Further Musings on Potential Predictors of Suicidal Behaivor

In the last post I discussed thoughts on why certain groupings of physiological measurements may turn out to be a better predictor of suicidal behavior than genes (check out that post here).  On top of that, I have some general ideas as to how this may play out.

I would imagine that each psychological disorder may end up having its own constellation of physiological factors with predictive power.  For instance, people with major depression without psychotic features would have a different constellation of physiological factors associated with suicidal behavior than people with schizophrenia.   The people in the major depression group may have lots of indicators of very low mood but a certain amount of anxiety / excitement too.  Currently, it is a commonly held belief among clinicians, researchers, and even the general public that a certain amount of energy is required to make a suicide attempt.  Rather than a 1 to 1 correlation between low mood and suicide - i.e. the people w/ the lowest mood are at the highest risk of making an attempt - low mood plus a certain amount of motivation/excitation to attempt is believed to be in the mix.  It's worth noting that the excitation wouldn't necessarily improve one's mood.  Low mood and excitation are not only likely to be separate and valid psychological constructs, but they would represent themselves differently physiological tests.   Speaking in terms of totally made up units of measurement to illustrate a point, a person with major depression may need lower than -100 endorphins (representing low mood) and somewhere between +15 and +30 cortisol (representing excitation) in order to qualify as being at imminent risk for suicide.  On the other hand, a person with schizophrenia may need lower than only -25 endorphins (representing low mood) and higher than +200 cortisol (representing excitation) to be at imminent risk for suicide attempt.  Continuing down the path of this totally fabricated example, high levels of excitation may be more indicative of imminent suicide risk in schizophrenia than in major depression for a couple of reasons.  If someone with schizophrenia attempts suicide, it has a decent likelihood of being because they heard a voice in their head commanding them to do so.  As such, the experience of hearing a scary voice telling them to kill themselves would hypothetically induce a physiologically state of excitation. On the other hand, a relatively low but existent amount of excitation would hypothetically be required for a person with major depressive disorder to attempt suicide.  Concurrently, their mood would presently need to be extremely low to be at risk for such destructive behavior.

Pulling back out of the examples and towards the larger picture, in short, I would imagine that each disorder would have it's own set of physiological risk factors.  Major depression, schizophrenia, bipolar, borderline personality disorder, etc. would all have different high-risk constellations.  Some more thoughts on the specifics to come.

Musings on Potential Predictors of Suicidal Behavior

I was recently asked for my thoughts about blood tests as a genetic predictor of suicide on Twitter.  I tweeted them out, but I thought I'd quickly organize them here as well.  It admittedly may be very flawed, but here's my logic:

1. Completing suicide is one isolated behavior that results from a complex myriad of genetic, biological, environmental, and situational factors.   As such, simply looking to genetics - the building blocks of life - to predict one isolated behavior seems far fetched.

2.  There's also a lot of noise introduced when your outcome is the one isolated behavior of a suicide attempt resulting in death.  Someone who may be prone to suicide, for instance, may die in an accident before they ever have the change to attempt suicide.   Further, people who may be prone to suicide otherwise may lead a charmed life & the thought may never cross their minds.  Alternatively, someone not genetically prone to suicide may have a terrible life, develop a substance abuse habit, and impulsively kill themselves one night while under the influence.  Because the environment and circumstance play such a large role in whether or not someone actually dies by suicide, looking to genetics intuitively doesn't feel right to me.  Studying epigenetic factors, however, may yield something very interesting, but my money isn't on it.  I don't think it will be the silver bullet we want it - or hype it - to be.  Think back to the human genome project. (P.S.  Psychologists will recognize this argument as part of the "low base rate behavior" issue.)

3.  It is true that suicidal behavior is linked with psychological disorders, but is perhaps more important to focus on this: the behavior of completing suicide is intimately tied to the circumstances in the immediate environment.  These immediate circumstances will have an immediate effect not a a person's genetics per se, but on their physiology.

