Healthcare and The Completion Bias

13th April 2017by victoriafenton0

My research base can be pretty broad. Because I’m both in healthcare AND I am self-employed, I tend to mix up the nutrition information with ‘business’ training.  My brain never keeps these streams in separate camps, however, as I have always found that business optimisation strategies are just as applicable in healthcare.

Today was a great example of this, and it sent me off on a bit of a thought experiment about the coaching I do to help my clients in healing from chronic illness.

The inspiration was actually a book about email inbox management called “Unsubscribe” (link) which discussed the concept of “Completion Bias”.

Completion Bias describes the psychological preference for doing shorter, more ‘simple’ tasks which can be ‘completed’ easily and relatively quickly. This concept is built on the fact that a small amount of dopamine is released at the point of completion for any task.

Dopamine is a neurotransmitter which can be associated with that sense of feel- good smugness we all get at having achieved something. Known as the “reward neurotransmitter” it is a mini-mind bath of self-congratulations.

The argument in this book is that we waste time doing ‘inbox management’ because we get lots of little ‘rewards’ every time we complete a response/file an email/get to inbox zero.  Managing a busy email account is a nice way to build lots of mini-achievements into our day, and lots of dopamine hits.

The problem lies in the fact that Completion Bias means we are likely to preferentially choose to work on tasks which can be accomplished in a short timescale.  Spending (or wasting) the day just marshalling emails may feel busy but it probably isn’t massively productive.

The net effect of all this dopamine-seeking, quick reward activity choice is that we put off doing longer-running tasks or ‘overarching’ goals.  We defer the big projects that will take more time because we’d prefer to keep ticking off the litany of tasks which we can do rapidly.

How to Circumvent the Completion Bias

Obviously, the productivity world go crazy for this knowledge.  Their recommendation?  Quite simple: break bigger projects which take weeks or months down into mini-goals and an itemised task list.  This provides the illusion of completion for each of the mini-tasks, but all of these work progressively towards the bigger goal.  Using this approach we don’t continually procrastinate on the larger projects because all the dopamine hits from tiny accomplishments are baked into the cake of the big goal.

What Does Completion Bias Have to Do With Healthcare?

So why do I care about Completion Bias?  (Other than the fact that I run my own business and email all my clients myself and am naturally someone who loves the state of “inbox zero”?!)

Healing from chronic illness is a long journey.  Anything that’s lasted as a web of symptoms in your life for any length of time greater than a few months becomes an overbearing part of your reality.  Shifting our wellbeing to the place where we are ‘over’ it can seem not only daunting, but also a drawn out process.

If our preference is for small tasks we can complete quickly, we are hardly likely to be attracted to the large-scale changes which a healing process may demand.  In my work I talk about lifestyle overhauls and nutritional revamps, I discuss reframing your entire mindset and up-levelling your emotional processing skills.  Basically, not small tasks.

So, when staring into the mouth of the dragon, or facing the oppressive mammoth of a mountain that is overcoming ill health, there is a tendency to fall into decision paralysis.

There’s no ‘mini-rewards’ on the horizon, and the overarching task is so overwhelming that we often don’t approach the work at all.

In this way, Completion Bias, and our preference for achieving even small tasks, halts any attempt to focus on what actually matters – completely re-evaluating every element of your life to build a healthier future.

The solution may seem simple: break down the task of ‘healing’ into mini-tasks.  And yes, a lot of my coaching work revolves around this art of ‘chunking’ the large project of healing.  Sometimes starting small, always being realistic, stepping just sufficiently far out of the comfort zone to be challenging, whilst always keeping a toe in security.  (Especially vital for immune dysregulation clients.)  As my father always says, “How do you eat the elephant?  One mouthful at a time…”

A More Subtle Danger Of Completion Bias in Healthcare

And yet, breaking tasks down is the easy part, really.

A more worrying side of Completion Bias as it manifests in healthcare is that, with the sense of achievement we get from ticking off small goals, we often mistake these smaller successes for an end result.

I was guilty of this countless times in my journey, which took over a decade.  So many times I had ticked off a small victory, proclaimed I was “done”, only to realise that all I’d done is taken one bit of the elephant, and there were countless more to go.

Just one example of where this shows up is on social media, where proudly displaying a picture of having made a ‘compliant’ meal (a mini success), merely covers over the fact that you’re still having to eat strictly according to (e.g) the autoimmune protocol despite it being years into your journey.

Celebrating the achievements of being ‘good’ with whichever ‘diet’ you have chosen can actually take the place of doing the real underlying work to resolve a
complex health condition.

I will always attract a bit of scepticism when I am critical of dietary restrictiveness being the end result of a healing process. But I really do believe that ‘nutritional rules’ are sold as ‘cures’ in this industry, to ill effect.

Reflecting on the Completion Bias, if you have a list of ‘rules’ you are abiding by, you can achieve a host of mini-successes (and that dopamine release) every time you eat according to those (often very restrictive) rules.  But this isn’t real success, in my opinion.  This is just ‘good behaviour’, according to an arbitrarily chosen metric of dietary perfectionism (whatever the science behind it).

I believe that in seeking smaller, daily ‘successes’ by sticking to ‘rule-keeping’ protocols, we often feel like we are actually getting somewhere, when really we’re just standing still.  In achieving such preliminary tasks, we are avoiding asking the more challenging questions and doing the deeper work.

Why is your immune system so reactive, why are you really suffering and how can you move to a place of not needing your security blanket of restrictions?  These are the questions and challenges of true healing.  And yes – it’s normally quite a large elephant.

However, I think that we owe it to ourselves, whether managing our inbox or embarking on healing our beings, to deny our bias to seek the smaller rewards in preference of attaining a much, much larger victory… Our full, liberated health.

victoriafenton


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