mental wellness

lot of question marks on white papers -decision fatigue

How to Combat Decision Fatigue and Improve Patient Care

The human brain is capable of making thousands of decisions in a day, but each choice we make comes at a cost. As we move through our day, we are constantly presented with decisions to make, both large and small. From what to eat for breakfast to whether to take on a new responsibility at work, the sheer number of choices we make can be overwhelming. This mental exhaustion caused by decision-making is known as decision fatigue.

Decision fatigue is a phenomenon where the quality of decision-making deteriorates as a result of mental exhaustion. It is a real and recognized phenomenon that can have a significant impact on our daily lives. When we experience decision fatigue, our ability to make decisions becomes impaired, leading to poorer choices or even decision paralysis. This is why, by the end of the day, we tend to make poor choices in our nutrition. We ate healthy food all day and suddenly we find ourselves picking up fast food on the way home.

woman eating cookie and saying shhhh

So Many Choices

One of the reasons decision fatigue is so prevalent today is the abundance of choices available to us. In the past, choices were limited, and decisions were simpler. Today, we are presented with an endless array of choices in everything from what to eat, wear, watch, and do. With so many options, it’s no wonder our brains can feel overwhelmed and exhausted. Even just scrolling through social media creates hundreds of decisions – where to focus your attention, what to “like” or “love,” what makes you mad, what you should click on, etc. 

Decision fatigue can also be exacerbated by stress and anxiety. When we are under stress, we tend to become more indecisive and have a harder time making choices. This can lead to a cycle of decision fatigue. The more decisions we have to make, the more stressed we become, and the more difficult it becomes to make good choices.

Unraveling the Impact of Decision Fatigue

Decision fatigue can have a significant impact on nurses, who are required to make a large number of decisions every day. Here are three examples of how decision fatigue might affect nurses:

Medication errors
  1. Medication administration involves a complex set of decisions. Nurses need to choose the right medication, the right dose, and the right time to administer it. They need to be aware of possible contraindications. When nurses experience decision fatigue, they may become more prone to errors,
Patient assessment
  1. Assessing patients is an important part of a nurse’s job, It helps to identify any changes in a patient’s condition that may require intervention. However, assessing patients involves a large number of decisions, Nurses make decisions such as which assessments to perform, what the results mean, and what interventions may be required. When nurses experience decision fatigue, they may become less thorough in their assessments. Or they may miss important details that could affect a patient’s care. They can be led astray by distracting findings.
Prioritization of tasks
  1. Nurses are responsible for managing a wide range of tasks, from administering medication to coordinating with other healthcare providers. When nurses experience decision fatigue, they may struggle to prioritize tasks effectively, leading to delays in care or missed opportunities for intervention. For example, a nurse may become overwhelmed by the number of tasks they need to complete and miss a medication administration or forget to follow up on an important lab result.

The good news is that there are tactics we can use to prevent decision fatigue and make better choices.

nurse giving medication to pediatric patient

Strategies to Boost Mental Stamina and Improve Patient Outcomes

Limit the number of decisions you make
  1. One of the simplest ways to avoid decision fatigue is to limit the number of decisions you make each day. For example, you could plan your meals for the week ahead of time so you don’t have to decide what to eat every day. You could also limit the number of choices you make when shopping by sticking to a list and avoiding distractions. Have you ever considered that meal planning could make you better at your nursing job? Crazy to think about!
Make important decisions earlier in the day
  1. Our ability to make good decisions declines as the day goes on, so it’s a good idea to tackle important decisions early in the day when our minds are fresh. This way, you’ll be more likely to make a good decision and avoid decision fatigue later in the day.
Use routines to simplify your day
  1. Routines can help simplify your day and reduce the number of decisions you have to make. For example, you could create a morning routine that includes exercising, showering, and eating breakfast in the same order every day. This way, you don’t have to decide what to do first each morning, and you’ll save your decision-making energy for more important choices later in the day.
Prioritize your decisions
  1. It’s important to prioritize your decisions and focus on the most important ones first. This way, you can avoid decision fatigue by only making the most important choices and delegating or postponing less critical decisions.
Take breaks
  1. If you’re feeling overwhelmed by the number of decisions you have to make, take a break. Taking a break can help you recharge your mental batteries and come back to your decisions with a fresh perspective. Sometimes taking a break can be as simple as sitting down, closing your eyes, and taking a few deep breaths.
Outsource decisions
  1. Finally, consider outsourcing some decisions to others. For example, you could hire an assistant to help with meal prepping or a personal shopper to help you with wardrobe choices (I use StitchFix for this). By delegating some decisions, you can free up mental energy and reduce decision fatigue.

