The Worthy Physician

Unlocking Motivation: The Role of the Habenula and an Iterative Mindset in Mental Health and Habits

• Dr. Sapna Shah-Haque MD

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Discover the intriguing role of the habenula in shaping motivation and behavior with our esteemed guest, Dr. Kyra Bobinet. This small but mighty brain region, often overlooked,  deeply influencing emotions and contributing to mental health conditions such as depression and anxiety. By understanding its impact, we challenge medical norms and empower individuals to break free from limiting paths, reclaiming mental health and motivation in the process.

Mindfulness and resilience are essential, especially in demanding professions like healthcare, where balancing multiple roles can be overwhelming. We explore how an iterative mindset can transform these challenges, allowing clinicians to experiment with behaviors and overcome the notorious 'no-do gap.' Dr. Bobinet shares insights on how turning off negative signals from the habenula can prevent burnout, encouraging a shift away from performance-based thinking towards a more sustainable approach to productivity and job satisfaction.

Embracing an iterative mindset in all aspects of life can lead to sustainable habits and prevent motivation loss. We discuss how setting performance-based goals can create cycles of motivation and self-blame, and how recognizing each achievement as an iteration can lead to growth and learning. Finally, learn about a unique habit formation app inspired by this mindset, designed to support users in building health habits naturally and sustainably, all while respecting privacy. Join us for a transformative conversation that promises to reshape your approach to motivation, habits, and mental health.

Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.


Learn more about female physicians' journey through burnout to thriving!
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Speaker 1:

Welcome to another episode of the Worthy Physician. I'm your host, sapna Shah-Hawk, reigniting humanity and passion for medicine. My question today is how much do we actually know about the brain, and do we actually know at what point we stop, or is our brain actually unstoppable? Today I have a wonderful guest, dr Kyra Bobinette, who's going to help us dive into this question. So thank you very much. Thank you for having me.

Speaker 1:

I'm interested in your work and we were talking before the recording that at some point in time during our medical just with the culture and with our training in general, with medical school residency and the world as an attending, it really is very much. Stay in your lane. This is what a doctor does. This is the definition of what your life is going to be like, and we're always expected to put ourselves last, put everything first, and that's a hill that we're going to die on, that's a sword that we're going to fall on for our patients, no matter what. But the truth is that I think there's more to life than just being a physician. There's more to life than just medicine. But it seems that in general, we're almost made to feel guilty if we think otherwise. But your book and your work. What's the different spin on that? Let's dive in, tell us about that. Tell us and break it down for us the way that you broke it down for me beforehand, because I love this and it makes complete sense. Yeah.

Speaker 2:

We'll start with a little obscure knowledge that has recently come to light, which is the new neuroscience of the habenula, which is a half a centimeter bilateral midline epithelamic above the thalamus, set of loci that are really insignificant up until about 10 years ago, discovered in like the mid 1800s or something like that, and then nothing. And then, in the 20 odds or the 2010, started to become really interesting. A couple of studies came out. One was that I saw in my first book. I put it in my first book. There was two studies that were out at the print of that book. One was showing that the habenula it lights up when the organism or the animal thinks they failed at something. And then the second was that if you stimulate this area of the brain to light up speaking more like the lateral habanula, of course this kills our motivation or kills the animal's motivation to keep trying.

Speaker 2:

So to me, having 30 years in the health behavior, social behavior, mental health behavior, whatever the case may be, that to me was a clue of unprecedented impact.

Speaker 2:

And since then we've had this cascade of literature that further expands the impact of this teeny, tiny area of the brain on our behavior, such that I currently believe that it is the most potent central control of our behavior, what we do and don't do.

Speaker 2:

That I've ever seen, that I've ever found, and that we don't know about it, like hardly anybody knows anything about this and yet is the biggest control over whether we do something or don't, and whether we have motivation or not, and whether we feel good or not. And it's basically the brain locus of aversion itself, which we know through behavioral economics. Loss in our brain, negativity, bias, is twice as powerful as gain, because it keeps us alive. Right, we have to be a little bit pessimistic to get through the skills of nature as a species to have arrived here. So that's basically the main thing is that everything we're doing is working against the brain is ignorant of this habanula action. And once people know about their habanula, once they know about that, they can do differently and they can retrieve their motivation and retrieve their power. And I don't say that in some sort of self-helpy way, I literally say that in a neuroanatomical way.