For instance, on any given day, a woman with moderate depression may be at a certain point in her menstrual cycle, on substances, vulnerable from a myriad of factors (e.g. relationship stress, lack of sleep, health condition, etc.), and feeling particularly impulsive.  Lets just say that we add a life tragedy to this vulnerable mix of factors and she gets admitted to an inpatient unit for suicidal thoughts.  Eventually she reports her suicidal thoughts have remitted, she is discharged, and then our hypothetical woman unfortunately makes a suicide attempt.  Some of the aforementioned factors (e.g. menstrual cycle, etc.) have a specific physiological impact.  If we had measurements taken from the inpatient unit of this woman's estrogen/progesterone levels, oxytocin, waking levels of cortisol, toxicity, etc. it would result in a specific constellation of physiological factors.  Over time, scientists can examine which constellation(s) of physiological indicators most often co-occur with recent (serious) suicide attempts / completions.  Determining & using immediate constellations of physiological factors to predict suicidal behavior in the near future seems to me like it will be much more accurate (i.e. have "incremental predictive validity") than our current tools (e.g. self-report questionnaires).  The general idea is that in the future we may be able to divine what people are actually feeling based on physiological measures rather than self-report.

4.  One last thought about the utility (and sensitivity) of genetic testing for suicide:
Not only do I think that blood tests for genetic factors will not yield reliable predictors of suicide completion, they will likely not be of much practical utility.  Consider this: what course of action must a clinician take with the information that a person is at genetic risk for suicide?  If someone is admitted to a psychiatric inpatient unit because of depression and suicidal thoughts, at some point they report they are not imminently at risk.  At that point, we must then discharge them from the hospital.  We would not be able to detain them longer based on a genetic test.  Correct?  How much longer would we keep someone on an inpatient unit based on a genetic test?  Genetic markers are not what we call sensitive measures - they are not sensitive to change.  They are static.  We would, however, have a more firm basis for detaining someone in the hospital if we had evidence that certain physiological constellations were present in a person & evidence that this type of constellation is associated with imminent risk of suicide.  Over time, we would have an idea about how generally someone would be feeling based on the output of physiological tests. Of course, how accurate or difficult to manipulate these hypothetical physiological constellations may be is unknown.  But if I were a betting woman, I would put my money on the scientists examining circumstantial physiological compositions winning the race of determining the most accurate, useful, & sensitive predictor of suicidal behavior.

In short, a suicide attempt is a behavior, not a disorder.  I'm not so sure that treating suicide attempts like a disorder by examining genetic contributions will produce the best predictors of this behavior.  Exploring physiological factors that represent immediate shifts in a person's internal experience however, intuitively feels more promising to me.

P.S.  This post was in response to this CNN article: link.

New Autism Theory: "The boy whose brain could unlock autism"

The article "The boy whose brain could unlock autism" from https://medium.com/ is beautiful. It is beautifully written. It is hosted on a beautifully designed site. And most importantly, the non-judgmental theory of autism presented is beautiful.  This theory is also pretty brilliant.

The article presents a theory that reconceptualizes autism as an "intense world syndrome."  This theory suggests that autism is not best thought of as a disorder characterized by a lack of empathy or intelligence, but by the existence of an overload of emotion plus a great capacity to learn.  Further, intense world syndrome suggests that people with autism experience sensations differently.  What an awe-inspiring idea.

There are so many different issues to discuss now!

Let's start with empathy.  Just because it may appear that people with autism lack empathy, doesn't mean this interpretation is correct.  It could be that a person's mind with autism is so overloaded that focusing on someone else is next to impossible.  Over time, this could result in lacking empathy for others.  Further, if people with autism are constantly bombarded with not only intense emotions (e.g. anxiety), but aversive sensory experiences as well (e.g. the act of brushing your teeth produces the internal sensations that nails on a chalkboard would typically evoke), certain consequences can be expected.  We know that spikes in anxiety result in increased calcium release and the encoding of memories.  This process could result in really rigid thinking.  Not to mention, one's focus is really narrowed in those moments.  So if there is constant anxiety, the brain is in a state of rapid-fire learning...on one hand.  On the other hand, it may be difficult to focus on anything but a particular target.  This combination of increased anxiety and rapid fire learning may carve out some pretty "strange" observable behavior patterns over time.  For instance, perhaps a hyper focus on learning calendar dates could result.  Also, the manner of brain processing could leave very little left over for attention on others, hence our current/previous perception of lack of empathy in people on the spectrum.