In Conclusion

In conclusion, decision fatigue is a real and recognized phenomenon that can have a significant impact on our daily lives. With the abundance of choices available to us, it’s no wonder our brains can feel overwhelmed and exhausted. However, by implementing tactics such as limiting the number of decisions we make, tackling important decisions earlier in the day, using routines, prioritizing decisions, taking breaks, and outsourcing decisions, we can bring some peace to our lives and decrease the chances of making a mistake.

You can read more about What Doctors Wish Their Patients Knew About Decision Fatigue

tiny habits habit tracker

Tiny Habits Book Summary

Tiny Habits: The Small Changes That Change Everything by BJ Fogg is abook that challenges readers to embrace small changes in their lives to achieve significant results. In this book, Fogg, a renowned behavior scientist, presents his theory on how tiny habits can create long-lasting change. He intersperses the concepts with stories of people who have put the concepts into practice in their lives.

3 Sections

The book is structured into three main parts. The first section introduces the concept of tiny habits and how they can help individuals create lasting change. Fogg explains that the key to creating lasting change is to start small (tiny, really…even smaller than you think) and work on habits that are easy to implement. The second section explores the intricacies of habit formation and how to effectively create tiny habits that stick. The third and final section provides practical advice on how to integrate tiny habits into one’s daily routine.

The essence of Tiny Habits is this: Take a behavior you want, make it tiny, find where it fits naturally in your life, and nurture its growth. If you want to create long-term growth, it’s best to start small.

B..J. Fogg


One of the standout features of this book is the practical nature of the advice. Fogg provides clear and actionable steps for readers to take to implement tiny habits in their lives. He encourages readers to start with small, easy-to-do habits and build from there. He also advises readers to anchor new habits to existing routines, making it easier to remember and incorporate them into daily life.

Keeping changes small and expectations low is how you design around fair-weather friends like motivation and willpower. When something is tiny, it’s easy to do – which means you don’t need to rely on the unreliable nature of motivation.

B..J. Fogg


Another aspect of the book that I found particularly compelling was Fogg’s emphasis on celebrating small wins. He encourages readers to celebrate their successes, no matter how small they may be. This is a way of reinforcing new habits and increasing motivation to continue on the path to change. Celebrating the positive things in our lives, even the tinyest of positive things, let’s your brain know that it’s important to you. The brain learns that celebrating feels good and therefore, it becomes your ally in doing your tiny habit and helping it grow.

Overall, I found Tiny Habits to be a highly engaging and informative book. Fogg’s approach to habit formation is refreshing, and his practical advice is easy to follow and implement. The book is well-researched and draws upon a wealth of scientific evidence to support its claims. I would recommend this book to anyone looking to create lasting change in their lives, no matter how small the change may seem.

Nurse smiling at man in wheelchair with gratitude

A Simple Gratitude Practice Can Reduce Stress

Nurses are the backbone of the healthcare industry. There are more than three times more nurses in the US than physicians. Nurses work tirelessly to provide care and support to patients, often at the expense of their own well-being. It’s no secret that the nursing profession can be stressful and emotionally challenging, especially in today’s healthcare climate, but one way nurses can mitigate the stress and burnout is by practicing gratitude. It sounds crazy, but research has shown that simply spending a few minutes each day in gratitude can make a powerful difference.

Gratitude is the act of appreciating and being thankful for the good things in life. It’s a simple concept, but it has profound effects on our mental and physical health. Numerous studies have shown that practicing gratitude can lead to increased happiness, better sleep, improved relationships, and reduced stress levels.

“In positive psychology research, gratitude is strongly and consistently associated with greater happiness. Gratitude helps people feel more positive emotions, relish good experiences, improve their health, deal with adversity, and build strong relationships.” (Giving Thanks Can Make You Happier)

Here’s how nurses can benefit from a gratitude practice:

Reducing stress and burnout

Nursing is rewarding, but it can also be an incredibly stressful and emotionally taxing job. Long hours, demanding patients, and the pressure to provide high-quality care can take a toll on nurses’ mental health. Practicing gratitude can help nurses cope with stress and prevent burnout. When nurses focus on the positive aspects of their job, such as the gratitude and appreciation they receive from patients, coworkers and their families, it can help them stay motivated and resilient during difficult times. On my worst days I can still find something to be grateful for. Sometimes you can only find micro moments of awesome to be thankful for.

