Amanda: Hello. Welcome back to the show today. We are going to tell you how to self coach, how you can coach yourself and get yourself out of some bad spots.
Kendra: So you say there's an option for self-coaching exactly. How do we do that? I sure paid a lot of money to- nah, just kidding..
Amanda: Yeah. Well, ideally, yes, we all learn how to do this. Now. I will say the very best coaches still get coached themselves. Because it's hard sometimes, like with really deeply held beliefs and stuff, sometimes you need an outside observer. But the better you get with practice, the more things you can get yourself out of without the help of a coach.
THOUGHT DUMP
Amanda: The first thing I would say that you do is just get all of the thoughts out of your head. It's a good thing to do every day, but especially if you're feeling a certain kind of way: you're feeling anxious about something, you're feeling sad about something. That is a fantastic time to get all of your thoughts out on paper so that we can look at them.
When I was doing this process, I would only write down pleasant things like, “what a great day! I'm, you know, happy to be alive,” and all that sort of stuff. That's not really getting to the source of the problem. This is a private thing between you and your piece of paper. You get out the nastiness, being harsh, judgmental, horrible things that are in your brain. That's the only way to get them out is put them on paper so that you can actually become aware that that is what's going on in your brain.
Laura: And I will say too, like the piece of paper is key. This is not like you're writing in your journal. This is not like your posterity stuff. If you want to keep it, great, but maybe in a separate journal. But if you have just that piece of paper, once you've processed your stuff, burn it.
Amanda: Yeah. And a lot of people, too, I even do this, where I'm like, “eh, I'm feeling lazy.” So I just try to do it in my brain. It's just not as cathartic as if you get it out on paper. Just let her rip, like all of the things that you've ever wanted to say, this is your chance. Get it out. And you'll be amazed like, oh, can't believe that was in there!
Kendra: When is a good time to do this? You said we should get all of our thoughts out there. What, what are you talking about? Exactly. And when is the best time to do this?
Amanda: Well, there are some people that do it daily. That's part of their morning routine. There's some people that do it nightly as part of their nighttime routine. I'm a little more scattered since, you know, I'm an ER doc, I'm not making judgements about that, but I tend to do it when something's coming up for me and I'm curious. Like why am I wanting to go scroll on social media incessantly? Why am I wanting to, you know, eat an entire bag of chips?
Because I'm SO not aware of my feelings, when I'm noticing strange behaviors or just urges to do something, that's honestly what triggers me to like, “okay, I can either eat the entire bag of chips or I can just get to the bottom of what's going on right now.”
There's no right way. It's whatever works for you, but a lot of people love a routine.I just kind of do it when chips are looking really good.
IDENTIFY YOUR CIRCUMSTANCE V. YOUR THOUGHTS
Kendra: So, you speak a lot about thoughts. How do we differentiate those? Like how do we say it's a thought it's a circumstance or maybe it's a feeling about a thought or a circumstance?
Laura: That's such a good question. So circumstances are really sometimes hard to nail down. So I remember one example was somebody was telling them that they were going to lose their house, and you take it kind of at face value that, you know, they're in foreclosure or something, but that is not the circumstance. The circumstance would be the bank delivered a note of foreclosure, today at 3:00 PM. Yeah. That's a circumstance.
Amanda: Like we talked about last podcast. It has to be verifiable in the court of law. It's not like, “he's always mad at me.” No. What exactly did he say? What are the exact words? What was the situation that was happening?
It could be, if you're struggling with like a medical condition, like diabetes or something. What's your hemoglobin A1C? It's facts; it's numbers. If there're still questions to get to the bottom of it, then that's not your circumstance. There have to be no questions. Like, it is 50 degrees outside, and there is no snow on the ground. Like that sort of factual- there is no argument about it- that's your circumstance.
Laura: And everyone would agree that the circumstance is as you stated.
Amanda: Yeah. It can't even be like, “he said something rude.” What are the words? Because “rude” is already bringing in some sort of feelings about it. It's just, what are the words they said? You know, put it in quotes. That did happen, you know. [Circumstances] are outside of our control. And again, again, like it can't be something like, “well, my boss is a jerk” because your boss would have to agree with that. And there's a pretty good chance– actually, Kendra is my boss, so….hahaha! She would never be construed as [a jerk], she’s so nice, but I've heard OTHER people say their boss is a jerk. But that's not a circumstance. That's an opinion still. Your boss may show up five minutes after the work day usually starts. Your boss may say certain words. Your boss may speak, you know, at a certain decibel level, more than other people. That sort of thing, like, where it's verifiable. That's a circumstance- facts.
