Author Archive for Jason Giles MD

Dr. Jason Giles is certified by the American Board of Addiction Medicine and the American Board of Anesthesiology. He is a physician specializing in the treatment of drug, alcohol, and behavioral addictions. He is the founder of Haywire.

How to deal with regret

My only regret in life is that I wasn’t someone else. –Woody Allen

A central theme in the mind of most addicts is regret. In the personal inventory-taking of the 4th step in the program of Alcoholics Anonymous the participant is encouraged to conduct a searching inventory of his past. There is emphasis put on recording the good along with the bad but most people are focused on the mistakes they made and resentments they hold. I regretted for years not going to college right out of high school, thinking somehow it would have made a difference in my station in life.

Pivotal events in the life of the individual when viewed through the lens of disappointment can produce a crushing sense of regret. It is the companion of “Why Me,” the lament of “if only.”  The supposition is that there was a mistake made in the past that if it could be done over would change everything.

DEFINITION: to feel sad, repentant or sorrowful over something that has happened or been done, esp. a loss or missed opportunity.

Is there any usefulness in rumination over previous choices? Is the idea of regret itself related to accountability? Are the protective effects of regret short circuited during active addiction? Let’s look a little closer. We start with gambling.

In 2007, Dr. Gregory Berns[i] and his colleagues at Emory University in Georgia studied 38 volunteer subjects by putting them into a scanner and giving them three buttons to push. They were shown a screen with three doors and asked to choose door number one, two or three by pressing the corresponding button. Randomly assigned doors had either a smiley face or a frowning face behind each door. If the frowning face was chosen, a painful electric shock was given to the top of the subject’s right foot.

As the test progressed, the likelihood of selecting a frowning face increased. They hypothesized that if the chances of getting shocked were low and avoided by choosing a smiley-face door the rejoicing would be lower and the regret higher if they were zapped in a low-probability test. Their prediction was accurate and they also found the results were flipped (more rejoicing, less regret) for getting zapped in the tests where 2/3 of the doors had shocks behind them.

They were able to map the neural correlates of regret to the medial orbitofrontal cortex, left superior frontal cortex, right angular gyrus, and left thalamus, all areas involved in judgment and decision-making. These same areas are implicated in the neural correlates of addiction.

In other words, when we think something bad is going to happen and then it does not we are hardwired to rejoice disproportionately. We are extra happy. Similarly, if we get hurt by a choice made when our estimation of possible pain is low we have far more regret. This makes sense but ignores the issue of probability before the choice is made.

Taking drug use as an example, if I fear rejection on the dance floor as I consider asking a beautiful woman to dance and then have a drink of alcohol to “steady my nerves” I have lowered my fear of rejection (anticipatory regret) and when she says yes (having only to do with being asked ad wanting to dance with me, not with my drinking) I have flipped the equation and now I am rejoicing.

Countless stories among addicts go this way: I was afraid, I took a drug or a drink, and I was not afraid anymore. No wonder it is so hard to stop the routine. I believe that altering the mind has the additional benefit in the dance-hall scenario above of lowering the stakes. If I am drunk when she says yes, I get to dance anyway. If I am drunk and she says no, only part of me was there to actually ask her. I have hedged my regret and taken myself out of the game a little bit.

Of what use is regret? It is a universal phenomenon and most behavioral economists believe humans have regret as a mechanism for better decision making in the future. Interestingly, regret is a mirror phenomenon and feelings of regret have been documented in the observers of a person experiencing regret. This is more complex by akin to the idea of mirror neurons and empathy.

In another fMRI study, this one in Italy, found that people watching gamblers losing experienced regret as seen by activation of the ventromedial prefrontal cortex, anterior cingulate cortex and hippocampus. These are the same areas of the brain that the Emory researchers identified as he location of regret. We not only experience regret but we can experience the regrets of others as if they were our own.[ii]

Many people become trapped in a pathological regret, roasting on the spit of rumination, seasoned with bitterness and self-doubt. They dwell on a specific edited recollection of events and they torture themselves imagining, but for that event, how their life would have been different than it is. The worldwide tally of this kind of self-imposed suffering is incalculable.

Like addiction itself, regret leads to tolerance of more regret. Higher levels of sorrow are required to support the erroneous conclusion that things might have gone differently. People can begin to feel they are unlucky and a paralysis of sort sets in as they patrol each new choice looking for similarities and clues to the previous “big screw up.”

Further separation from friends and loved ones happens if this pathological regret continues. The position taken by the regretful has to be defended. It can come to define everything about the person and any challenge from the outside is often taken as personal critique.

I believe the morbidity of pathological regret is a mechanism to avoid personal responsibility and accountability. Remember, in all addictive states the individual assumes responsibility and power where he has none (changing the events of the past, for example) and avoids responsibility and power where he has complete power (attitude and behavior). The serenity prayer is a handy mnemonic for sorting out the two. Some things we can change, others we cannot. We need the courage (heart) to change the things we can and the serenity (acceptance) to leave alone the things we can do nothing about.