Improving job satisfaction

When nurses focus on the positive aspects of their job and their life, they are more likely to feel satisfied and fulfilled in their work. Gratitude helps nurses appreciate the impact they are making in their patients’ lives, even during challenging times. This can lead to a sense of purpose and meaning in their work, which can translate into higher job satisfaction.

Enhancing patient relationships

Nurses who practice gratitude are more likely to build strong, positive relationships with their patients. When nurses express gratitude towards their patients, it can help patients feel more valued and appreciated, which can improve their overall experience. This can lead to better patient outcomes and higher patient satisfaction rates. Both parties benefit.

Boosting mental and physical health

Practicing gratitude has been linked to numerous health benefits, including improved mental health and better sleep quality. Nurses who practice gratitude may experience reduced symptoms of depression and anxiety, which can improve their overall well-being. Additionally, gratitude has been shown to boost the immune system and reduce inflammation, which can lead to improved physical health. A gratitude practice can be as simple as writing down 1 to 3 things you are thankful for at the end of the day. Give it a try. I can testify that it works. Even when I was going through my cancer treatment I could always find things to be grateful for.

“In recent years a very large body of evidence has emerged suggesting that gratitude is strongly related to all aspects of well-being…” (Gratitude and Well-being: a review and theoretical integration)

In conclusion, practicing gratitude can have numerous benefits for you as a nurse. By focusing on the positive aspects of your job and expressing gratitude towards patients and colleagues, you can reduce stress, improve job satisfaction, enhance patient relationships, and boost your mental and physical health. As a result, you can continue to provide high-quality care and support to patients while maintaining your own well-being.

photo of woman resting on the couch

Nurse, nurture thyself

As a nurse, you dedicate your life to providing quality care and comfort to others. But in order to be successful in your profession, you must also take the time to nurture yourself. Flourishing as a nurse requires that you find balance in your life and develop the skills to manage the stress and demands of your job. While there are times to pitch in and work extra hard, I see so many nurses working long hours, picking up extra shifts or doing overtime, and not getting good sleep. You can only go so long without making your own health a priority before your health begins to suffer. There are way too many nurses that are stressed, exhausted, and suffering from chronic illnesses. We often don’t take the advice that we dish out to our patients.

Here are some tips to help you flourish as a nurse.

1. Take Time for Self-Care: Self-care is essential for nurses to stay healthy and perform at their best. Make sure to take time for yourself each day to do something that brings you joy. This could be anything from reading a book, exercising, or meditating. Taking time for yourself will help you to recharge and reduce stress. Honestly, I think all 3 of those things are essential parts of a well-rounded day. Having a gratitude practice has been shown to improve happiness.

2. Develop Healthy Habits: Good habits such as eating nutritious meals, getting sufficient sleep, and exercising regularly can help you to stay healthy and energized. These habits can also help you to stay focused and alert during long shifts. Foundational habits for optimal health include fueling your body, moving regulary (formal exercise and other daily movements), and 7-8 hours of sleep.

3. Connect with Colleagues: Working in a team environment can be demanding, but it is important to foster positive relationships with your colleagues. Make time to connect with others, share experiences, and support each other. It’s been proven that the healthiest teams support each other with positive feedback. We love it when our bosses give us positive feedback, but we can do the same for each other on a regular basis.

4. Set Boundaries: Setting boundaries is important in order to maintain a healthy life. Set limits on how much time you spend at work and make sure to take breaks during your shift. This will help you to stay focused and keep your stress levels in check. Work hard when it’s time to work, but take your rest seriously as well.

5. Practice Mindfulness: Mindfulness is a powerful tool to help you stay in the moment and reduce stress. Take a few minutes each day to practice breathing exercises and focus on your thoughts and feelings. Doing a thought download each day can be helpful to gain clarity and reduce stress. Even just 1 minute of stopping and taking some deep breaths are helpful for resetting my stressed out mind.

As a nurse, it is important to take care of yourself in order to be successful in your job. Taking time for self-care, developing healthy habits, connecting with colleagues, setting boundaries, and practicing mindfulness are all ways to help you flourish as a nurse. By following these tips, you can stay healthy and energized, and better manage the demands of your job.

desperate and stressed attractive middle aged Asian woman holding notepad asking for help feeling overworked and exploited working at computer office desk suffering stress and fatigue

Gain Clarity With a Thought Download

I don’t know if this ever happens to you but there are times that my brain just seems to freeze up. I have so many thoughts swirling through my head that I get overwhelmed. We have 40,000 to 60,000 thoughts per day. Some just pass right on through without notice and others are more intrusive. Some thoughts are helpful. And others are negative and critical.