Speaker 1:

I appreciate that, and now that we're having science come out and back this up, and now that we're having science come out and back this up, it makes total sense, right? Because evolutionarily, we do need to have that negative feedback in the brain that, okay, don't touch that, that's hot, don't go near that animal, it's scary, it's going to eat you, mm-hmm. How do we undo some of those things, seeing that in today's age, those early threats are no longer a threat, it's more modern day? How do we filter that out?

Speaker 2:

Yeah, I think, before we get to that, let's expand the understanding of how powerful the benula is, which is that this is now the locus or the source of depression, of anxiety, of OCD, of PTSD. Of course is networked with the prefrontal cortex and the amygdala and hippocampus and all these like areas, but it is the central controller. It dominates stochastically, dominates dopamine, it dominates reward, the reward pathway. It is actually called the anti-reward pathway and I know that as the science progresses that there will be more and more links in the chain, if you will, to see what exactly it's connecting to. But so far it's connecting and controls everything. It controls hunger, it controls sleep, it controls satiety, it controls all of our functions. And it makes sense because, again, like if you are trying to live and you're trying not to eat the poison plant more than once that gave you a belly ache the first time, maybe the second time it'll kill you. You need some really strong breaks to stop, to halt yourself from taking a life-threatening risk. And so we're living in an environment that essentially can be seen as a soup of triggers for the habanula to be activated and that has very broad, sweeping data on mental health epidemics, like we're having all of these sort of telltale signs that the habenula is being activated by millions and millions of people and also is the central source of control. If somebody wants to control you, they intuitively target this area of your brain and so, understanding just how much of a puppet string it is for us, we need to take that seriously and take that soberly. So I just wanted to linger there a little bit more so that the audience really understood the gravity. This isn't just, oh, this cute little area of your brain, this is everything Addiction. It also controls whether addiction happens or not. So we can unpack some of the neuroanatomy of that or neurochemistry of that, neurofunction of that.

Speaker 2:

But going to the solution, which is that I accidentally found during some behavioral research that I did for the largest retailer in the US on their frontline workers, I was looking from a public health perspective what is working for people who live in food deserts and have all of the social determinants of health in the world and have everything stacked against them single parenthood, taking care of their parents, sandwich generation, maybe working two jobs, have no time or money. And in doing that research, what I found is that there's rare, but there are these individuals scattered around that don't know each other that all have one thing in common, which is that they are able to change their health, manage their weight, improve their eating whatever the case may be and sustain it. To me, I was burned out on all of the programs, the goals and the tracking and smart goals and the wearables, and I've done all. I've been there and done that. I've tried all of those programs, steps, programs and competitions and leaderboards and text programs, everything you can imagine. I have done it.

Speaker 2:

And in this research, seeing these individuals, these like super humans that seem to be defying all obstacles, I got really interested. Are they all trying Weight Watchers? Are they all using wearables? Are they all eating the same diet? Are they all doing similar things? And they were doing nothing similar from each other. And so then I looked at the psychometrics and it turned out that in qualitative research, at that point, going deep dive, what they were all sharing in common was only one thing, which is that they were using an iterative approach of experimenting and iterating. When they got stuck, that kept them going. And just that keeping going, that keeping an effort, almost like area under the curve aspect of their experience, was what caused them to not only succeed but also to maintain that success, whereas 99% of everybody else relapsed, and we've all seen this in clinical practice.

Speaker 2:

It's no doc, I forgot or no. I used to eat well, but now I'm not eating well and you're like, why not? And you don't have the time, as a physician, built into your work stream or into the revenue model of healthcare to help unpack that and to do much of anything. So most docs and most clinicians develop what I've seen it, or what they call a spiel Obesity medicine. Docs talk about this a lot, like I give them my spiel, but it's a one size fits all spiel. We don't know really what's going on with that person.

