What's Wellness 911?

Abstract

Restlessness, boredom, and a feeling of being stuck are uncomfortable, and many physicians respond by numbing rather than listening. This article reframes those so-called negative emotions as growth signals rather than problems to avoid. Drawing on the Motivational Triad (Lisle & Goldhamer, 2006), research on discomfort and personal development (Woolley & Fishbach, Psychological Science, 2022), and vivid analogies from lobster biology and bison behavior, the authors argue that leaning into discomfort, rather than fleeing it, is the mechanism of genuine growth. Seven domains of physician life are examined where turning toward discomfort produces measurable gains, from mental mastery and relationships to financial health and new experiences. The central reframe: avoiding discomfort doesn't prevent it, it trades productive discomfort for the quieter, more corrosive discomfort of being stuck.

Key Findings:

  • The Motivational Triad, seek pleasure, avoid pain, conserve energy, is an evolutionary survival mechanism that reliably interferes with modern human growth and fulfillment when left unexamined (Lisle & Goldhamer, 2006).
  • In a five-experiment study of ~2,000 adults, participants encouraged to view discomfort as a signal of personal growth were more motivated, engaged, persistent, and open to difficult information than those given generic learning instructions (Woolley & Fishbach, Psychological Science, 2022).
  • Avoiding discomfort doesn't eliminate it, it trades the productive discomfort of growth for the corrosive discomfort of boredom, restlessness, and complacency, while adding numbing behaviors that create additional harm.
  • Poor boundaries in relationships are reliably predicted by low tolerance for discomfort; conversely, mastering discomfort tolerance is directly associated with improved relationship satisfaction (Killian, LPC).
  • Reframing discomfort as a signal of progress, rather than a sign of failure, is a learnable cognitive shift that increases motivation and persistence across diverse domains, from exercise and nutrition to emotional processing and political openness.

The Motivational Triad: our evolutionary brain vs. our growth

Prefrontal cortex

The "thinking brain"
Rational, logical, deliberate. Governs decision-making, empathy, and measured response. Active when calm and regulated.
Active during: clinical reasoning, difficult conversations, empathic listening

Amygdala

The "emotional brain" (hijack mode)
Threat-detection and survival responses. When activated under stress, blood flow is diverted here, away from rational thought.
Triggered by: fatigue, perceived danger, chronic stress, conflict with patients or colleagues

Amygdala

The "emotional brain" (hijack mode)
Threat-detection and survival responses. When activated under stress, blood flow is diverted here, away from rational thought.
Triggered by: fatigue, perceived danger, chronic stress, conflict with patients or colleagues

How an amygdala hijack unfolds

  • 1 A perceived threat is detected, a difficult patient, a rude consultant, a safety concern, or accumulated stress from the shift.
  • 2 The amygdala fires and diverts cerebral blood flow away from the prefrontal cortex toward the limbic system.
  • 3 Fight-or-flight activation: heart rate rises, rational thinking narrows, emotional reactivity takes over.
  • 4 The physician says or does something disproportionate, out of character and later regretted.
  • 5 Without intervention, repeated hijacks reinforce the pattern; with practice, neuroplasticity can reduce vulnerability over time.

Seven strategies to short-circuit amygdala hijack

  • 🏷️ Name your emotion (affect labeling)
    Say it explicitly: "This is rage" or "I am frustrated." Research shows naming a negative emotion measurably reduces its intensity, you don't have to act on what you can name (Torre & Lieberman, 2018).
  • 🔍 Identify the secondary emotion underneath
    Anger is rarely primary. Ask: what's underneath it, fear, an unmet need, anxiety? Writing it down adds an additional calming effect and helps surface the real issue.
  • 🤲 Ground yourself with a safety statement
    If you're not in actual danger, place a hand on your heart and say "I am safe" or "everything is okay." This simple act can interrupt the amygdala's threat signal.
  • 🌬️ 4-7-8 breathing: engage the vagus nerve
    Inhale 4 seconds, hold 7 seconds, exhale 8 seconds, repeat up to 4 times. Deep breathing stimulates the vagus nerve and shifts the nervous system from sympathetic to parasympathetic (Gerritsen & Band, 2018).
  • ✏️ Hold a pen, stay in thinking brain
    Before a potentially charged conversation, hold a pen as if about to write. You are conditioned to use the neocortex when writing, this physical cue helps keep rational brain engaged. Mental math works too.
  • 🚪 Remove yourself and engage the thinking brain
    If already activated, step away if possible. Then practice something requiring cognition, reciting causes of anion gap metabolic acidosis, renal physiology, to shift blood flow back to the prefrontal cortex.
  • 🧘 Prevent hijack with mindfulness practice
    Consistent meditation and mindfulness develop emotional regulation capacity and, through neuroplasticity, structurally strengthen the prefrontal cortex, reducing amygdala sensitivity over time (Wu et al., 2019).

"Developing the ability to respond rather than react is time-consuming, but it is so worth it. Through neuroplasticity, we can strengthen the prefrontal cortex so we will be less subject to amygdala hijack in the future, and keep the Hulk out of the emergency department."

Publication details:

JOURNAL
Common Sense (AAEM)

VOLUME / ISSUE
Vol. 31, No. 1, pp. 15–16

PUBLISHED
January/February 2024

AUTHORS
Amanda Dinsmore, MD; Kendra Morrison, DO; Laura Cazier, MD

SERIES
The Whole Physician

PUBLISHER
American Academy of Emergency Medicine (AAEM)