A thought download is a way to take the thoughts from your head and get them on paper. It can also be called a brain dump. It’s a helpful habit to do once or twice a day. Doing them in the morning can help you get clarity for the day ahead. Doing it at night can help empty out all the thoughts from the day and allows for a better night’s sleep. I am working on a practice where I also do it when I’m feeling overwhelmed.

Three times to do a thought download

  1. First thing in the morning – this is a great way to clean out your mind and gain clarity for you day. You can start with just writing whatever comes to mind – plans for the day, thoughts that you woke up with things you’re working on today, etc. If you get stuck you can start with a journal prompt to get your thoughts rolling. Just write, don’t edit. Let it be messy.
  2. At the end of the day – dump out all the thoughts that have been bombarding your brain all day. Put anything down that’s on your mind. Again, let it be messy. Any successes you had today, anything you learned, anything that’s bothering you.
  3. When feeling overwhelmed – a great way to unravel all the stuff running through your brain to sort out what’s important now and what you can just put down on paper and let go.

Then what?

Many times, simply doing this will be enough. It clears out your head and tells your brain that you’ve “dealt with” many of the thoughts it was trying to remind you of. Sometimes you may be surprised at the things you wrote down. Things that you didn’t even realize you were thinking. It’s like being able to be on the outside and view your own thinking. And you may decide that some of those thoughts are things you want to keep thinking. But some of them are maybe thoughts you want to question. They may be thoughts you want to do some mindset work on. You can do this by putting it through a process like the self-coaching model. You can learn more about doing that on my post The Ultimate Practice to Boost Your Mental Wellness.

suffering, man walking through dark forest

Chosen vs. Unchosen Suffering

What is chosen suffering?

My recent cancer journey coincided with reading a book called Chosen Suffering. It was a book that one of my church pastors quoted from and I was intrigued. It was been a timely read in the midst of what I was going through. The book is written as a leadership book by Tom Ryan who is a college wrestling coach. He talks about chosen suffering as in the suffering an athlete chooses in order to become elite. Unchosen suffering enters his life with the sudden, unexpected death of one of his young children.

What about unchosen suffering?

Reading the book helped me reframe what I was going through. The cancer diagnosis itself is unchosen suffering. I did not choose it or ask for it. But I have choices following that diagnosis. And that has given me a new mindset. My surgeon, oncologist, and radiologist recommend treatments based on their knowledge and I had the option of choosing to take those actions or pursuing other treatments. When I have side effects from treatments, I can dwell on the suffering that I’m currently feeling, or I can remember that I chose this option. I can spend my mental energy on getting through the challenges in the best way possible. Or I can be the best I can be with the circumstances that were outside my control. We can’t control other people or many of the things that happen to us, but we can control our responses to those things.

“Pain is the feeling. Suffering is the effect the pain inflicts. If one can endure pain, one can live without suffering. If one can withstand pain, one can withstand anything. If one can learn to control pain, one can learn to control oneself. ”
― James Frey, My Friend Leonard

― James Frey, My Friend Leonard

A silhouette of an archer, on the backdrop of a sky with exploding gun powder.

The second arrow

I have a choice in how I walk through unchosen suffering. Choosing to add more suffering on top of that is never going to be the best option. There is a Buddhist parable about this. Imagine walking through a forest and getting hit by an arrow. There is pain and probably fear as a result of getting struck by an arrow. The second arrow refers to your emotional reaction to getting hit by that first arrow.

When I finished my 12 weeks of chemotherapy I was looking forward to 30 days of recovery before having to start radiation. I was looking forward to rebuilding my stamina. I couldn’t wait for food to taste good again. Two weeks into this recovery period I got COVID. I was sick, exhausted, and lost my sense of taste and smell. Unchosen suffering. The first arrow.

And then I added on the second arrow. I got angry, disappointed, and frustrated. I wallowed in, “It’s not fair.” I whined and complained. Thankfully, I didn’t stay in that emotional funk for too long. But I didn’t have to add on all that extra uncessesary chosen suffering. I ultimately focused on the things that I was grateful for, despite my circumstances as in one of my favorite Bible verses:

Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things. What you have learned[e] and received and heard and seen in me—practice these things, and the God of peace will be with you.