So that's the first thing to identify is what is your circumstance that seems to be causing your feelings, (which we know is not causing your feelings).
Kendra: So when we identify our circumstance and we understand that it does bring a feeling, how do we differentiate the fact that we have the thought causing the feeling, or does our feeling cause our thoughts?
Amanda: Well, the cognitive thought model would suggest that there's a circumstance and you have to have a thought about it, which then tells the amygdala and the middle, the limbic part of your brain, to feel a certain emotion. That thought triggers an emotion. And then that's what then ultimately ends up driving your actions. And the things that you do from day to day and the things that you're not doing from day to day are what gives you the results of your life.
So that's actually the self coaching model- to work your way all the way down [the model]. If there's some sort of result that you have, we can figure out what is that thought that's creating that result for you?
So, first thing, get the brain dumped down on paper, figure out what the exact circumstances, the neutral circumstance, and then let's start working on what your thought is about that. That's triggering that feeling for you.
Laura: Yeah. I love that.
Kendra: So how about we worked through an example of this, ladies?
COGNITIVE THOUGHT MODEL
Laura: All right, let's do that. But I wanted to share this quote, if that's okay, from Victor Frankl, the psychiatrist and Holocaust survivor. And he said, “Between stimulus and response, there is a space. In that space is our power to choose our response.” And that's what we're talking about is in that space is the thought, and we can consciously choose what happens to us,
Amanda: Yeah. So, you'll hear us say sometimes: C T F A R. That stands for circumstance. Thought, you have a thought about it. The F is the feeling, the thought creates the feeling, the feeling is what drives your actions. And then your actions, that's the A, gives you the results of your life. If we ever do use CTFAR, we'll try not to do that because it's real coach speaky, but that's what we're referring to.
So sometimes once you figure out what it is that you're thinking and the feelings that you're having about it, we're all really…we all don't like to feel badly. But my teacher always told us not to rush that. Sometimes the whole point of this is to actually feel the feeling, and let it come up.
As a professional field feeling stuffer, that is a lot of my work is to stop. And something terrible did happen, you know, or there was something sad that happened. Figuring out what I even was feeling, since I would numb out so often with it, that's sometimes the whole work of the self-coaching, just to reveal to yourself what's going on.
There may be other times though, that you don't. You're tired of having that particular thought, and there's things that you can do to start challenging that if that's of interest to you, but I would still encourage you to process the original feeling first before you even consider moving on from there.
Laura: Yeah. So if you are finding yourself annoyed with something, like somebody cuts you off in traffic. And you, maybe you become angry. You want to honk at them, or you're just super annoyed. You can ask yourself, “Okay. Well, what is the circumstance here?” Circumstance is that car changed lanes without signaling and they were close to my car.
You can ask yourself, what’s the thought driving your annoyance? The thought is most likely that they just don't care, or they're on drugs, or they're not being careful. Your thought is not, you know, they, they may be distracted because something is going on with them and maybe a teenage driver.
Amanda: Maybe your wife is giving birth in the car?
Laura: Maybe! Yeah. You never know, or they're just a bad driver, or maybe they just have ADHD, and it's really not a big deal, and you don't have to be annoyed by it. So that's, that's kind of how that works, identifying like what the facts are. And then, identify the thoughts that you have that are driving the feelings you're having.
Amanda: Once you identify that thought that is creating the whole rest of the cascade. Sometimes it's worth challenging that. You know, we just have automatic thoughts sometimes that don't necessarily serve us. So once you finally figure out what it is that, you know, is making you feel that way and causing you to, you know, do the rest of the things.
CHALLENGE YOUR THOUGHTS
You've figured out what you're thinking, but there's several other questions that are worthwhile to ask yourself after that.
* Of the infinite numbers of thoughts available to you, why are you choosing that one? I mean, a lot of times it's just a habit, but it's worth considering that. You know, why are you jumping to that conclusion when there's so many other possibilities.
