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A Conversation with … Ethan Kross PhD, the Psychologist Who Knows What We Should Say When We Talk to Ourselves

2022; Lippincott Williams & Wilkins; Volume: 480; Issue: 11 Linguagem: Inglês

10.1097/corr.0000000000002411

1528-1132

Seth S. Leopold,

Mind wandering and attention

From time to time, I confess on these pages. Here's one now: I enjoy meditating, and it's been a daily practice of mine for years. Read to the end for two even-more-lurid disclosures. While you wait, consider this observation from a friend of mine whose meditation practice runs longer and deeper than my own: "The heart beats, the lungs breathe, the mind wanders." So, for those whose self-talk includes sentences like, "I can't meditate, my mind doesn't stay focused": Join the club. It seems to include people who've been at it for decades. Science says my friend is right. Psychologist Ethan Kross PhD, Professor of Psychology and author of the bestseller Chatter: The Voice In Our Head, Why It Matters, and How to Harness It [7] describes the wandering mind as our "default state" [8]. Of course, Buddhists (and others) say my friend is right, too. They've been writing about this for thousands of years [4]. But what makes Dr. Kross's work so much fun—and so germane to surgeons—is just what happens when our mind wanders, and what we can do about it to become better at a key part of our day jobs: healing others by moving our hands. Dr. Kross calls what happens when the mind is wandering "self-talk," an experience we're all familiar with. If you've ever been bothered by pressured "mental speech," you're not alone, either. One study estimated that humans are capable of talking to themselves at a rate equivalent to speaking 4000 words per minute out loud [6]. President Reagan's Berlin Wall speech ("Mr. Gorbachev, tear down this wall!") was nearly 30 minutes long, at 2671 words. It'd have been a full 40 seconds worth of self-talk at that clip. Turns out that inner voice is a real motor-mouth. What about when that voice gets nasty? You know what I mean. Let's say you've cut the tibia in varus during a knee replacement. OK, fine, so I've cut it in varus. Either way, it needs recutting. Heck and damn. (Confession #2: Maybe worse than "heck and damn"?). Cut it straight this time, you monkey. (Confession #3: Maybe a little worse than "monkey"?). Three confessions in one essay, must be a personal record. I've played a lot of sports and had a lot of coaches. None of them ever taught me to think negatively. Yet somehow it's in my repertoire. Yours too? Still, I never really saw the harm. Wrong again. A fun Canadian study in dart-throwers found that negative self-talk results in fewer points in the cork [3]. Merde! And positive self-talk both sets a favorable table for psychomotor tasks and also sharpens skill, including putting in golf [1]. That finding seems generally to be replicable especially in fine-motor-skills tasks [5], just like the ones surgeons sometimes perform. Coach was right, it seems. Still, it's not always so easy to get those voices to come along. Dr. Kross calls negative self-talk—when we ruminate, worry, catastrophize, or worse—"chatter." He calls this buzz in our heads the "dark side of the inner voice" [12]. But he's done far more than categorize or measure the effects of this, since by now they're well known. What makes this worth your time is that he offers evidence-based tools to mitigate or at least come into better relationship with our chatter. His solutions are both effective [9] and easily implemented [10]. He suggests shifting the voice into the third person to create some distance (imagine you're advising a friend), reframing how you think about physical sensations (the butterflies in your stomach before a big move in the OR, the heat rising in your chest when you learn your next case was bumped by a transplant for the second time this week), and maybe even engaging in "mental time travel" to imagine how whatever is upsetting you will feel in a week or a year [8]. But these three tools only scratch the surface. Dr. Kross covers many more and the science underlying them. Read his book The Voice In Our Head, Why It Matters, and How to Harness It [7], but before that, let's go deeper in a conversation with Dr. Ethan Kross, the psychologist who knows what we should say when we engage in self-talk. Seth S. Leopold MD:You say that chatter "happens precisely when we need our inner voice the most—when our stress is up, the stakes are high, and we encounter difficult emotions that call for the utmost poise"[8]. Sounds like surgery. How harmful is chatter in those settings, really? Ethan Kross PhD: Very. Chatter undermines our ability to think and perform in two key ways.Fig. 1: Ethan Kross PhDFirst, it undermines our ability to focus. Attention is a limited resource; you only have so much of it that you can deploy at any moment. If all of your attention is focused on your chatter, that doesn't leave much to do the things we often want and need to do. If you've ever tried reading a few pages in a book while you were worrying about something only to find that you didn't recall what you've read, you've experienced this phenomenon. That's one way that chatter impairs us. Chatter also leads to "paralysis by analysis"—we overthink routine behaviors that we normally perform automatically to the point where we dismantle those behaviors. Take a professional golfer as an example. There are multiple components to a golf swing. A golfer has to know how far back to retract their club on a swing, how much force to swing with, how much to rotate their hips, what angle to hit the ball against the club, and on and on. Normally, a golfer executes these behaviors without thinking; they don't contemplate each step in their routine when they're swinging their club. But if a golfer experiences chatter about their performance, they start hyperfocusing on the individual elements of their behavior. Am I squeezing the