Phillipians 4:8-9

Why we don't sleep. Image is frustrated woman with insomnia

Why We Don’t Sleep: Simple Ways to Improve Sleep

Sleep is one of the foundational habits for flourishing. It is also one of the things we tend to sacrifice. We often don’t realize the cost of a lack of sleep. More than 17,000 scientific reports show that getting a full night of rest regularly can improve your memory, lower your risk of disease, improve your creativity, decrease risk of depression and anxiety, and increase your sense of happiness. (Why We Sleep by Matthew Walker) If you consistently get less than six to seven hours of slumber, you double your risk of cancer. It is estimated that two thirds of Americans don’t get the recommended 8 hours of sleep. Are you one of them?

Tired = Drunk?

One skipped night of sleep has the same effect of being drunk. Not sleeping dramatically diminishes your performance in all areas and also diminishes your psychological well being. I used to work night shift and I know some days I was so tired driving home from work that I probably could have been pulled over for being drunk. My commute is about 35 minutes. I used to have to stop halfway home and take like a 15 minute nap in a parking lot before I could drive the rest of the way home safely. One morning I didn’t make it all the way to my resting point and had an accident. I know I was not the safest driver on the road those days.

Let’s look at why we don’t sleep:

1. We don’t value it. You might think, “oh, I’ll just stay up late and watch one more episode on Netflix,” and you sacrifice that extra hour (or more) of sleep.

2. We are inconsistent. Having a consistent bedtime and a consistent bedtime routine sets the stage for your brain to initiate the sleep process.

3. Too much light. In general, we go to bed we have light from multiple screens like our phones, iPads, or television. Getting all that blue light exposure reduces our melatonin which in turn delays the onset of sleep and also delays the onset of deep sleep. So even once you get to sleep, it takes you longer to get deep sleep. Blue light also stimulates cortisol, your stress hormone due to stimulation from TV shows internet scrolling, etc.

4. Substances. Caffeine, alcohol and tobacco can all impair sleep.

5. We eat too close to bedtime. Your body performs all sorts of vital functions as you sleep. If you are still digesting at bedtime, it can delay the body’s ability to do those functions.

6. We exercise too close to bedtime. Stimulation from exercise can keep you awake longer than you’d like.

7. No sleep sanctuary. Your bedroom should be cool and as dark as possible. Even small lights from electronic devices can impair your sleep. If you are a night shift worker sleeping in the daytime, have blackout curtains on your windows and soundproof your room as much as possible. A sound machine is a great investment to mask the sound of family members or neighbors while you rest.

Numb to the problem

The funny thing is, when we’re sleep deprived, especially if it’s chronic, the less your body is able to sense it. You feel like you’re okay. And until you start getting really good sleep, you don’t realize how not okay, you are. There’s a Greek philosopher, Seneca, that said “The worse a person is the less he feels it,” and that seems to be true when it comes to sleep deprivation.

So, what can we do for better sleep?

Here are some tips to improve your sleep based on the challenges above. See which habits you might want to include in your routine.

  • Stop caffeine 4 to 6 hours before bedtime. Some people might need to stop even earlier.
  • Exercise at least 3 hours before bedtime. Excercise gives you a 12 hour mood boost so the earlier you can do it, the more benefit you will get from that.
  • Stop eating 4 hours before bedtime. At a minimum, stop 2 hours before.
  • Shut down technology at least 1 hour before bedtime. The stimulation from tech will keep you awake longer.
  • Create a sleep sanctuary in your bedroom.

What will you work on?

Comment below and let me know what you plan to work on first.

If you’re working on new habits this post might interest you next: Morning Routines

If you are in healthcare and want to join the Nurses Getting Healthy Community, we’d love to see you in the group.

smiling woman

The Ultimate Practice to Boost Your Mental Wellness

Would you describe yourself as burned out or flourishing?

How do you describe your current level of mental wellness?

There are times in life when we are disillusioned with where we are in our jobs, our families, our lives. Times when we are ready for change. If that is you then keep reading. My mission is to help nurses go from frustration, burnout, and stagnation to flourishing. According to Dr. Lynn Soots, “Flourishing is the product of the pursuit and engagement of an authentic life that brings inner joy and happiness through meeting goals, being connected with life, passions, and relishing in accomplishments through the peaks and valleys of life.” The opposite of flourishing is stagnation, languishing, feeling stuck. It’s when the comfort zone just starts to feel like a rut.