* How is this particular thought making you feel? That's part of what we're getting at with this model.
* Is that thought serving you? Sometimes our negative thoughts ARE serving us if they're prompting us to make changes in our life. If they're prompting us to confront a situation or make changes in the world. Sometimes negative thoughts are very useful, and we don't want to get rid of them.But if it's not useful, and all it's doing is making you miserable, then it's not serving you well.
* Is there any way that it's possible that there's a different perspective that you could take? That's step two.
After you get your unintentional model, the automatic one that happens for you,
that's giving you results in your life that you don't like- then let's examine it by asking those questions like, “Is this thought serving me? And is this a thought I want to keep? And if not, what are other ways I can think about this?”
So after that, you've gotten your unintentional model. You've considered, if that thought is useful, and if you want to keep it or not. If you decide you're ready to move on, and you've already processed the feelings from the first one. Then you can come up with what's called an intentional model,
And that's where you move into, “Well, this isn't helping me, this thought isn't helping me. It's clear. I'm not enjoying myself at work. I'm numbing out with all of the different things. I'm actually creating more problems for myself.” Then you can go to an intentional model. And so we'll show you, let's take you through an example.
THOUGHT MODEL EXAMPLE
So the circumstance is you're on a 10 hour shift in the ER, the patient hold times are 48 hours. This is reminiscent of recent COVID times, or we would have psych holds a lot that would be that long. And there are less nurses present than available shifts. So see how that's all very factual? There are slots. Nursing slots. There are not as many bodies there as there are slots. That is a fact. Yup. Right. “Understaffed-” see how you're bringing in a little bit of emotion with that? Yep. So if you have that circumstance, one thought that I repeatedly had was, “work sucks.”
Anybody have a wild guess? Like what you might think or feel if you are thinking “work sucks” all the time?
Laura: Dread
Kendra: Annoyed.
Amanda: Yeah. I felt deflated a lot. I just felt stuck and just the victim of it all. I spent a lot of time there. So from that feeling, I would have like a low mood going into work, complain with my coworkers, how bad everything sucked, so then I'd bring others down. And I also wasn't particularly motivated to do a whole lot more than just baseline minimum. So the result of that thought “work sucks” was pretty much my experience at work sucked, like I made that happen. My brain dutifully found every piece of evidence to support what I was telling it to find. Your brain is just doing what you're asking it to do.
And, and when you're looking at it and finding evidence for how bad work sucks all the time, it just reinforces that. And it's real easy for that to become a habitual thought.
So another, when I finally figured out that the only person that I was making miserable with that particular thought, “works sucks” was myself. Like, because I wasn't marching off to admin, let's just be honest. I was just going home and complaining to myself. Not only was I making work suck, I was making my life suck because I wasn't leaving it there. When I left. I was telling everyone about it, bringing everyone down.
Laura: I can't believe that.
Amanda: Well, you know what I mean? Like, not every day, but, but definitely there were some days. As opposed to every once in a while I would have some shifts…you know, the crew in the ER is pretty fun. There can be some shenanigans from time to time, and that's available too. That's available every day that works sucks. It's just as available that there just may be some shenanigans. Like there may be a patient that has a surprise, number two in an unexpected location. There may be all kinds of things that happen. Who knows what's going to happen?
If I go into work with that sort of thinking, then I'm feeling more curious. And instead of just finding all the evidence and reasons why work sucks, my brain’s a little bit more open to, like, “What if things are about to go down, and it gets interesting in here?” It's just a much better place to be, and so if I have the thought, “there could be some shenanigans” as opposed to “work sucks,” then my ultimate result is a much better experience than my shift, a better experience of my life. If I'm not willing to do anything, if I'm not willing to quit my job yet, and I'm not willing to march off to admin, then that's a much better thought for me to think. See what I mean?
So that was just one example of an intentional and unintentional model. What do you guys think?
Laura: Oh yeah, absolutely. I've had to, I've had to change my thoughts in those arenas all the time. And now I'm going to try to figure it out. I was super annoyed at work the other day, because I don't know. I know I need to, but I'm going to dump it right now. I was, you know, I mean, our hospitals had a lot of turnover, and I assume there's been turnover in the lab. I literally waited four hours for a urinalysis. I was an hour past when I was supposed to go home, just because I didn't want to pawn it off on my partner just with the urine. Because I'm thinking it's coming back any second now. Anyway, I guess I can look at that as I had all this extra time to just to look on Up To Date and catch up with work friends while waiting for the urine. I don't know.