grip too hard? How far should I pull the club behind me? Am I rotating my hips enough? Once this happens, the entire behavior unravels and performance declines (for a recent example of this, see Simone Biles's experiences with "the twisties" in the summer Olympics back in 2021). Dr. Leopold:Some of your suggestions are reminiscent of those I see offered by mindfulness gurus; essentially, they suggest putting some distance between ourselves and the thoughts. But you've said that you think meditation really isn't the trick, or at least not on its own[12]. Given how similar some of your suggestions seem to that approach, what do you mean by this? Dr. Kross: I don't think there are any single magic pills for managing chatter. Different tools, and different combinations of tools work for different people in different situations. Meditation is one tool that research indicates is helpful for managing chatter. But many others exist, and some of them likewise function to help people adopt a healthy, distanced perspective as they relate to their feelings. To be clear, I have nothing against meditation. To the contrary, I think it works very well for some people. I've meditated periodically since I was 5 years old. But the sooner we can shift away from the narrative that suggests that there are one-size-fits-all solutions for managing chatter, the better. Dr. Leopold:We've all heard that the best way to deal with stress is to "get it off your chest." Yet you've said that venting one's emotions just "keeps the chatter brewing rather than helping [one to] suppress it"[12]. You've even called a venting session "co-rumination"[2]. I hope you don't mind if I steal that line. But who's right (those who recommend venting, or you) and is trying to "suppress" it really the goal, or should we shoot for something else? Dr. Kross: There's a popular belief in our culture that when you're experiencing stress you should find someone to vent your emotions to. There has been a lot of research on venting, and here's what we've learned: Venting on its own doesn't help us when it comes to managing chatter. It often makes it worse. When you find someone to vent to, and they take the time to listen, that can be good for strengthening the relational bonds between two people. It feels good to know that there's someone out there who is willing to take time to listen, empathize, and validate your experience. But if all you do is vent, that keeps the problem active in your mind and does little to change the way you think about your circumstances. The result? People remain upset. The key to getting good chatter support is to do two things. First, you do want to spend some time talking about what happened to you and what you felt. It is helpful to express your emotions; don't suppress. At a certain point in the conversation, however, the person you're talking to should ideally cue you to stop venting and instead help you reframe your experience (let's look at the bigger picture; how could you have acted differently; does this really matter in the grand scheme of things). Other people are in an ideal position to help us do this because they have distance from our experiences. So, the key to getting good chatter support is to find people who allow you to both express your feelings and broaden your perspective. Both are important steps to managing chatter. Dr. Leopold:We've all seen those sports movies where the hero's concentration narrows to a pinpoint—the spin on a baseball, the opposing boxer's gloves, you get the idea. What, really, is the relationship between positive, self-supporting self-talk ("anti-chatter"?) and an individual's ability to "get into the zone"? As a patient, I'm guessing you'd like your surgeon to spend as much time "in the zone" as possible… Dr. Kross: Positive self-talk can be useful for helping people get in the zone if they're struggling with their motivation (ergo, the popular call to summon your "inner coach"). That said, once you find "the zone," people often want to turn off their self-talk so they can let their practiced behaviors operate on autopilot. An athlete standing at the free-throw line doesn't want to talk themselves through their shot; they want to rely on their muscle memory to effortlessly find the hoop. That said, if you're performing a new procedure that you haven't mastered, talking yourself through it step-by-step in a positive manner can be helpful. Dr. Leopold:Like us, our patients catastrophize and ruminate. But some do it severely enough to result in all sorts of problems after surgery; persistent pain, clinical dissatisfaction, and even objectively poorer function from the same operations. Giving them a little friendly advice about dealing with self-talk isn't going to be enough to change the habits they've developed over a lifetime. How should surgeons help patients whose chatter is measurably problematic, and what's the run time on those interventions? How long do we wait before operating on someone, and how do we know when it's okay to do it? Dr. Kross: Inform your patients about the science-based tools that exist for managing chatter and encourage them to start trying out different combinations of tools. We know a great deal about individual tools that exist; we know less about how those tools optimally combine to help different people grappling with different chatter-provoking situations. So, we need to get people to start testing out different tools so they can find the ones that work best for them. In terms of knowing how long to wait, that's a great question that I wish I could answer. Everyone varies. Depending on the person and what they're experiencing chatter about, different tools can take different amounts of time to benefit people (for example, it'd be easier to get over chatter surrounding an argument at work than a terminal diagnosis). Right now, we're still primarily reliant on self-report techniques to assess how people are doing, but we're working on developing reliable biomarkers of chatter.