One thing we are not taught while growing up is how to take care of our own mental wellness. Then, we go into healthcare and have to deal with some of the most difficult parts of the human condition. Dying patients, neglect, abuse, horrific trauma, and more. We work with people on the most difficult days of their lives. And we are on our own to figure out how to cope with it all. Me? I just shoved it all down. Stayed numb. But you can only do that for so long. It’s like holding a large beach ball under water. Eventually it pops up through the surface. 

On the opposite end of the spectrum, a flourishing nurse is content and satisfied. She feels like her life and her job have purpose. She is engaged in her life and is accepting of all parts of herself. She has a sense of personal growth and works on her mental wellbeing and spiritual health.It is a state of being. It’s a process that takes effort and attention.

It does not mean you are always happy or that you only feel positive emotions. But it means you can feel a full range of emotions and you don’t have to hide from them or stuff them down in order to function. 

Personally, I want to be a Flourishing Nurse. I want to understand that I can be happy despite my circumstances. I want to be a person who is ok with feeling discomfort – whether that means nervousness, sadness, grief, fear, or anxiety. I want to know just what to do when I feel these feelings. I want to have a self-care routine that takes care of my physical, emotional, and spiritual health on a daily basis. I want to know how to seek help when my own routines are not enough and I want to be unashamed to do so. I want to take responsibility for the things I can control – my own thoughts, feelings, and actions. I want to stop trying to bear the burden for the things I can’t control – these include other people’s thoughts, feelings and behaviors – they are not my responsibility. 

If you’ve read this far I want to give you some practical information that you can begin to implement today to get you closer to the person you want to be. A tool called the self-coaching model has been such a valuable practice in managing my own mental wellness, dealing with adversity, and consistently moving towards my goals and dreams. This is a long post packed with information. I also created a summary ebook with a self-coaching checklist for you to download if you’d like. CLICK HERE and I’ll send it over to your email inbox.

The Self-Coaching Model

butterfly flourishing

I use a concept called the self-coaching model in my own daily practice and in my coaching. The Model is a way of describing how we function in the world. When we are going through our days we don’t really realize that this process is happening. It is very automated.

This particular way of describing how we think, feel, and act was developed by Brooke Castillo of The Life Coach School, one of my mentors. You can learn more about Brooke and her work at The Life Coach School. If you study psychology you will see these principles worded many different ways. It’s not a new concept. For our purposes, we will use the term “the model.” We dig deep into how the model plays out in your specific circumstances in my Flourishing Nurses program. But for now I want to give you an idea of how it’s playing out in your life and how you can intervene to create better results.

When studying the Bible I read things like “renew your mind” or “transform your mind.” I’ve always desired to do this but I didn’t really know what steps I should take to accomplish this. I had the desire to do it but I couldn’t figure out “the how.” My brain just seems to keep offering up my usual negative way of thinking. The framework of the model helps me to understand this transformation in a way I can understand and gives me the clarity I need to take action.  Self-coaching is the term I use for the daily process of recognizing my current thinking, gaining understanding on how it’s affecting my results, and tweaking it to bring about the results I want in my life.

The Unintentional Model

The term “unintentional model”  is what is already happening in our brains without being conscious of it.  Author Jon Acuff describes these unintentional thoughts as the soundtracks of our lives. They are the  thoughts that just play in the background without conscious thought or effort. Many of these thoughts are negative. Thoughts like, “I’ll never lose weight,” or, “This relationship was a mistake,” or “I’m never going to figure this out.” Thinking thoughts like this over and over become beliefs for us. And your brain works really hard to prove those beliefs true. 

The Intentional Model to Take Action Towards Better Mental Wellness

Once we recognize this unintentional process and what it’s creating in our lives, we can create an “intentional model” and put it to work to create our desired goals. But first we have to acknowledge that our current way of thinking, feeling, and acting is what is getting us the results we have now in our jobs, our relationships, our health, etc. We have to stop blaming things or people outside our control. The blame game just keeps us stuck as victims of our circumstances. Let me explain more.

Where are you now?

Before we dig into the model itself I want to take you through an exercise. Think about a goal you want to achieve. It can be a big goal or even just one step of a larger goal. Grab a sheet of paper and write down your goal. It can be any goal. Some examples:

  • Clean out my closet
  • Lose 50 pounds
  • Obtain my Bachelor’s degree
  • Run a 5k in under 30 minutes
  • Become a Nurse Practitioner
  • Clean out my email inbox
  • Take a new job or switch departments

…any size goal will do for this exercise.