Speaker 2:

What they had in common, these superhumans, is that they would practice something or experiment with it. They wouldn't turn it into a hard goal, get to that in a second and then, whenever they would reach an impasse, say it was a failure to launch, say it worked for a while, but then something in their life changed, or say that it worked really well but they got bored and they needed variety or they needed to switch it up or level up. In any of those cases, what they would do differently is they would iterate, which is they would tinker, they would tweak, they would add something, they would remove something, they would fit it to their life. They would. If they didn't like raw veggies, they would cook the veggies. If they didn't like cooked veggies, they would eat only raw veggies. It was that process of iteration to get to what fit them individually that set them apart from everybody else. And you can imagine that set them apart from everybody else. And you can imagine we talked about the habanula. That's a failure detector.

Speaker 2:

So if you're iterating, you never send that a signal of I'm failing in any form. Your habanula stays nice and quiet and sleepy and you don't poke the bear, and you maintain your motivation and your empowerment.

Speaker 1:

That's fascinating, that's very fascinating, and it's just by. Not it's more than just ebbing and flowing, but it's being, it's adapting to where you're at or to your situation.

Speaker 2:

Yeah. I think the ebbing and flowing is somewhat exploited, like resilience training.

Speaker 2:

Right, it just takes you to take it more Right no definition that your habanula is on and that the cure is to turn it off, not to pump yourself up, because that's the dopamine system and that's what people do. They try to make people feel better and I was guilty of this too. I had a real passion for mindfulness back when I was designing large scale health interventions for 33 million people. I was the first to bring a workplace mindfulness program in there and since then I've seen I've had friends who are docs, who did mindfulness trainings for burnout for physicians and stuff like that. Those are good skills to have.

Speaker 2:

In a sense of it's better to be able to access your metacognitive state than not, because otherwise you're just in your limbic system and you're just burning flesh otherwise. But I feel that it took a wrong turn when the institutions who provided these for clinicians were basically using them as a way of further wringing out the energy of their clinician workforce. Yeah, so I think it's been a tool of abuse and also blame, Like what's wrong with you? Aren't you mindful? What's wrong with you? Aren't you resilient? What's wrong? It can be very isolating because you think it's you.

Speaker 1:

And that blame is not to be on the physician or the healthcare worker, because we're some of the most resilient people with the training we have to go through, the amount of hours and knowledge and then the sacrifice that we choose to give up. So there's not a lack of resilience. And while mindfulness in and of itself, I try to have that in my life, just to be in the moment and not have all these distractions, because I'm a mom, I'm a daughter, so there's besides being a physician, so there are many points that many people are questionable flat me at the same time. Having said that, I try to enjoy that because that'll pass. Like in five years, it'll be different. So I'm trying to enjoy that. But what you're saying is now it has become a toxic tool, and I'm saying that it's your fault, doc, because how are you supposed to be resilient? You're supposed to be superhuman, you're supposed to take care of everyone else.

Speaker 2:

Come on, we had four days off in the last 28 days, yeah, and to your point, whenever we think that we are failing at meeting somebody else's expectations and we as clinicians are by nature servant leaders, like we are here to serve humanity and that can really get under our skin if we think we're failing at that and so that failure signal and, by the way, failure has a lot of it's like a whole crayon set, but it has frustration, disappointment, demoralization, helplessness, powerlessness, doom scrolling recently has been found to turn on the habanula.

Speaker 2:

So all of these flavors of life experience can trigger the lateral habenula, the habenula, to be active, and what we didn't realize is that, oh, we need to turn off the habenula. So how do we turn off the habenula becomes the question, and certainly the mindfulness research on how it calms the rumination. The default mode network and those kinds of things helps. But that's just think of the prefrontal cortex, the dorsolateral prefrontal cortex, and the default mode network, as like the cloud system, where so the rumination is like on the backdrop, it's like the engine running, the energy that's running, but the cloud system doesn't strike ground. The habenula is the lightning strike to ground, it's the thing that activates the actual don't do.

