Dr. Joseph Arpaia is the husband of Oregon veterinarian Mary Arpaia, DVM. He specializes in treating stress-related conditions. He operates a solo practice in Eugene, Oregon, and is a consultant for the University of Toronto. His work on stress physiology is used by first-responder organizations in North America and Europe. Dr. Arpaia is the co-author of “Real Meditation in Minutes a Day: Enhancing Your Performance, Relationships, Spirituality and Health.”Read Articles Written by Joseph Arpaia
How often have you heard the line, “Just do your best.” How often do you tell it to yourself?
A psychiatrist for 25 years, I specialize in treating stress-related conditions. Many of my patients work in veterinary or human medicine. Many of them are burnt out or suicidal. One significant reason is their drive to constantly “do your best.”
To be effective and healthy, we must — absolutely must — STOP doing our best. But how can we do that, and is it OK? And what do we do if we are not doing our best?
When we were children, we all had someone — maybe a parent, English teacher or track coach — who encouraged us to “Just do your best.” Their words were intended to reduce the pressure on us to meet an external goal and instead reach an internal goal. If we gave it our all, then the outcome didn’t matter.
Unfortunately, doing our best meant pushing ourselves to the limit. Only if we exhausted ourselves could we be sure we did our best. If we had any energy left, then we felt uneasy because of the nagging feeling that we hadn’t done our best. We thought we were disappointing anyone who had instructed us that our best was required.
Over time, we internalize past authority figures. We carry them with us, and if we have not pushed ourselves to the limit, we can see the disappointed look on our teacher’s face or hear the track coach’s disparaging comments about how we didn’t do our best.
“Best” Does Not Exist in a Complex World
“Best” can be defined only in simple situations where a linear or numerical rating scale is involved. School and sports are examples. We can have the best time in a footrace, the best score on a test or the best grade in a class, but school and sports are not real life, and even in mildly complex situations, there is no single “best.”
Consider an appointment with a client whose cat is sick. What is best for the wealthy widow, Ms. Wilson, who dotes on her cat and spares no expense, differs from what is best for the busy professional, Ms. Clarke, who has three children and needs to get in and out quickly. It’s also different from what is best for the newly employed Ms. Johnson, who has little disposable income and wants to be treated compassionately and not judged because she is unable to do everything for her cat.
When we operate in a complex world with no “best,” then the only sign that we have done our best is an internal feeling of having pushed ourselves to the limit. We, therefore, find ourselves compelled to push harder, even to perform in ways that are not particularly helpful, in order to experience that internal state of having done our best.
Minimal Effective Effort
To start the escape from the “do your best” trap, let’s shift gears for a minute and think about choosing the medication dose for a sick patient. When we administer medication to treat a particular condition, we need to have two dosages in mind. One is the minimal effective dose (MED) and the other is the maximal therapeutic dose (MTD). If we give less than the MED, the medication will not have the desired effect. If we give more than the MTD, the medication will do more harm than benefit. The dose we give needs to be between those two amounts. If we are more concerned about side effects, then we might give a dose closer to the MED. If we are more concerned about effectiveness, then we might give a dose closer to the MTD.
In the same way, when we deal with a situation, we need to have a sense of the minimal effective effort (MEE) required. That is the minimum effort that will meet the situation’s demands. If we put in the MEE, then we will meet the demands effectively. We also need to keep in mind that as we put in more effort than the MEE, the additional effort will start to have negative consequences. The extra effort might run up the client’s bill, take up too much of the client’s time, take away staff time from other patients, or tire us so that we are not able to meet the demands of other patients or the needs of our family or ourselves. The more effort we put in, the greater the side effects. Eventually, the negative effects will be greater than any benefit from our effort.
So, there is now a maximal beneficial effort (MBE) that we need to avoid exceeding.
In almost every situation, the minimally effective effort will be significantly less than our best. In fact, even the MBE might be less than our best at times, meaning that doing our best will make the situation worse. We will have to get used to doing less than our best and doing less deliberately.
“I Choose Not to Do Better”
If we have practiced doing our best for years, we tend to feel uneasy when we do less. We will feel an intense desire to push harder. If we give in to the unease and push harder, then we are simply going back to our old habits. We must have a process for unhooking from the unease and creating a new habit.
The feeling of unease and the urge to push harder activate our sympathetic nervous system and shut down our parasympathetic nervous system. We must correct this imbalance in order to unhook from the unease. Relaxation techniques to reduce sympathetic activation will not work because they take our attention away from the tasks at hand. Instead of relaxing, we reset.
The One-Breath Reset
You can correct the imbalance of sympathetic excess and parasympathetic deficit by using a single breath to increase parasympathetic activation. This increase gives you a window of a few seconds to refocus your attention so that you do not slip back into your old habits. To do a one-breath reset:
- Inhale briefly.
- Lightly purse your lips and tense your muscles as you begin a four- to five-second exhalation.
- Release the tension as you complete the exhalation.
- Notice the sensations of being supported by the earth.
This one-breath reset stimulates a strong vagal or parasympathetic response for a few seconds. With practice, it can be done smoothly and unobtrusively. It can be repeated every few seconds if necessary. The reset breath improves performance under pressure, even in high-stress situations.
The reset causes a physiologic shift that allows us to refocus. Instead of being focused on the need to push harder or on the internalized English teacher or track coach, we can pull back our attention and look at the bigger picture. What does the client want, what does the patient need, what other demands must be taken into account? Of those demands, what are my priorities? What resources are available to meet the demands, and how do I allocate them efficiently?
We might need to reset a few times as we refocus. The refocus enables us to determine the options likely to be effective and the effort required for each. Our goal is not to do our best but to recognize the minimal effective effort and the consequences of exceeding it so that we avoid using more than the maximum beneficial effort.
Reset, Refocus, Respond
The shift in attention has given us a more precise, more complete view of the situation, our possible responses and their likely effects. We can now choose to respond in a manner that is at least minimally effective. Depending on other demands and resources, we might choose to expend even more, but we will not exceed the maximal beneficial effort.
The increased parasympathetic activity from the reset also improves our listening and expressive skills so that we can communicate effectively with clients and staff.
The habit of doing our best is not likely to change immediately. We can increase the speed at which we change by using mental rehearsal, a technique from sports psychology. First, vividly recall situations in which we acted effectively by using less effort than our best. That is a review. Then, recall a situation in which we expended more effort than was necessary. We then imagine using the reset-refocus-respond process to act effectively with less than our best. This is a redo. We will change our habit quickly if we review and redo a few times a week.
The reason for limiting the effort we put into most activities is so that we have the energy to do more than the minimum or to do our best in the activities important to us. We discover this by reflecting on our values — what is really meaningful to us. We do less than our best so that we have the energy for what is important but not urgent. In the hectic pace of life, it is easy to lose sight of our values and slip back into the habit of doing our best.
Making It Work
It was my last appointment of the day and my patient, a physician, sighed and said, “My family is not going to be happy with me. I still have two hours of charting to do after I get home.” I raised my eyebrows and our eyes met. I asked her about her priorities and where charting fell on the list of those. She listed patient care, time with her family and self-care as more important than charting. I reminded her that she just needed to put the minimal effective effort (MEE) into her charting. She smiled and said, “I now only have 30 minutes of charting to do after I get home. Thanks.”
To learn about the model of stress developed by Dr. Joseph Arpaia, check out a 2019 Frontiers in Psychiatry article, “The Unease Modulation Model,” at bit.ly/2JMITTb.