Now write down where you are now in relation to this goal. What is your current situation? Write as much detail as possible. How do you feel when you think about it?

For example if you had a weight loss goal you might write:

I weigh ___ pounds. I am out of breath when I go up stairs or play with my children. I am reluctant to play on the floor with my kids because I struggle to get up again. I have aches and pains that I never used to have. I avoid certain activities (get specific) that I used to enjoy because my weight causes a problem. Riding on amusement park rides are uncomfortable because of my size. I eat until I’m uncomfortable sometimes. I can’t stick to my diet. I am frequently disappointed in myself. I don’t tell my friends I’m on a diet because I’ve failed so many of them before. Etc., etc., etc.

Write as much as you can about where your starting line is.

Where do you want to be?

Then, brainstorm how it would look if you achieved your goal. What does that look like to you? What are the actions you take? What do you think? How do you feel? What kind of person have you become by achieving?

Continuing on with the weight loss example I might write this:

When I achieve my goal I will be able to fly on an airplane without a seat belt extender. My blood sugar levels will be in the normal range. I will be able to play with my children without getting short of breath. My feet and knees won’t hurt anymore. I will be able to enjoy hiking with my family. I will be a good example of healthful eating and taking care of my body. I enjoy delicious foods but I don’t overeat. I have learned that I can do difficult things and I take the things I learned in my weight loss journey and apply them to other goals. I am proud of myself. 

 Keep writing…as much as you can think of. 

Brainstorm Your Obstacles

The next step is to brainstorm all the obstacles that are in your way of achieving that goal. 


I don’t know what to eat to lose weight.

I can’t exercise because my knees hurt.

My doctor says I need medication to lower my blood sugar.

My family keeps junk food in the house.

I’m addicted to junk food.

I eat when I’m stressed and I’m under a lot of stress right now.

Think of every obstacle in your way.

Now set your paper aside. We’re going to dig into some detail about the model and then we’ll come back to this exercise and plan your strategies.

Overview of The Model

The beauty of the model is that we can use it to solve ANY problem. Isn’t that amazing? We abbreviate the model with the acronym CTFAR. 

Circumstances * Thoughts * Feelings * Actions * Results.

First there is a circumstance (C)

You have a thought about that circumstance (T)

The thought creates a feeling (F)

Your feelings drive your actions (A)

Actions, in turn, drive your results (R)

Your result always ties back to the original thought that drove this whole model.

Let’s dig in a little deeper

Circumstances are neutral Just the facts. (C) • 

Circumstances are things that happen in the world. Things outside of our control. This can be a diagnosis, something someone said to you, something that happened to you, or anything really. It is a fact, provable in a court of law. Everyone would agree. Your weight on a scale is a fact. We could all look at it and see the same number. The judgement, “I am fat” is not a fact. That is your thought about the number on a scale. When you write a circumstance there should be no adjectives. It’s very plain, boring, “fact-y.” We tend to think that these circumstances are to blame for how we feel, act, or for what results we’re seeing. But…

The reality is thoughts are always the problem (T) • 

Our thoughts are just sentences inside our brains. It is estimated that we think 40,000 – 60,000 thoughts every day. Most of those thoughts we are not even aware of. We accept most of these thoughts as true even though many (most?) are not true. Thoughts are not facts. They are thoughts. We know this because 5 people could see the same thing and have 5 different thoughts. Maybe you see someone dancing around on the sidewalk in front of a store.

You might think:

“He’s on drugs.”

Someone else might think,

“He sure looks happy.”


“This is embarrassing.”


“I wish I felt so free and wasn’t worried about what other people thought.”


“I wonder if he needs help.”

Same circumstance – man dancing. 5 different thoughts.

Your Thoughts Create Your Feelings (F) • 

Once you have a thought in the mind, your body reacts with a feeling/emotion. This can happen in an instant. Often so fast that we don’t connect the thought to the emotion. Many times we think that the circumstance created the feeling. As in, “He yelled at me and made me so mad!” Really he yelled at you and you had a thought that made you mad. The thought was probably something like, “He shouldn’t yell,” or “I hate it when he yells at me,” or “Oh, snap! Now it’s on!” That thought unleashed the emotion of anger.

Here’s the thing, if you think that your feelings come from things outside of yourself (what other people say, what they think about you, your situation at work, a diagnosis, etc.), then you have to either control the world or feel really crummy about yourself and your situation when you can’t control it.