Speaker 2:

And one of the telltale signs of this being on is if you know what you should do, or you know what you want to do but you're not doing it, that's the no do gap. And if that is happening to you, whether it is in your life or your relationship with food, your relationship with your kids, your relationship with your job yourself, whatever the case may be, wherever you see these no-do gaps, you know that you have a habanula that's on and you know that the cure or the most protective thing you can do is to use an iterative mindset, which is let me see, let me practice something, let me practice a new behavior, see if I can get that to go, let me iterate and tweak on it so that it keeps going, and let me not blame myself for any of it, because those are failure signals that will undermine my ability to keep going.

Speaker 1:

So would you say, it's almost like experimenting with behavior. Let's see if this sticks, let's see if this has a good outcome and let's see if I can run with this.

Speaker 2:

Yeah and that attitude. We're all indoctrinated with something called performance mindset, which in the literature is called performance-based goal orientation or PGO, and my team has done large scale studies on. These are observational studies on thousands of people looking at learning mindset, performance mindset and then iterative mindset, and it turns out that, over and above performance and learning mindset, iterative mindset predicts productivity, job satisfaction, retention in the workplace, career, all of those things, including over-optimism. Even so, it's not just about having a sunny disposition or optimism about something, somehow being iterative, being that kind of figuring it out. Energy, that puzzling and that solving energy tends to be the way through the valleys and the difficult times and is the most strengthening factor that somebody could adopt.

Speaker 1:

That's fascinating. That's fascinating because it feels like you're speaking to humanity in general but focusing on physicians, we're problem solvers. We're problem solvers the amount of thinking that we have to do on our feet and pull out solutions not out of thin air, but I'm in primary care in a rural area. So would I give an answer to? One person is gonna be different from the other, obviously, but we have that ability. At what point do we actually lose it? Because it's almost like performance, the productivity, the RVUs, et cetera, et cetera.

Speaker 2:

Yeah, how do?

Speaker 1:

we change from one to the other.

Speaker 2:

Yeah, exactly, and I think that we can't. We're not going to get rid of goal, performance goals, even though my mission, hopefully before I'm done with this life, will be to recast that as iterative goals. But you make a really good point, which is that, like in one domain as a physician, helping other people to iterate, you're constantly blocking and tackling on all the little like nuances and weird like. We tried this before. Now let's try this one. You change drugs, you change doses, you change situations, you get them into occupational therapy, whatever the case may be. You're constantly thinking like that.

Speaker 2:

But what happens in my research is that while somebody might be super iterative at work, it doesn't occur to them to do that for their eating and exercise habits. Or they might be super iterative with their parenting, but they are flat footed at work. They're just performer. And if you perform, if you go into a performance state, you are controllable by another human being because you're basically there's no crossover in the neural networks in the brain that control intrinsic versus extrinsic motivation, and extrinsic motivation is performative and intrinsic motivation is iterative because it's for me, it's me being a clever human being in my genius, whereas performing for somebody else to be safe or to not get fired or to be better. You'll compete with other people because I'm getting safer or I'm making more money, or whatever the case may be. That's the trapping is that if somebody can get you to dance for them in a performative way, then you are disempowered.

Speaker 1:

That was so brilliantly put. I never thought of that. That just makes a lot of sense.

Speaker 2:

Wow, I didn't answer your question, though, which is like how do we deal with this performative world?

Speaker 2:

I think there's a way in which we can see performative tools as iterations themselves. So let's say, I had a friend who trained for a marathon and her BMI was probably 30. And she was using this as a lightning rod for her to get do something for her health. And so she's. I knew but I didn't know at the time how to break it to her that she'll go through a life cycle of excitement, super deep, intense practice, and then she'll start subconsciously breaking up with the running after the marathon is over. Sure enough, after the marathon was over, she didn't have the motivation to keep running because there wasn't that next milestone or that next marker to work towards. So, in fact, the marathon training was a iteration, a long one. It was a year long one. It lasted for a year. It got her to be in shape, it got her to be out there, and this was a person who's running in the middle of Minnesota in the winter. Like it was insane what this person was doing. Yeah, and so she was doing that.

