My main goal out of doing a dopamine detox was to increase my productivity by improving my attention span. It seems that removing distractions was essential to a dopamine detox (Meurisse 2021; Knapp and Zeratsky 2018) and reaching deep work (Newport 2016) and no better way to start that than with open systems.

Open Systems

The idea of an open system is a source of enjoyment which is effectively endless (e.g. Facebook feeds but even things like messages¹). This ultimately revolves around short form videos and memes. I figured there was effectively two ways to “close” an open system:

1. Not engage in the open system at all, by going pretty much cold turkey or making it so annoying to use that you only use it productively
2. Setting a limit (such as time or frequency) on an open system so you’re unable to access it after you reach the limit

I used approach 1 for facebook, instagram and reddit. I uninstalled the applications from my iPad and phone. If I have to use instagram and facebook I use them inside the browser but also set a time limit as well. Viewing reels inside of the browser is such an unpleasant experience that I don’t do it for very long if I ever do it. If I did ever really need to use the app version, I would install it but then quickly uninstall it after completeing whatever required me to use the app².

I used approach 2 for youtube mainly. I uninstalled/disabled the Youtube app from my phone and iPad. This worked quite well provided that I had the self control to not use the application. On my laptop I used the addon LeechBlock which limits the time I can access open systems to a certain duration³.

On Social Media

You’ll also find a propensity of videos describing experiences and advice regarding quitting social media and it is almost always mentioned in passing when discussing a dopamine detox

• Quit social media | Dr. Cal Newport | TEDxTysons
• i quit social media, and it was the best decision of my life
• The Actual Benefits of Quitting Social Media (Dopamine Detox)

Some people suggest the benefit of quitting social media on their mental health. Quotes such as the following come to mind when discussing such things:

“If you try to be someone else, you’ll become nobody at all. The only great person you have the possibility of becoming is the greatest version of yourself, and that is a pretty great person.

I never really found myself to be using social media for posting and improving my self image to begin with, so my main benefit from detoxing derrived from not engaging in unproductive behaviours.

The Daily Highlight

This is the idea that you set one task that should be done for that day as the highlight of the day. I realised the importance of setting a daily highlight on reflecting halfway into my 8 week placement realising that medical school thus far this year has felt like a blur loosely consisting of:

1. Waking up
2. Going to placement
3. Going home tired
4. Studying for a bit
5. Go to sleep

Importantly, I was letting placement be the dominant thing in the day. Instead, the purpose of a highlight is essentially what accomplishment or moment you want to savour for that day. I began by picking highlights based on urgency (i.e. What’s the most pressing thing I have to do today), but it felt like I was reacting to my circumstances and my highlights were mainly studying or medicine related tasks.

Part of the process of a dopamine detox is to substitute hyperstimulatory activities with less stimulating activities (i.e. instead of watching Netflix, going gym or reading). To do this, I made my highlights more related to satisfaction and joy.

Importantly, do not choose a highlight that cannot be completed in that day. I found that this was bad because:

1. I didn’t finish it
2. Once I realised it was too long and didn’t complete it, I’d become unmotivated

Knapp and Zeratsky 2018 recommends choosing a highlight that takes sixty to ninety minutes.

Reflect

I will also try to reflect on the day to see if I managed to complete my daily highlight, how I feel about detoxing, where I wasted time and in general. I currently just use an org-roam dailies capture template for this:

("r" "reflection" plain
             (file "~/reflection.org")
             :target
             (file+head "%<%Y>/%<%B>/%<%Y-%m-%d>.org" "
:PROPERTIES:
:ENERGY: %^{Energy|~|1|2|3|4|5|6|7|8|9|10}
:FOCUS: %^{Focus|~|1|2|3|4|5|6|7|8|9|10}
:HIGHLIGHT: %^{Highlight achieved|yes|no}
:END:
#+title: %<%A, %d %B %Y>
#+filetags :Dailies: "))

Where ~/reflection.org is:

* Reflection
- Today's Highlight :: %(mapconcat 'identity (org-ql-select (org-agenda-files) '(and (ts :on today) (tags "highlight")) :action '(org-get-heading t t)) " ")
- Tactics tried today :: %^{Tactics tried}

** How it went
%^{How it went}%?

** Moment I'm grateful for tomorrow
%^{Moment I'm grateful for}

** What to try for tomorrow
%^{What to try (again) for tomorrow}

This is the function to pull today’s highlight. It uses org-ql.

(mapconcat 'identity
           (org-ql-select
             (org-agenda-files)
             '(and (ts :on today)
                   (tags "highlight"))
             :action '(org-get-heading t t))
           " ")

I generally try to link the tactics using org-roam to nodes specific for that tactic. This way I’m able to show backlinks (using org-roam-dblocks from nursery) and lookup properties for days where I used this tactic such as whether the highlight was completed that day, what my focus and energy levels for that day was. For example I have a node specific for the tactic of writing down your highlight on a sticky note and putting it in front of you.