Speaking of the "spectrum," as a field we are very comfortable examining autism on this spectrum.  But it seems to me that there is still the perception of a dichotomous cutoff whereby some people have autism and others don't.  Right now, once a diagnosis of autism is made, then you are examined on the spectrum as compared to others with this diagnosis.  But what if we viewed every single person as representing a different degree of autism on a full spectrum?  What if the spectrum was thought to encompass all humans?  Well, I think that'd do us a huge service when conceptualizing cases.

Eating disorders, OCD, and self-injury are all jumping into my mind as relevant to this new theory of autism.

Let's take eating disorders for starters.  I'm too invested in writing this blog post right now to look it up, but I remember learning at this year's International Conference on Eating Disorders in Montreal that autism and eating disorders are related.  This was an internal hypothesis of mine for ages.  When I saw the data, I literally scribbled "I knew it!!!" in my notes.  [P.S. Even though I'm not going to look up the exact presentation I saw, here's a Medical News Today article on the relationship between eating disorders and autism from August 2013.]

Similar to what this new theory of autism posits, people with eating disorders are also in a state of anxiety, which results in rigid thoughts (e.g. "fat is bad"), compulsive behaviors (e.g. calorie counting), and a self-centered focus.  There's also usually an increased level of intelligence in people with eating disorders... or perhaps it's better conceptualized as "fast learners."   Sounds a bit like high-functioning autism, huh?  

Unlike autism though, many times people with eating disorders report desperately wanting the approval of others.  So, even if the behavior is seemingly self-centered (e.g. wanting to look good), I maintain that the function of the behavior is not completely egocentric.  But reconciling this seemingly self-centered focus and a desire to please others is usually not easy for family members of people with eating disorders.  The idea is difficult to grasp that intense anxiety about other's approval ironically results in a "self-centered" disorder. In short, I think it could be really useful to use intense world syndrome concepts in fostering understanding about eating disorders. 

Here are a few last notes before I move on with my Sunday: I think eating disorders relate to autism in the same way OCD is related to autism.  In fact, I conceptualize eating disorders as a specific subtype of OCD.  It appears to me that the process is the same in both disorders, but the content of the worry differs.  And as such, slightly different treatments are needed... but not too different.  I'll publish more on what I've written about this in the future.

And lastly, there is the example of how self-injury may relate to autism.  I've blogged here before about my hypothesis on self-injury's relation to sensory integration issues.  To read, click this link.  The idea that intense emotions can create perceptual disturbances (auditory hallucinations such as hearing voices) is not new in psychology.  But the idea that intense emotions can also lead to sensory disturbances remains an area where we need work.  Taking that a step further, exploring exactly how emotions are moderated with sensory acts like self-injury (or even doing things like soothing oneself with lavender hand lotion) is worth researching.

We need to know the following: is there a dose response relationship between intense anxiety/emotion and 1) sensory disturbances, 2) learning, 3) rigid thinking, 4) compulsive/repetitive behaviors, and 5) a self-centered focus?  If not, is there some relationship?  What mediates/moderates that relationship?

This new idea of conceptualizing autism as "intense world syndrome" clicked a few pieces into place of an enormous puzzle that I have been kicking around in my brain for years.  I very much look forward to learning from research on this theory in the coming years. 

Is Multiple Personality Disorder Real? - The Response

In April 2011, I wrote a post called "Is Multiple Personality Disorder Real?"   It is the third most popular post I've written here and certainly generates the most polarized comments / emails.   While I encourage you to read the original if you're interested in the following response, the gist is that Dissociative Identity Disorder (DID) - which was once called Multiple Personality Disorder (MPD) -  could potentially be Borderline Personality Disorder peppered with some delusional qualities. 

One very interesting & thought-provoking comment from 9/25/2012 inspired me to write this (belated) response.