Speaker 2:

But then the fact that she didn't know about iteration and then finish the race and then sunk into a depression and it's self-blame because, oh, I don't have motivation to run anymore. I don't like. We subconsciously blame ourselves because we don't know, the habenula doesn't cause a sharp pain to the back of the neck or anything, so it's silent, it just it goes on. We suddenly don't have motivation to do what we thought we would do. We have a no-do gap. And then we blame ourselves for being lazy, unmotivated. Fill in the blank what's your favorite negative self-talk thing that you use to flog yourself? And so she was doing that. So had she planned it differently or had a different mindset and said, okay, this performance, this marathon, is a iteration, and then, after it's done, I'm going to need another iteration.

Speaker 2:

So people who think iteratively, they don't wallow in these relapses. There is no relapse. They're just like what's my next thing? What's the next thing that's going to engage me? Was it this? And they sample and they figure it out. And then they, when they get some momentum, they ride that momentum until it ends, and it could be a season or a lifetime that something works for somebody. But the way that they see it is the most operant thing, that they don't see it as a win-lose. I used to be able to be a marathon runner. All those things that kind of are failure types, that they're failure. Diseases that kind of overtake us, and if you can avoid that pitfall and just keep iterating, realizing there's another iteration beyond the marathon, then you become unstoppable, and that seems to be the key.

Speaker 1:

So it's that trying to change the next thing, trying to keep moving forward, and okay, this didn't work out, I didn't like running, but I'm going to try something else. Let's say walking or Zumba, or cycling.

Speaker 2:

Exactly and people who think like that. So what you'll see with your patients is that you'll see that there's about 10 to 20% of any population that tends to iterate. There's one to 5% who are lifelong performers, like it's not that performative tools don't work. They work for one to 5% of the people, but that's not a lot. And if you can support somebody who doesn't know how to iterate, we've shown that it's teachable.

Speaker 2:

Mindsets are our lead indicators for habit formation. In iterative mindset way and we've done studies on does iterative mindset produce health habits, work habits and health outcomes? And in fact, it does in sustainable outcomes. Performance-based mindsets actually have no correlation with habit formation and they have no correlation with weight loss and long-term outcomes. So we're using the wrong medicine for the disease. We're mistreating what's going on by using performance and it's more likely. You can imagine that if I set a hard goal that I'm going to lose 10 pounds by this date, and if I, if I that doesn't happen if it's like 9.5 pounds or if it's whatever it is I'm going to have a failure event. My habanula is going to go on and then I'm going to lose my motivation to keep trying. So that's the problem we need to solve is this trip wire of failure that leads to motivation loss in our patients and in ourselves, so that we become naturally resilient, not because you're in some class or some workshop.

Speaker 1:

Right, you really, I think, used a key phrase is that it is teachable. So, that way, anybody can learn it, implement it and then teach it.

Speaker 2:

And not only is it teachable, but it's accessible, because the people that taught me that this is a thing were at the lower, ses sectors of our society. They were the ones who didn't have the education. They didn't have the fancy, fancy minds and fancy families, and these were salty earth, everyday people who were genius. This was their genius.

Speaker 1:

I appreciate that. I really appreciate that, and I appreciate the practicality and the, and I'm interested to see what will come of the Hibini. I really do think that functional MRIs will have a big play in the future of how we understand the true function of the brain, and so I'm interested to see what neuroscience will show us and what potential it has for not just human behavior and human awesomeness, but also disease treatment. So if the, if the listener wanted to reach out to you to look to sorry, so I have an editor this will please remove this part out because of I don't know, but it's not a failure.

Speaker 2:

That's all I know. There's no failure. No, this is this is what's happening now.

Speaker 1:

Right, this is my reality I love this because, yeah, I just, I love my kids.

Speaker 2:

They're great and yeah I think every parent thinks that, but I'm glad you're focusing on the importance of being really in this time with them, because it is so fleeting, it is so ephemeral.

Speaker 1:

Yeah, yeah, I mean, we have a six, a four and a two-year-old, and it's just wow.

Speaker 2:

Are you going to have another one? Are we going? To have eight, six, four, two. Okay, no, we're done, we're done.

Speaker 1:

Three was three's. Good, we're outnumbered, but they have each other, you're outnumbered. It too, there's like a quotient, there's like a multiplier well, luckily I have a very hands-on husband and my dad lives with us. That's and then. And then there's the cats and the dog, and it's a whole zoo.

