The devil is not in the details, it’s in the beginning and the endings

Patients’ memories of the past may influence their decisions about the future, yet memories are imperfect and susceptible to bias. We tested whether a memory failure observed in psychology experiments could be applied in a clinical setting to lessen patients’ memories of the pain of an unpleasant medical procedure. We studied consecutive outpatients undergoing colonoscopy who were medically stable, mentally competent, and able to speak English (n=682). By random assignment, half the patients had a short interval added to the end of their procedure during which the tip of the colonoscope remained in the rectum. Pain during the procedure was measured with a ten point intensity scale. Memory following the procedure was measured using both a rating scale and a ranking task. Randomization resulted in two similar groups. As theorized, patients who underwent the extended procedure experienced the final moments as less painful (1.7 vs. 2.5 on a ten point intensity scale, P<0.001), rated the entire experience as less unpleasant (4.4 vs. 4.9 on a 10 cm visual analogue scale, P=0.006), and ranked the procedure as less aversive compared to seven other unpleasant experiences (4.1 vs. 4.6 with eight as the worst, P=0.002). Rates of returning for a repeat colonoscopy (median duration of follow-up 5.3 years) averaged 50.4% and were slightly higher (odds ratio=1.41, P=0.038) for those who underwent the longer procedure controlling for prior colonoscopy, procedure indications, and abnormal findings. Memory failures observed in experimental conditions can be found in clinical settings involving awake patients and may offer opportunities for improving patients’ willingness to undergo future unpleasant medical procedures.

Now, such results may not be very applicable to other situations, however there’s some evidence that our memory in general seems much more capable at capturing beginnings and endings… therefore when you design your experiences (work, holidays, etc.) it could be important to place extra emphasis on beginnings and endings.

Experience vs. Memory – Journaling to be happy

The last few days were spent intensely travelig, meeting people (both
old and new friends), talking, partying and in the small breaks
between reflecting.

In many ways these days marked the end of things – the end of my
intense engagement with AIESEC, the end of a relationship, the end of
my past year’s job and so on.

It caused me to think about the way we experience and remember thing.
There is a very interesting TED talk on the theme and it provides some
guidance in how to make the most out of both what we experience and
what we remember. The most interesting part is that the way we
experience things and the way we remember them are two very different
things – essentially our memory is a story teller that will create a
narrative primarily based on such things as major peaks or events, big
changes to the experience and most importantly how the experience ends.

By making the right choices about our experience it seems to me that
we can have influence both of the amount of well-being we get through
the experience but also the amount of well-being we feel when
remembering the experience. The remembering part of the experience is
also crucial (says Kahneman) because this is the part that we use to
make future decisions!

For example, an essentially good relationship in experiences, that has
a bad ending might in the end entail a bad memory, meaning that you
would be much more careful about choosing another relationship because
of your minds expectation that the experience next time will be
similar to it’s story or memory of the previous experience (even
though it was just the ending that was bad!)

In order to deal with this, I read about another research that showed
that journaling about our experiences had a profound effect on the
amount of negative effect or well-being we could induce. Most likely
this effect comes from the way that journaling allows us to create a
more coherent narrative for our memory to process.

So, during the weekend I resolved to journal both my negative and
positive feelings about the experiences that I had been through during
the year, about how I felt about them ending and about both the peaks
and the low points – however my main focus, as always will be to bring
out what worked and not spend my time endlessly ruminating about what
failed.

Finally – since gratitude is important for both your well-being and
others – I would like to express a deep gratitude to everyone I met
and especially to Orsika, Arie, Phil, Arjanne, Gloria, Alexandra and
Irina for making the weekend very special!

More on experience and memory in Kahneman’s TED talk:

http://www.ted.com/talks/daniel_kahneman_the_riddle_of_experience_vs_memory.html