Family physician, author, blogger, speaker, physician leader.

Willpower Instinct – the Book Every Primary Care Doctor and Patient Should Read

In the spring of 2013, I heard Professor Kelly McGonigal speak at the Stanford Health Innovation summit and learned about her book, The Willpower Instinct – How Self-Control Works, Why It Matters, and What You Can Do to Get More of It. Fascinating, practical, and evidence-based, it is a book highly recommended for every primary care doctor and patient to read. McGonigal wants all of us to embrace our human nature, specifically that we have two minds in one brain. This setup often seems to thwart us from doing the necessary things to be and stay healthy. We have an emotional irrational mind. We have an analytic rational mind. By understanding these differences allows us the opportunity to be successful in what endeavors we pursue, like a New Year’s Resolution. After all, who doesn’t need more willpower?

Over the past year, I’ve used many of the stories and strategies in the book to coach patients on how to think so they are successful in becoming healthier. These are some of my favorite stories I share regularly:


Chimpanzees versus Harvard students.

Both groups were given desirable treats. Chimpanzees were offered either 2 grapes or 6 grapes.  Harvard students were offered either 2 M&Ms or 6. Which number would they choose? No surprise here. Understandably 6 is better than 2. The majority in both groups reached for 6. However, what percentage of chimpanzees and Harvard students would wait 2 minutes to get 6? Could they delay gratification for 120 seconds to get 3 times the amount? A impressive 72 percent of chimpanzees waited for 6. Harvard students? Less than 20 percent! As McGonigal notes:

“When we’re on our best behavior, humans’ ability to control our impulses puts other species to shame. But all too often, we use our fancy brains not to make the most strategic decisions, but to give ourselves permission to act more irrationally. That’s because a big prefrontal cortex is good at more than self-control. It can also rationalize bad decisions and promise we’ll be better tomorrow.”

In other words, we can find all kinds of reasons to take the 2 M&Ms now. The M&Ms are right there. We know the right answer is we should wait 120 seconds, but we can do that tomorrow. We had a rotten day. We promise to be better tomorrow. The situation will be better tomorrow. We have grand visions of what our “future self” will be tomorrow – stronger, healthier, and with more willpower. Just. Not. Today. Ever had those thoughts?

In another version of the study, students were asked if they preferred the 2 or the 6 M&Ms without actually seeing them and being tempted by them visually. Like the previous example to get the 6, one would have to wait. Without a visual cue and immediate temptation (emotional irrational mind), the more rational choice was chosen. Far more students choose the 6. Out of sight truly means out of mind. What might you do to shape your environment to be more successful? My personal vice is potato chips. This is why I rarely have potato chips in the house.

Our perpetual optimism.

She notes, “Psychologists have shown that we wrongly predict we will have much more free time in the future than we do today…We look into the future and fail to see the challenges of today. This convinces us that we will have more time and energy to do in the future what we don’t want to do today.” Sound familiar? Groups of people were asked how often they would work out in a week over the next month. Others asked the same question but told to think about it in an “ideal world”. In both situations the answers were about the same. As McGonigal notes, we implicitly assume our choices are in an ideal world.

When participants were asked to think “realistically” to call out our implicit default of an ideal world, participants were even more wildly optimistic on what they could accomplish.

When data showed participants were not as successful as they expected, researchers asked participants to predict their goals for the next two weeks. What do you think happened? They predicted an even more optimistic outcome! It was almost as if it was an effort to overcome past performance which fell short of their goals.

Understanding this bias, that somehow we always have more time, more energy, and more opportunity in the future allows us to put off what is important today in getting stuff done.

Instead, McGonigal asks us to consider if it is a good idea and if the consequences are worth putting off the task today. Plan accordingly. (Something I’ll try to remember as April 15th looms closer!)

Oh, what the Hell phenomenon.

My absolute favorite anecdote to share.

When anyone breaks a diet with an extra piece of pie or has an extra cookie, the thought “oh, what the hell” jumps in. The though of “I’ve broken my plan. I might as well eat more”, resonates with many of my patients. We’ve all been there. As McGonigal notes, “Giving in makes you feel bad about yourself, which motivates you to do something to feel better. And what’s the cheapest, fastest strategy for feeling better? Often the very thing you feel bad about. That’s how eating a few potato chips becomes looking for crumbs at the bottom of an empty, greasy bag.” I’ve been there. You?

Forgiving oneself for being human and having a slip is the way to break the cycle. Saying it’s ok.; it happens. The mindset that because I’m human and I expect that sometime I am not perfect, actually improves self-control! Instead of feeling guilty, one reflects on what happens and moves on. Without bad feelings of guilt and shame, we don’t seek out those rewards, like food, to remove those feelings of guilt and shame.

“If you think that the key to greater willpower is being harder on yourself, you are not alone. But you are wrong. Study after study shows that self-criticism is consistently associated with less motivation and worse self-control… In contrast, self-compassion—being supportive and kind to yourself, especially in the face of stress and failure—is associated with more motivation and better self-control.”

McGonigal’s book certainly has changed how I do many things both personally and professionally. Better health is simply a matter of a few tweaks, understanding what makes us human, and more importantly embracing who we are.

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