** Write it Down
Here are all the days on which I used this technique and managed to accomplish my highlight:
#+BEGIN: backlinks :filter (my/roam-db-filter "HIGHLIGHT" "yes" it)
- [[id:some ID][Friday, 10 February 2023]]
- [[id:some ID][Tuesday, 14 February 2023]]
#+END:

Here are all the days on which I used this technique and managed to accomplish my highlight:
#+BEGIN: backlinks :filter (my/roam-db-filter "HIGHLIGHT" "no" it)
- [[id:some ID][Tuesday, 28 February 2023]]
#+END:

Where my/roam-db-filter is:

(defun my/roam-db-filter (property value node)
    (equal value (cdr (assoc property (org-roam-node-properties node)))))

My Lessons

I found myself to still be as easily as distractible as before, the main change being that by limiting my access to distractions I am more likely to make progress on meaningful work. I’ve found some tactics that help me engage in deep work more readily, and while dopamine detoxing helped I found that it helps more in sustaining deep work rather than initiating it. In essence, I still need to plan out my day otherwise I’ll find some way to engage in a dopamine binge. In summary:

• I’m still distractible but have put up barriers to getting distracted
• Its still hard to initiate work unless you do other things (e.g. setting up a schedule)
• I’ll occassionally engage in a dopamine binge, but importantly I try not to get upset about it

References

Say for arguments sake I tested positive. This does not mean that I am 95.9% likely to have SARS-CoV-2. If we take a look at the formula for sensitivity we note that it gives the probability/chance of having a positive result in this test if I already know that I am positive.

\[ \rm{Sensitivity}=\frac{\rm{True\; Positives}}{\rm{All\; With\; Disease}}=\frac{\rm{True\; Positives}}{\rm{True\; Positives}+\rm{False\; Negatives}} \]

Instead we are interested in the chance that I have the disease knowing that I have tested positive (in mathematical terms \(P(\rm{Have\;Covid}|\rm{Test\;Positive})\)). This is called the positive predictive value and can be calculated as:

\begin{align*} \rm{PPV}=&\frac{\rm{TP}}{\rm{Test\;Positive}}\\ &=\frac{\rm{TP}/\rm{Everyone}}{\rm{Test\;Positive}/\rm{Everyone}}\\ &=\frac{P(\rm{Test\;Positive}\cap\rm{Have\;Covid})}{P(\rm{Test\;Positive})} \end{align*}

If we assign event \(A\) as having covid and event \(B\) as testing positive, we can prove that:

\begin{align*} P(A|B) &=\frac{P(A\cap B)}{P(B)} \\ P(B|A) &=\frac{P(A\cap B)}{P(A)} \\ \therefore\quad P(A\cap B)&=P(B|A)P(A) \\ P(A|B)&=\frac{P(B|A)P(A)}{P(B)} \end{align*}

This implies that:

\begin{align*} \rm{PPV}&=\frac{P(\rm{Test\;Positive}|\rm{Have\;Covid})\cdot P(\rm{Have\;Covid})}{P(\rm{Test\;Positive})}\\ &=\frac{\rm{Sensitivity}\cdot P(\rm{Have\;Covid})}{P(\rm{Test\;Positive})} \end{align*}

If we test positive we know that we could either have the disease and tested positive (i.e. a true positive) or we could not have the disease and tested positive (i.e. a false positive). We can therefore calculate the probability that we test positive (\(P(\rm{Test\;Positive})\)) by calculating the chance we test positive given we have the disease (\(\rm{Sensitivity}\cdot P(\rm{Have\;Covid})\)) and the probability we test positive given that we don’t have the disease (\((1-\rm{Specificity})\cdot P(\rm{Don’t\;Have\;Covid})\)). Thus:

\[ \rm{PPV}= \frac{\rm{Sensitivity}\cdot P(\rm{Have\;Covid})}{\rm{Sensitivity}\cdot P(\rm{Have\;Covid})+(1-\rm{Specificity})\cdot P(\rm{Don’t\;Have\;Covid})} \]

This raises the question: What is the probability that I have Covid (before having the test), i.e. what is \(P(\rm{Have\;Covid})\)? And hence what is PPV?

If we were to think about this realistically, \(P(\rm{Have\;Covid})\) is dependent on a clinical judgement based on my symptoms and who I was exposed to. For arguments’ sake lets just ignore of all of this and say that \(P(\rm{Have\;Covid})\) is the prevalence of Covid-19.

As of writing this article there are 14,621 active Covid-19 cases and 2.667 million people in my region. This gives a prevalence of 0.737%. Plugging this in we get:

\[ \rm{PPV}=\frac{95.9\%\cdot0.737\%}{95.9\%\cdot0.737\%+(1-99.4\%)\cdot(1-0.737\%)}\approx54.3\% \]

The Bayesian Paradox

Weird right? So if I get a positive result on the RAT I can only be 50% sure I actually have SARS-CoV-2. Therein lies the Bayesian Paradox. Though its not really a paradox but rather contradictory to what one might expect.

Suppose I go to a different pharmacy and buy another rapid antigen testing kit but from a different company just to make sure the results are totally independent. What we substitute as \(P(\rm{Have\;Covid})\) is 54.3% as this is the probability that I have Covid (before doing the second test).

\[ \rm{PPV}=\frac{95.9\%\cdot54.3\%}{95.9\%\cdot54.3\%+(1-99.4\%)\cdot(1-54.3\%)}\approx99.5\% \]

Which makes considerable sense. The probability of having two false positives should be much lower than the probability of just having 1 test screw up and giving a false positive.

Concluding Remarks

When talking about Bayes’ Theorem, many explain how counter-intuitive it is (myself included). Instead Derek, in his video, argues that Bayes’ Theorem is really the opposite, i.e. maybe we’re too good at internalising the thinking behind Bayes’ Theorem.

He argues that we can get used to results. Getting rejected or failing at something or getting paid a low wage and so we keep updating our beliefs to a point of near certainty so that we think that this is the that nature is. Consider the quote:

Everything is impossible until it’s done – Nelson Mandella

In essence he further states that your prior \(P(H)\) might even be 0 if you’ve seen no instances of something like what you aim to do being done before.

References and Useful Links

Derek’s video introduced me to the topic which was quite nice

As you can imagine Bayes’ Theorem holds a place in medicine and I would argue that it is intrinsically used my clinicans when generating differentials. As such statmed.org exists. In its own words, it uses Bayesian inference to formulate differential diagnoses.