Speaker 2:

We have that too. We have a whole fun little cadre of cats and dogs and horses and birds and a snake and we're oh wow, yeah yeah, we're all over the place.

Speaker 1:

Yeah, that's okay it's just, I don't know. It's just life, and I love how insane it can get and we try to optimize and look, just enjoy it. Just enjoy it Because if you always wait for that one sunny, perfect day, you spend most of your time waiting for five minutes of fun and to me that's just not what. That's not living, no, that's not living Like. When my mom died. She died back in, thank you. She had a stroke quite some time ago and just had a decline over several years. But I'm sad that she died.

Speaker 1:

But at the family viewing one of her siblings, was very distraught because it was his birthday and his favorite sister wasn't there. I said you know what, theo, I love you. She was too young, but it was her time, and you know what? We're not not gonna cry today. We're gonna go celebrate your birthday because you're in this chair and you're alive and you're not in a casket. So we're gonna we leave here, we're gonna leave our sorrows here and then we're gonna go celebrate your life and you being alive and beating cancer and being cancer free for two years. That's what we're gonna go do, do and, yeah, we'll laugh, we'll cry, we'll have memories, but we're still going to go celebrate your birthday, because that's what my mom would have wanted.

Speaker 2:

That's lovely, and you stepped into being the matriarch at that point.

Speaker 1:

That's just my personality, I guess. So my mom has a younger sister. She's in her 60s and I can see that. I don't think really anybody in that room was able to say that maybe. But we still have to celebrate the fact that we have each other, whoever we have left, and in that moment that's what we had doesn't mean I didn't miss my mom, but we carry that person on in memory, right absolutely just in another form exactly, exactly.

Speaker 1:

I truly believe in an afterlife and I truly believe that we just change from one energy to another. We connect with our ancestors through prayer, through meditation and other forms. So they're not gone, They've just changed. Now, if somebody wanted to connect with you to read your book books, if you have two how do they get a hold of you? Where is the best way to? To read more about the amazing things that you're?

Speaker 2:

doing. Yes, my personal website is drkyrabobinettecom and so you can access there. The books are available. On amazon and burns and noble and everywhere where you find books, and my company is freshtrycom.

Speaker 2:

There's a free habit formation app. That is the only software that helps somebody to iterate on their health habits. It is free, believe it or not, and we don't sell your data and we don't advertise to you, and it's a nice little and I'm going to keep it that way. I'm going to keep it pure as long as I possibly can, because we make our money by offering this to employers for their employees, and so we can. That allows us to offer a free version for the public, and and so I, just as a public health physician, I really want people to have resources and tools that are more natural for them than all of the performative stuff, because everything else out there.

Speaker 2:

You're going to get meal plans and trackers and all these things, and it's okay to use those as an iteration. It's good to know for a week what you have been eating in a week. If you have no connection with that's good to know that, but lifelong measuring of your food is, again performative and only going to work for 1% to 5% of people sustainably. So I really want to drive home the point that, like hey, the world is iterative, the way is iterative, and hopefully that with the books and also with the app, that people really have the resources to be able to do it in a way that works for their brain.

Speaker 1:

I really appreciate that, and the links will be in the show notes, so, listeners, go check it out. I actually have your book on my to read list and it's just it's been a crazy summer. I love the neuroscience behind it. I'm really interested to see what I can pull out of it and I really do want to go down and download your tool to see and see how good I am at iteration and see if I can teach it to my patient.

Speaker 1:

I mean, seriously, this is awesome. So this is real information based on real neuroscience. I mean, seriously, this is awesome. So this is real information based on real neuroscience. Go check it out. So thank you for your time. What is one last pearl of wisdom you'd like to leave our listeners?

Speaker 2:

Failure is an illusion. You haven't failed. You cannot fail at your life, you cannot fail at your job. All of it is just messages and guidance and mystery, and for you it's a puzzle to figure out. And so, if you are blaming yourself, if you are feeling like a failure, if you are feeling disempowered, this is the way out.

Speaker 1:

That's awesome and thank you for that. If you've found this episode helpful, share with a friend, because we can all use camaraderie.