Have you ever exhausted yourself doing sprints at the beginning of a workout and then struggled to muster the energy for the rest of your exercises? Or burnt yourself out with a busy morning of chores only to have a lazy, unproductive afternoon? What about a long day of medication alert after medication alert, or counting carb after carb, and then staring at your health tracking apps at the end of it all, too tired to make sense of everything you just tracked and why it even matters? Whether it’s as taxing as testing your blood sugar multiple times a day or as simple as logging a meal here and there, these decisions, both the conscious and unconscious ones we make, can add up and cause what’s known as ego depletion.
“Actually, what we’re really talking about here is decision fatigue,” explains Dr. Harpreet Nagra, PhD, VP, behavior science and advanced technologies at One Drop. “For example, research has shown that those living with diabetes have to make hundreds of extra decisions per day, compared to somebody who doesn’t live with diabetes.”
Whether it’s diabetes, high blood pressure, or another chronic condition that requires some semblance of self-management, you’re responsible for a lot of details: doctor appointments, treatment protocols, medical supplies, medical bills, the list can go on and on. Over time, the fatigue of weighing all these different decisions and responsibilities can deplete your mental resources, potentially leading to ego depletion, or a loss of your available willpower to stay on track with your goals, explains Dr. Nagra.
So, what exactly are the possible consequences of ego depletion, and how can you conserve your energy when it comes to managing a chronic condition?
Allie Strickler: Tell us more about what ego depletion means. What examples might we see of it in everyday life, and how can it manifest itself when it comes to chronic condition management?
Dr. Nagra: What we really want to highlight is that the additional decisions that come with chronic condition management are taxing on our brains. Ego depletion is the result of that sustained stress on our brains.
According to a theory developed by Daniel Kahneman (a psychologist and economist known for his work on the psychology of judgment and decision-making), when our brains weigh decisions and process information—health-related or not—they function within two types of systems.
The first is our intuitive, or instinctive, system, which we tend to use most of the time throughout our days. This is sort of our unconscious system in which we’re making decisions rather quickly—decisions we can make “on autopilot,” so to speak, like brushing our teeth or making coffee.
The second system entails more analytical, rational, or deep thinking. This type of thinking takes effort; it’s deliberate, and it’s slower because we’re taking into consideration a lot of information and trying to come up with the best solution or conclusion.
When you’re living with a chronic condition (especially in the early stages of diagnosis, or even in the throes of burnout, whether it’s related to your health or even an entirely different stressor), you often need to use more energy to use that second system of thinking and recalibrate your thoughts after the fact.
For example, in early diagnosis, you’re probably still trying to figure out how to fit your chronic condition management into your day-to-day life alongside your work and home life, and your personal relationships. There are a lot of new decisions to make, both big and small, which can deplete your energy resources and, over time, cause that ego depletion we’re talking about.
Similarly, when you’re experiencing burnout, because your energy levels are so low, and you need to use even more energy to re-engage with the ongoing management of your condition, you might feel hesitant to go through these processes again and again.
Allie Strickler: What factors can contribute to ego depletion, and how can they affect your ability to manage your health?
Dr. Nagra: There are multiple factors and types of factors that can exacerbate ego depletion. For people living with diabetes, that might include hypo- or hyperglycemia (a.k.a. low or high blood sugar), or long-term health complications that can arise as a result of how you’re managing your blood sugar. Others might deal with fatigue from exposing their body to multiple types of medication or treatments in order to stay at baseline—not only in terms of side effects, but even the mental determination and motivation it can take to stay consistent with medication and anything else in your life that may interact with that medication. However it manifests, your mind and body can get physically exhausted going through these different experiences, and that can leave you feeling depleted overall.
There are also social factors that can contribute to ego depletion. We’re all social beings, so any time we’re sharing our space or our life with another person—whether it be a co-worker, a loved one, or even our healthcare team—the way that person shows up can impact how we potentially feel about ourselves. That means any type of interpersonal difficulty that might arise, any conflict or stress that might be present within that relationship, can make ego depletion worse—even if that interpersonal stress is totally unrelated to the stress you were already feeling in the first place. Because, again, that stressor represents (at least) one more decision, one more thought process that you have to spend energy reviewing, analyzing, and evaluating to figure out how you’ll respond to it. That can make everything a lot more challenging.
Economic resources can also impact how you interact socially: If you don’t have enough financial resources, that might promote a sense of isolation and loneliness, while fulfilling those resources can promote higher levels of socialization because you have the energy to spend more time with other people.
The reality is that you can’t entirely avoid decision fatigue, ego depletion, or the many different types of stressors that can lead to these experiences. It’s going to happen from time to time. But, psychologically, when you deal with ongoing stress, and you don’t find a way to cope with it, that’s when it can really take a toll on your ability to manage your health. And when we constantly feel a sense of powerlessness around something as important as our health, that can contribute to more burnout, which might mean you’re less likely to stay consistent with medication, health goals, or even doctor appointments—and the cycle goes on and on. What we want to do is recognize and try to mitigate some of these stressors as much as we possibly can, so that decision fatigue doesn’t creep in as quickly as it would when these stressors are present.
Allie Strickler: How can people living with chronic conditions prevent ego depletion?
Dr. Nagra: Many people feel alone in their experiences, so I always encourage folks to find support. It doesn’t necessarily have to be from your family or from a large number of people; it’s more about the quality of the support you’re getting. If you have friends, co-workers, or other peers around you who can nurture that sense of belonging we’re all looking for, that can help eliminate or lessen some of the burdens you might feel in managing your health.
It’s also important to take time to rest. In practice, that might mean setting boundaries around what time of day you’ll directly engage with your chronic condition. If blood sugar management is part of your self-care, for example, consider creating a system around how you check your glucose levels. Instead of checking sporadically, maybe you set reminders or notifications at specific times, and perhaps you only sync the results to your phone once a day instead of multiple times in one day. That’s just one example; the goal is to figure out what those boundaries look like for you.
Along the way, make sure you’re checking your self-talk, too. We all have a tendency toward negativity, and when you live with a chronic condition, it’s easy to feel like you’ve done something “wrong” to bring about these difficulties in your health. With that, we can end up nurturing a sort of victim mentality, so we have to pay attention to what we’re saying to ourselves, the stories we’re telling ourselves. Ask yourself: Does this help me? Are these kind thoughts? Do I get anything out of this? You have to be really honest and reflective with yourself.
The truth is, it can feel validating to have that victim mentality. But you have to work to analyze and self-reflect about what the underlying reason is for that mentality. Why does it feel validating? In the process, you might find it helpful to talk to a health coach, therapist, or mental health professional to help you understand why this type of thinking comforts you, why you’re stuck in that narrative, and what you might need to work through in your mental health in order to change the narrative.
Finally, remember that you are not your chronic condition. You’re a living human being with thoughts, opinions, feelings, goals, and dreams that may have nothing to do with your health. Make sure you’re nurturing those other priorities and thinking about how you can manifest your goals—health-related and not—into reality.
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This article has been clinically reviewed by Jamillah Hoy-Rosas, MPH, RDN, CDCES, and VP of clinical operations and program design at One Drop, and Dr. Harpreet Nagra, PhD, VP, behavior science and advanced technologies at One Drop.