Amanda: So somewhere though, there's a thought that you shouldn't turn that patient over. You know what I mean? That's something interesting. Kendra and I had a partner who had good thoughts about something like that, sitting around waiting for imaging results to come back. He was just like, you know, I just decided a long time ago that I'm going to give the same attention to my last patient as I did my first patient. And I'm just going to be good with it. I was like, wow. All right. Sometimes I think you probably were expecting that the urine should come back before four hours. You know what I mean? And just really resisting that, even though sometimes it happens, you know what I mean? But here's the situation. It hasn't come back after three hours. What am I going to do about it?
Laura: Well, that's a whole other story because the nurses may or may not have labeled it incorrectly and didn’t tell me, but it's all good. It's all good. But one thought I have that helped me overcome dread a lot is that I have the opportunity and privilege to touch lives at work.
And I get to interact with people who I would not normally interact with in my own privileged sphere, you know. I get to speak with people who are in destitute circumstances often because of their own personal choices. And I get to offer them words of encouragement that may or may not help them, but I like that. I like that. And when I think about it that way, it’s more fun. It's just more fun knowing that you can do good in just about every patient's life while you're at work in the emergency department.
Amanda: Yeah. The other thing too, though, is, yeah, it's fine to be a little bit annoyed with urine taking four hours.
Laura: Right.
Amanda: You know what I mean? That's very human. We can all have compassion for that.
Laura: Yeah, I wasn’t trying to talk myself out of that one.
Amanda: We're not trying to gaslight people that they should be wildly excited to be up 24 hours for call or something like that. But it is what it is. And trying to resist reality is exhausting actually. So just accepting, like, yeah, it took four hours this time. I can either next time make a plan for that, or just, it happens with this job sometimes.
Laura: Right. And I choose this job, and we can choose a different job if we don't like our current job. A lot of us don't think that, right. We think that we are now doctors, and that is who we have to be forever and ever.
Amanda: You know, I'm thinking we'll attach to the show notes a little thought download section and like just a self coaching model worksheet that you guys can download and you can choose to do. I mean, you can make your own, but just kind of an idea of what to do and. help you guys. If you can do it daily, that's ideal, but at least do it whenever you're having feelings come up, that you're, you can't really identify what it is that's causing it. Or why you're feeling so annoyed. I don't know about you guys, but I just was a professional NOT examiner of what was going on…just put my head down and keep working sort of situation. And that's what ultimately we're getting away from. It’s much healthier to be able to take ownership of all of this.
Laura: Yeah, absolutely. It would have been really helpful to have those in medical training. When you're kind of in the throws of being under thumbs of shamers and whatnot.
Amanda: Well, that'll get us started. And anybody have any closing thoughts?
Laura: No, just that, that practice of self-coaching. It really is transformative. It just helps us learn how to deal with everything and gives us confidence that we can deal with any situation that arises. We can examine our own thoughts and create a reality for ourselves in a very real way. So super duper worth practicing and learning how to do this skill.
Kendra: And I found this to be very encouraging because even when you think, “well, that's the way I've always thought, or that's the way I've always handled it.” Thank goodness that our big powerful, brilliant minds and brains are so dynamic and neuroplastic, and we can change that. So, absolutely. Yes, It's very encouraging
Amanda: Awareness is the first step, and then we can change it from there. I love it.
Laura: Yeah. All right. You guys have a great week and we will talk to you next time.
UNINTENTIONAL MODEL
C: 10 hour shift, less nurses than available slots, hold times 48 hours
T: work sucks
F: deflated
A: complain to others, low mood, do bare minimum, look for all the evidence for how bad work is, miss any evidence of that is isn’t terrible, complain at home later
R: I guarantee work sucks, but I also take it into my time off as well, so making more than just my work life suck.
INTENTIONAL MODEL
C: 10 hour shift, less nurses than available slots, hold times 48 hours
T: there could be some shenanigans
F: curious
A: brain more open to looking for the fun and interesting, don’t complain so much, more energy
R: much better outcome for the same shift
