Do I have to do everything shown in a Growth option I pick?

Do I have to do everything shown in a Growth option I pick?

Yes. You must do everything shown if possible, though you can do it in any order.
Usually, there's no downside: Reclaiming, gaining Energy/Power Cards, and adding Presence are almost strictly good. (You can always reposition a Presence already on the island when adding Presence [p. 14], so "running out" isn't a concern.) Spirits with "Move a Presence up to Range N" Growth effects can Move it 0. However, a few Spirits do include things you'll have to work around, including:
  • Ocean's Hungry Grasp often requires you to Push or Gather Presence;
  • Heart of the Wildfire often adds Blight along with Presence, so being required to add Presence can be dangerous;
  • Downpour Drenches the World and Ember-Eyed Behemoth both discard Power Cards as part of one of their Growth options;
  • Breath of Darkness Down Your Spine must let pieces escape the Endless Dark.
  • Several Spirits have Growth options that add Presence to particular land types, which could force Presence outside of that land type to be repositioned accordingly in the unlikely case where the Spirit has no Presence left on Presence tracks and no Presence on the island is already in that land type (else it could be repositioned into the land it's already in). Note that "a land with your Presence" can't cause this problem, since that allows any Presence to be repositioned into a land its already in.
If you can't do something in a Growth option, do as much as you can and skip the rest – you're free to pick Growth options where you can't successfully complete all of the instructions. (E.g., if you Push Presence from each Ocean, and there's a board where none of your Presence is in the Ocean, you simply don't Push Presence on that board.)
Nevertheless, you can't skip paying an explicit "cost" for a Growth option, which must be paid in full order to pick that option and perform the associated actions.