Comment:
This blog post reads like it was written by someone who's never read a book or an article on DID, who's never worked with people with DID, who's just making wild assumptions. There are people dx'ed with both DID and BPD. There are also people dx'ed with BPD who don't have BPD at all, but have DID. You also make no mention of PTSD which all DID patients have, but not all BPD patients have. Look at somewhere that actually treats DID and PTSD specifically like the trauma Ward at Sheppard Pratt. But your theories seem a little half cocked.

This is my response:
Fair enough - I've admittedly not had much experience with DID - however; allow me a belated response (apologies for the delay).

First, I was generally very impressed when visiting Sheppard Pratt in May 2012.  My impression was that they offer top-of-the-line treatment.

As for DID though, I have read a bit about it.  For a summary, I would see Prof. Rich McNally's book "What is Mental Illness?" from 2011, copyright, President and Fellows at Harvard College.

In short, the book explains right after the book Sybil was published, "from near-nonexistence, MPD spread throughout North America, with the number of diagnosed cases soaring to 50,0000."  And then the "epidemic of MPD ended abruptly" because a study showing that asking leading questions is more likely to "create false memories than to recover them" (Ceci & Loftus, 1994).

The book also reads "MPD therapists inadvertently undermined the credibility of their own field when they began helping patients recall alleged memories of satanic ritual abuse" (McNally, Remembering Trauma). And that the FBI failed to uncover any physical evidence of these types of abuses (Lanning, 1992).

Interestingly enough, stories about abuse and trauma Sybil herself endured were also unfounded.  What seems to be the (even more disturbing) truth is that Sybil sought treatment with Dr. Cornelia Wilbur, who appears to have implanted false memories with the (unwitting) use of leading questions and social positive reinforcement.  When treatment tapes of the sessions between Wilbur and Sybil were researched, convincing evidence of this was revealed.  The book also states "indeed, Sybil admitted in writing to Wilbur that she had manufactured her MPD symptoms."

As such, while the symptoms of DID are in the DSM-IV, this does not mean that the disorder is not socially constructed, at least for the vast majority of cases.

[By the way, I'm not saying that there was never an organic (non-socially constructed) case of DID out there.  Saying that 100% of DID cases are socially constructed is a bit like meeting 50,000 Elvis impersonators in the year 2013 and then concluding Elvis Presley never existed. It stands though, that the ratio of hypothetical Elvis impersonators to Elvis Presley himself is still 50,000:1.] 

If someone presents with a case of DID, undoubtedly the situation is severe; however, I would argue that give the citations provided above, the idea  that the etiology (or cause) of the disorder is organic seems dubious at best.  Of course, understanding etiology is extremely important for treatment - especially if the treatment itself is indicated as a possible cause of the disorder, as was in the case of Dr. Cornelia Wilbur and Sybil.

For the cases that are not organic, but socially-constructed - which the evidence seems to suggest is most of them - perhaps a BPD identity disturbance / delusional quality may be present.  That's all.

Sensory Integration and Self-Injury

I spent the last semester working with children who have autism.  During this time, I heard the term "sensory issue" a bunch of times, but had no clue what it really meant.  Even after asking questions about it, I never felt like I really understood it.

I ended up learning the most about sensory integration issues at an unsuspecting event - at a writer's conference in NYC.  There, I so happen to have met Nancy Peske, the co-author of the book, Raising a Sensory Smart Child, and a mother of a child with the conceptually elusive sensory integration issue.  I figured she'd be the perfect person to ask about this stuff.

I ended up learning that some people are prone to either seek out intense stimulation or find even the most mild sensations aversive.  For instance, some children have an extremely high tolerance for what would cause most of us pain.  Conversely, the same child may find light tickling painful or aversive.  Although many people with autism have these types of sensory integration issues, we also see this in people who don't happen to have autism.

Relevant to my past research, we find that children who engage in self-injury are more likely to have a high pain tolerance and engage in repetitive behaviors.  While we previously thought that having a high pain tolerance was caused by repeated episodes of self-injury, I'm wondering if actually there is an underlying sensory integration issue here.  [In fact, we're finding that the traditional tolerance theory is not supported.]

