Summary: To persevere when you just want to quit therapy, a new study on the neurobiology of cognitive fatigue shows the key may be finding sufficient motivation.
Key Points:
- The work of therapy for mental health can be difficult, tiring, and induce cognitive fatigue in your brain
- Increasing levels of cognitive fatigue can prevent you from completing difficult tasks, such as continuing therapy
- When incentives increase, evidence shows the likelihood of completing tasks – such as continuing therapy – that induce cognitive fatigue also increases
- Various cognitive-based therapies can help you identify what motivates you
Effort, Fatigue, and Motivation: How to Keep Going When You Want to Quit
In research on physical activity, exercise scientists have learned that to overcome physical fatigue, incentive matters. Simply put, the greater the fatigue, the greater the incentive needed to continue.
Most of us can relate to this and have experienced this type of situation countless times in our lives. For instance, let’s say you’re doing a job that involves physical labor. It’s hard work, and you may want to stop, but when someone says, “Five more minutes and we can take a water break.”
That’s enough to keep you going. The promise of reward overcomes the signals you get from your body to stop.
An hour later, however, the prospect of a water break may not be enough to overcome the accumulated fatigue. But then someone may say, “Finish this [insert task] and I’ll give you a $50 bonus.”
That may well be enough to keep you going. But the reward doesn’t have to be money. If you’re an athlete, winning may be sufficient motivation. If you’re doing physical work, the sense of accomplishment you feel upon completing the task may be sufficient to overcome the physical fatigue you feel.
But do the same rules apply to cognitive fatigue?
If you engage in a series of tasks that increase cognitive fatigue – which can happen during recovery – can finding sufficient motivation help you overcome that cognitive fatigue, the same way increasing a reward can help you overcome physical fatigue?
New research has an answer to that question.
About the Study: Cognitive Fatigue, Effort, and Choice
A group of researchers at Johns Hopkins University and School of Medicine published a paper called “The Neurobiology of Cognitive Fatigue and Its Influence on Effort-Based Choice” – here’s the full text .pdf – that explores that question.
With full knowledge of the relationship between physical fatigue and motivation at hand – what we describe above – the research team formulated this hypothesis:
“We hypothesize that fatigue, resulting from repeated cognitive exertion, will reduce individuals’ willingness to exert.”
To test this hypothesis, the team recruited 28 young adults, age 21-29, to participate in an experiment on the impact of cognitive fatigue on the decision to either stop or continue a given task. Here’s how it worked:
- Participants agreed to engage in the study for $50 each, with the chance to make more money during the process.
- The study itself involved completing a series of progressively more difficult cognitive tasks.
- Participants were offered 40 unique choices, with a reward attached to each.
- Before each new task, participants indicated the choice to continue or stop by pressing one of two buttons on a handheld box.
- Rewards were $1 to $8, in $1 increments.
- Pairs of effort/reward options were presented in linear sequence, in ascending level of difficulty
- Participants had two contexts in which to decide:
- Once with effort presented first
- Once with reward presented first.
- Offering tasks in this sequence presented options for two different valuation of effort pathways that were detectable by fMRI
Baseline levels of brain activity were established by fMRI – functional magnetic resonance imaging – a technique that allows clinicians to observe brain activity in real time. During the task sequence, participants remained connected to the fMRI, which allowed clinicians to compare brain activity associated with the subjective decision to continue with the next task, or stop.
That’s how it worked.
Let’s take a look at the results.
How Can You Overcome Cognitive Fatigue?
As the tasks got progressively more difficult, the researchers observed changes in two brain areas:
- The right insula, associated with cognitive fatigue:
- Activity more than doubled as task became more difficult
- The dorsal lateral prefrontal cortex, present on both sides of the brain, directly involved in working memory:
- Activity more than doubled as tasks became more difficult
At this point in the process, the researchers observed:
“We found that when participants became cognitively fatigued, they were more likely to choose to forgo higher levels of reward for more effort.”
But that was only the first part of the experiment.
What happened next is what interests us most, and is most relevant if you get tired, frustrated, and want to quit therapy.
When participants reached a point of observable cognitive fatigue, they needed more incentive to keep going. The need for increased incentives to complete tasks escalated along with increases in cognitive fatigue, with progressively greater incentives required to overcome progressively greater accumulation of fatigue.
Researchers theorized:
- The right insula and the dorsal lateral prefrontal cortex work together to send signals to avoid more effort and reduce fatigue
- Perceptions of fatigue resulting from increased activity in the right insula and dorsal lateral prefrontal cortex may underestimate the true effort capacity of the human brain
- Increasing incentive allowed participants to override stop working signals from the right insula and dorsal lateral prefrontal cortex.
Therefore, they concluded, one way to overcome the very real phenomenon of cognitive fatigue is by allowing the brain to identify an incentive that’s greater than desire to stop completing tasks. In other words, the greater the reward, the more likely an individual will be to work through cognitive fatigue and complete a given task.
We’ll elaborate on these results – and what they mean if you’re in therapy – in the section below.
To Persevere When You Want to Quit Therapy, Reconnect With Your Why
When you get tired, your mind can make poor decisions. It can tell you to stop doing something when, in fact, you have the capacity to continue. Here’s how the research team describes this phenomenon in terms of their results:
“These findings are consistent with the idea that miscalibrated recruitment of neural activity in cognitive regions is related to increased feelings of fatigue.”
However, when you decide that the reward at the end of the task is sufficient, you can overcome the cognitive fatigue that appears in the form of messages from your right insula and dorsal lateral prefrontal cortex and complete the task.
Therefore, if you’re in therapy for any mental health disorder, from depression (MDD) to anxiety to posttraumatic stress disorder (PTSD) to schizophrenia, and you experience cognitive fatigue and your brain encourages you to stop, one way to keep going is to find the motivation that can override your cognitive fatigue.
And how do you do that?
By rediscovering, redefining, or reconnecting to the reason you’re in therapy in the first place, i.e. finding your why. The good thing about this is that you’re not on your own when you do this. Yes, the decision is personal. Yes, your why is unique to you. But – and this is significant – there are at least three types of therapy that help you find a meaningful why:
- Cognitive behavioral therapy (CBT). CBT can help you identify your big-picture goals for therapy, and help you identify and correct/resolve patterns of thought – including those that may appear when you’re fatigued – that make you want to give up.
- Motivational interviewing (MI). This approach can help increase your desire to change, your commitment to the recovery process, and your ability to complete treatment.
- Behavioral activation (BA). This approach can help you identify and pursue rewarding activities in your life, as well as develop personal techniques to overcome obstacles to important goals, and reduce the impact of habits like procrastination or avoidance.
When you engage in any of these three approaches to treatment, you’ll have a therapist with you to guide you through the decision-making /motivation-building process. You won’t be alone, but the gains you make by sticking with treatment will be yours.