Recognizing how your thoughts and feelings work together is the key to taking action towards your goal of improved mental wellness. (A) • 

It’s also the key to understanding how you are getting the undesired results you are currently facing in your life.

We take action FROM our feelings. When we are feeling angry we do different things than when we are feeling curious. When we are feeling motivated we take different action than when we are feeling shame. Feelings are the fuel. If you want different results, you need the right fuel. You get the fuel by managing your thoughts. See how it’s all coming together? 

Your actions create your results (R) • 

Usually, we try to accomplish things in our lives by changing our actions. Often, we fail over time because we don’t know how to consistently maintain those actions. Using the weight loss example, you might try to lose weight by doing a super restrictive diet and increasing exercise. It works for a while…days, weeks, maybe even months. But then you fall off the wagon and it all goes wrong. Likely you were taking that action from a place of shame, dissatisfaction, frustration, or other negative emotions that got you started on your journey. Unfortunately, those emotions are not emotions that fuel consistent action.

Let’s put it all together

A thought download, or brain dump, is the one of the most effective ways to getting to your thoughts so that you can apply the self-coaching model. If you did the exercise at the beginning of this post about where you were, where you want to be, and the obstacles in your way, you already did a version of a thought download. That was kind of a guided, more organized thought download.

Thought downloads are often disorganized, messy, and all over the place. Because that’s how our brains are! We have 40,000 – 60,000 thoughts a day. Thought downloads help us pull some of those thoughts out so you can see them, decide if they are helpful thoughts, recognize what those thoughts are creating for you, and then decide if they are thoughts you want to keep. I recommend you do a thought download at least once a day to uncover your thoughts and apply the model.

Go back to the exercise you did at the beginning of this post. Write CTFAR down the left hand side of the page. Look at the sentences you wrote in the “where are you now” section. What part of those sentences are facts and what part are thoughts? Put one fact in the C (circumstance) line and your thought about that circumstance in the T (thought) line. In the F (feeling) line, write how that thought makes you feel. Then, next to the A (actions) list all the actions you take or the actions you avoid when you are feeling that way. And lastly, next to the R (results) write the result those actions are creating.


f I go back to my weight loss example I could write the following model:

C – I weight ___ pounds

T – I can’t stick to my diet

F – discouraged

A – deprive myself then comfort myself with food, give up, beat myself up emotionally,

R – I don’t stick to my diet

Can you see how, in this example, my thoughts are leading me to the very result I don’t want? When I take action from a place of discouragement I am never going to find sustainable actions.

Now write CTFAR down the page again.

The C will be the same as the previous model. I weigh ___ pounds.

For the T line, choose a thought from the things you wrote in the “Where I want to be” section above. For my example I chose:

T – I enjoy delicious foods but I don’t overeat

F – encouraged

A – I plan realistic foods, I plan for delicious foods, I stop eating when I’m satisfied because I know I can have this food again, I don’t tell myself I’m deprived, I don’t tell myself I’m restricted, I evaluate when I do have times when I eat too much so I can learn, I don’t beat myself up about any overeats

R – I am able to enjoy foods I love and still lose weight

So, with this model you can start to see how thinking about the situation (my weight) a bit differently, I generate a feeling that helps me institute activites that move me towards my goal instead of sabotaging myself with the previous thought of, “I can’t stick to my diet.”

Changing thoughts doesn’t just happen in an instant. Your brain has had a lot of practice thinking the old thoughts. It takes practice. You can apply this process to anything you want. You look at how your current thinking is producing your current results. And then you play around with thoughts that could lead you closer to your goal until you find a thought (or several thoughts) that actually lead you closer to where you want to be.

Go back through the obstacles you listed in the exercise above. Put some of those obstacles in the model and see if you can put them in the model and come up with some solutions to get you to your goal. Reach out to me if you need help with this.

Your Current Level of Mental Wellness

Your current mental wellness is a measure of the quality of your thoughts. We all have times when our circumstances seem to drive how we feel. But in reality, it’s our thought life that has the power to do that. That is such good news! Because we don’t always have the power to change our circumstance. But we always have the power to change our own thoughts.

This doesn’t mean that we will always have positive feelings. Throughout life there are times where we do want to feel sad, or disappointed, or angry. But you can decide the feelings you want to feel on purpose and know that they don’t just happen to you.

Again, if you’d like a summary of self-coaching with a reminder checklist you can CLICK HERE and I’ll send it over to your email inbox.