Ironically, pathologic regret does nothing to turn back the clock and in fact prevents the sufferer from benefiting from the prior mistake. In a situation that is analogous to chronic pain, the regret takes on a life of its own and can become whelmed over. A grim moroseness descends and everywhere the regretter looks there are reminders of the fateful choice not made. A person can become impaled on the spindle of past mistakes made.

Part of the organizational structure of the brain is its astonishing ability to create and manage process routines for behaviors. Newly learned skills are repeated until the components of the movement have been mastered. Once so ordered, the whole routine can be filed and recalled with much less effort. Consider the toddler who obviously must concentrate on each of her steps until she can do them without thinking. Or think back to when you learned how to drive or play an instrument. What used to require immense concentration eventually is done almost without thinking. People become so confident of their driving skills the believe they an text and drive safely.

The human brain is also good at organizing negative information, especially regret. What was an especially uncomfortable experience can be transformed into a nearly automatic thought process. Without deep analytic review the brain can assume events into evidence because the contrast between them and the remembered sequence of events is seen as familiar and similar.

What can be done to manage regret?

There are five ways you can reduce or eliminate the driving force of regret in your decision making and regain control of your mind. They are all small steps that when taken together can have a liberating impact on your life. They are as follows:

1) Write it down.

This is a powerful technique for getting the thoughts out of your head and onto a sheet of paper. They are much safer there. The mind has a tendency to amplify and echo thoughts of regret and remorse. If you can see the words written down before your eyes a different part of your brain is engaged to process the information. This helps to encapsulate the event so you can study is for more than the same old angle.

2) Identify your role.

Along with writing down the story of the regretful events pay attention to the part you played in them. Yes, that’s right, you have a role here that you are playing. Classic roles include the righteously indignant and the victim but they can be more subtle as well. I am NOT saying that the events that led to your regret are your fault.

Nobody “asked for it.” I am saying that regrets need care and feeding to be maintained. There is usually a big payoff for maintaining the regret, even if it is just a hall pass from further responsibility. Keeping the regret on life-support means you don’t have to take any more risks with your feelings. Here a good friend or a therapist can help you see your blind spot regarding your part in this

3) Change your story.

Once you can see clearly that you are playing at least a supporting role in your regret movie you can move off of that script and have a different story. Sure, you may have made what in hindsight appears to be a bad choice. That is not the problem of regret. The problem is the additional generalizations people form about themselves. “I make poor decisions,” or “I have bad luck.” The misery expands to fill the space you give it.

It may be that you are a human being who has to make decisions in the moment with imperfect information, just like the rest of us. You are not a prisoner to your prior choices and now that you can see more clearly you can take a different path. This is probably the most important technique of the five because it is the story you tell yourself more than the bad choice you made that weighs down your life.

4) Get a team of advisors.

The best run companies use a board of directors. You are no less important than Coca-Cola or General Electric. You probably already have a circle of friends and confidantes who listen to your whining and do their best to comfort when they can. Take a closer listen to what they are saying. Are they using your story to make themselves feel better? Do they challenge your assumptions and your death-grip on your view of the events you regret?

Sometimes we need to listen to a different point of view. The regret cycle is much like a spell or hypnotic trance. It is difficult to escape when you can’t see your way out. Taking the spirit of reading this article and extending it into asking for help is liberating. Given how strong you “regret muscle” has become over the years I recommend you keep the team beyond the immediate need for relief and perspective. There is a good chance you will relapse back into regret even if it is on a different event.

Also helpful is for your personal board of directors to be in communication with one another when you are not there. You are not a burden and they will appreciate being able to help someone they care about. Soon enough you will be able to repay the favor in kind.

5) Get busy

Depression has been called anger without enthusiasm. Sure your are sore and there may be no way to reverse the events of the past. So what? Are you going to let something that happened in your past be the needless death of your spirit? As a person here on planet Earth you have numerous people around you and in your life whom you love. You have been given gifts that are gathering dust in their unemployment. Roman emperor Marcus Aurelius may have said it best regarding regret in Meditations:

Adapt yourself to the environment in which your life has been cast, and show true love to the fellow-mortals with whom destiny has surrounded you.

And

When force of circumstance upsets your equanimity, lose no time in recovering your self-control, and do not remain out-of-tune longer than you can help. Habitual recurrence to the harmony will increase your mastery of it.

You have worked the terrain of regret long enough. You do not need to forget the trauma of the past but you have not learned from it if you remain emotionally affixed to it. Practice letting go of the way you regard the events and like anything you’ll get better at it. Most people have stories about things they thought were the worst that later turned out to be the best. Maybe this is the case with your story too.


(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2265597/)

(Neurobiological Regret and Rejoice Functions for Aversive Outcomes

Neuroimage. 2008 February 1; 39(3): 1472–1484.

Pammi V.S. Chandrasekhar,1 C. Monica Capra,2 Sara Moore,1 Charles Noussair,2 and Gregory S. Berns)

Canessa N, Motterlini M, Di Dio C, Perani D, Scifo P, et al. 2009 Understanding Others’ Regret: A fMRI Study. PLoS ONE 4(10)