Decision Fatigue

During my treatment for FBC (f-bomb breast cancer for new readers), I had mental fatigue as much as I had physical fatigue. There were days when even the teeniest decision sent me into a full meltdown. White shirt? Blue shirt? Arghhhhh!!!!

Based on comments from patients with whom I have worked as well as The Silver Pen readers, I can’t begin to tell you how pervasive “decision fatigue” is among people who are coping with a world-rocking illness.

Social psychologists describe “decision fatigue” as difficulty in making good decisions late in the day, or when people have had to make a series of choices in a compressed period of time…as is the case after a FBC diagnosis.

What the researchers have also found is that decision fatigue is a physiological reality. In other words, it’s not our imagination. Decision fatigue means that brain energy for choices is depleted and any important decision we make runs the risk of being flawed. This information is a major Silver Lining for me because I often thought that I was losing my mind when I couldn’t make the smallest decision.

Decision fatigue is not limited to illness, however. When you think about it, most people routinely make gobs of decisions every day. Each and every decision takes a dollop of brain-power. Add in a stressful doctor’s appointment, for example, and the ability to think clearly and weigh options wisely declines.

In a New York Times article, John Tierney explores the causes and impact of decision fatigue. The article reviews recent data that confirm the fact that the complexity of making choices or decisions can be very fatiguing. In fact, he suggests that the very act of making a decision exacts a “biological cost”. When I read this, I began nodding my head (and didn’t stop until the end of the article).

[…] No matter how rational and high-minded you try to be, you can’t make decision after decision without paying a biological price. It’s different from ordinary physical fatigue — you’re not consciously aware of being tired — but you’re low on mental energy. The more choices you make throughout the day, the harder each one becomes for your brain, and eventually it looks for shortcuts, usually in either of two very different ways. One shortcut is to become reckless: to act impulsively instead of expending the energy to first think through the consequences. (Sure, tweet that photo! What could go wrong?) The other shortcut is the ultimate energy saver: do nothing. Instead of agonizing over decisions, avoid any choice.

So as we make decisions throughout the day, our brains become fatigued, and either we act impulsively and choose unwisely or even take unnecessary risks, or avoid making any decision at all. Consequently, this has a direct effect on our ability to continue to make good decisions.

What’s also interesting is that researchers discovered by accident that when our brains have been making lots of choices, we also run low on glucose. The Silver Lining is that recent research indicates that a shot of glucose helps the brain overcome decision fatigue and restore some ability to think clearly (no, this doesn’t mean a candy bar – sorry!).

The implications for people diagnosed with FBC and other potentially life-threatening illness are clear. Serious illness involves myriad choices to be made, often in quick succession. The decision fatigue research shows that it is not necessarily the magnitude of decisions, but the quantity of them. As if it’s not already difficult enough, further adding to decision fatigue, patients and families have to figure out how to navigate the complex health care system from where to park to how to deal with insurance issues.

Here are a couple of Silver Lined things to do to help keep decision fatigue at bay:

  1. Pay attention to what time of day you are scheduling important appointments. If you can, see your health care providers in the morning – and they will make better decisions too!
  2. If you have to do things late in the day, make sure you have something nourishing to eat. Nuts and dried fruit, a cracker with some peanut butter – you know the drill. Just be sure to give your brain some fuel.

Have you ever had decision fatigue? If so, how have you coped with it?

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  1. eileen says

    Super article. As caregiver to my Dad with his C, I can relate both for him as well as myself. Even though he is now flying with the angels somewhere, the 2.5 yr journey left the brain depleted. So nice to see this validation a few years later. Thanks a ton for yet, another great SL post. Your truly an inspiration! ~ Eileen

    • says

      Thanks so much for your kind note, Eileen. I'm so sad to hear about your dad. What a gift you gave him at the end of his life. I really appreciate your kind words!

  2. Kim C says

    I experienced fatigue with big decisions around the cancer diagnosis and then afterwards with the smallest decisions too. I learned a technique for decision making at a course for cancer care. For the bigger decisions I learned to inquire about it and clearly think about the pros and cons. Write it all down. Then clear my head with a long walk, eat well and generally practise self care, such as deep breathing, laughter and going easy on myself. Within a day or two or longer, I would come back to the decision and it was usually clearer. If not, I would do a little more inquiry, repeat the process and gave myself lots of time. Now I find the practise of meditation or walking meditation is much more efficient. Learning to listen to and trust our own inner wisdom. Of course, on the days where I can't make the tiniest decisions – I just try to go easy on myself and maybe laugh about it. Find someone to help you laugh – I've learned that this helps to lighten it no matter how heavy a decision may seem.

    • says

      Dear Kim,
      As always, beautifully said. I couldn't agree more about writing everything down (I can't count how many Moleskin journals I've gone through in the last year!). And laughing. It's so incredibly important and makes the stress of everything so much lighter. Thanks for sharing! Take good care. Hollye