, we're doing this." [00:21:00] The brain is already feeling down and it doesn't respond well to threats. It's already in threat detection mode, right? So and just to mention that it doesn't need to be elaborate, but like an anchor could be the same wake-up time.
Like even though I don't feel like it, we're gonna get up at the same time today. Just some sort of structure into my day. It could be having a real meal instead of skipping it each day. It could be some form of movement or a wind down before bed. Four fixed points in an otherwise chaotic feeling day so that the brain has something predictable to hold onto can be helpful.
The weaponized version though turns that same routine into, " if I don't hit every one of these markers today perfectly, I've failed yet again," which you can see how like we're going into a spiral cyclone that we don't need to be doing. That's just gonna re-trigger the threat response when what we're really trying to do is calm down.
Yeah. And this is where self-compassion comes in, and she [00:22:00] frames this as neurologically necessary, not just a good idea. Self-criticism activates the same threat systems already in play. So like A said, we're not saying like, "No excuses. Go." Like, " Keep, keep going. Don't, don't do it," you know, "Don't screw it up again."
Which is- Jerk ... I can't imagine why we're not motivated. Yeah. Yeah. Yeah. So you can see why some of these things do not work or not as effective. But self-compassion actually activates the brain's caregiving system instead, which is actually what restores emotional balance and brings that prefrontal cortex back online, which is always the goal 'cause we are in our wise adult and we make better choices when we can bring in that PFC.
Herch suggested question in the moment might look something like, "What would support look like right now?" Or what-- I mean, even if that seems a [00:23:00] little out there, just what, what do I need right now? What, what do I need? And, and while I think sometimes doctors especially have a hard time asking for what they need, and I think we've talked about this on a podcast, if not, that would be an, a good one.
But because we're so used to taking care every- everybody else, it, it might be difficult or maybe just abstract to actually turn that inward and say, "What do I need?" And it could be rest. go walk, I need a walk, or maybe I need a routine. This is what I need to do in the morning to get my brain back online, or sometimes both.
Whatever it is, it's just important to turn that same caregiving that you're so good at every single day inward and actually care for what you need. So if the automatic thought is, "I should," remember our bad word that we need to bleep out, "I should be handling this better by now," the swap isn't toxic positivity, 'cause we're also not a fan of that.
It's [00:24:00] not, "Oh, everything's fine," right? The, our, our mascot, the dog in the fire with the coffee mug. " I'm fine. Everything's fine," right? It's not that. It's literally just asking out loud, if you need to, " What would support look like right now?" Or, "What do I need right now?" And then actually answering it instead of suppressing it, steamrolling over it, or completely ignoring it, which unfortunately we're very good at.
And so the last point that she makes is that setbacks are signals, and it does not mean that we have failed or we're horrible. The brain is not asking to be punished, and our brains are never asking to be punished. It's asking to be recalibrated so that it can move on and continue to grow. And she, she's very clear that by using these small actions that some of these that we've talked about and creating a [00:25:00] consistent and kind structure, not a punishing structure, and real self-compassion, people can recover from setbacks and often come back stronger than before.
And a word that sometimes people use for that is the concept of anti-fragility, where-- or post-traumatic growth, where we become better after these difficult situations. So an actionable takeaway maybe that you could do s- with your commute to and from work, think about these questions about something that maybe felt hard, felt like a failure, felt like a setback.
Is this actually a setback or has it turned into a failure, or has it turned into a failure story that I'm just making up about myself? Am I just creating a nasty autobiography that's not true? What is one tiny [00:26:00] little thing I could do that's just different? That something I could do even maybe before I walk in the door after work that could maybe make things a little bit better in my brain, so I'm showing up better for myself and then better for the people at home.
And what do I really need? Like, what would help me and my brain feel supported, cared about? Do I just need to go take a hot bubble bath? I s- I do that every night, every, especially every night shift I work, and throw some, I throw some bleach in there just to get r- oh, get rid of the germs. Maybe, maybe it's a defined amount of Instagram time, probably not three hours cutting into your sleep.
Maybe it's an early bedtime. What, what is it that would help you feel like you're really taking good care of yourself? Yeah, this is really good. I think these are not only awareness that we've created for you in this podcast, but just some actionable steps, and not major things. These are minimal things, [00:27:00] but like we've laid out in this podcast, it's about doing the small things just to recruit that dopamine back online to get your PFC back in charge so that we don't rely on climbing out of our amygdala hijack, and also leaving us vulnerable to further at- attacks because we're in our amygdala, and so everything is seen as, as a threat detect at that point.
So that's it for the podcast. Dr. Mark's full YouTube video is worth watching if any of this had landed. We'll drop the link in the show notes. So a quick recap of the core ideas, setback and failure feel identical in the moment, but they're not the same thing, and which story you tell yourself changes how your brain processes what actually happened.
Small actions, structure without weaponizing it, and actual self-compassion, that's the whole toolkit. Remember, setbacks are just signals, not [00:28:00] failure, and they're not a part of who you are as a person either. So it's not about that. So thank you for listening today, friends. If you found this conversation helpful, the best way to support us is to subscribe.
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We would love to give you a couple of invitations before we go. We will be hosting our first exclusive physician-only wellness retreat. We're working with MedTreks International, and it is at the lush Bodhi Tree Yoga Resort in Nosara, Costa Rica. So we want you to join us this November 2026, and we will have workshops, we'll offer up programming by yours truly, all the [00:29:00] afternoons open for you to indulge in this amazing tropical paradise.
You'll be surrounded by people that connect on your level and fellow physicians who understand the unique challenges of practicing medicine today. So we will also provide that link in the show notes. So join us. We'd love to have you. It's gonna be amazing. Thank you for spending time with us today.
Until next time, you are whole, you are a gift to medicine, and the work you do matters.