On top of that, we have been conceptualizing repetitive behaviors as a precursor to self-injury; however, now I'm thinking that perhaps they both emerge out of the same sensory integration issue that may have been present from before / soon after birth.

And speaking of birth, in Deliberto & Nock, 2008, we report that in utero complications are seen more in children who engage in self-injury than in controls.  Like repetitive behaviors and in utero complications, these findings are also seen in people who have autism.  Although these data are correlational, the relationship among in utero complications and repetitive behaviors, self-injury, and autism is worth considering in my opinion.

In short, I'd bet that both self-injury and some of the underlying commonalities between this behavior and autism are sensory integration issues relating to touch.


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Why Do People Talk about Cutting Themselves?

I just received the following inquiry: I know some one thats very public about cutting themselves. Is this normal? And why do you think this is?

Here's my answer:

Good question. Although I cannot assume I understand this specific person, I can speak generally about the topic of openly discussing one's own self-injurious behavior.

My first inclination is that the person may be seeking what we call "social reinforcement." There are two types of social reinforcement - positive and negative.

What we call "positive social reinforcement" is what people not in the biz call "getting attention." This would come in the form of sympathy, interest, concern, or even people expressing shock. Particularly if a person feels disconnected / a lack of social support (and want these things), they may be prone to be seeking interaction with other people in this way.

So what we call "negative social reinforcement" does actually not mean punishment. In my experience, people in the public misuse the term "negative reinforcement" quite frequently. Negative reinforcement simply means to remove something aversive or to get out of a responsibility. For instance, an adolescent working on a boring group project might tell her peers that she's a "cutter" so they put less of a workload on her. In this example, if the teen gets out of doing something boring, she is negatively reinforced for telling people she cuts.

This brings us to an interesting point. It is my opinion - which is not shared among people with whom I've worked - that when people are socially reinforced (either negatively or positively) for telling people they self-injure, it isn't necessarily the cutting itself that is affected. What I think is more influenced is the actual disclosure of the behavior. This would mean that if someone is socially reinforced for telling people they cut, the actual act of cutting wouldn't necessarily increase, but the number of times self-injury is discussed would increase. To be crystal clear, I think that social reinforcement may shape the largely impulsive behavior of cutting itself, but not as strongly as the seemingly more deliberate act of discussing the behavior.

It is my opinion that people primarily engage in self-injury for emotion regulation purposes. In other words, to decrease their anxiety or to pull them out of a disoriented state (to learn more, I posted a link about this at the bottom of the page). It doesn't make sense to me that people engage in self-injury just so that they can receive attention for it later. My intuition tells me that the reinforcer of social approval is too far removed from that actual act of cutting to be incredibly potent. To my knowledge though, no research has been conducted to support this. In fact, self-report studies show that people report thinking they engage in self-injury to gain approval, therefore, it is advisable to take this into consideration when considering the thoughts previously expressed.

Perhaps self-injury can start out so that one may gain approval (positive social reinforcement) or even get out of something (negative social reinforcement). It could also be the case that someone starts cutting just for the emotional effects, but then starts telling people about it. I just can't buy into the idea that the only reason someone would cut is for social reinforcement.

Anyhow! I digress. Back to your question. It could be the case that this person is trying to connect with people, shock them, or remove his/herself from responsibility. On the other hand, perhaps he/she is just trying to work through previous shame about the behavior and finds it liberating to talk about it. I really don't know. But these are my best guesses!

Speaking to your question regarding whether or not it is normal: based on no data but my experience, about half of people who cut themselves report telling other people, while the other half don't tell anyone but maybe a mental health professional. While I'm not sure how normative it is for people to talk at length about their self-injury, I have some thoughts about this.

We can't make assumptions that talking about engaging in self-injury is necessarily a maladaptive / bad thing. For instance, perhaps the person will end up getting into the right treatment and get support for stopping the behavior. And as previously mentioned, perhaps the person used to feel much shame about the behavior and is working through it by speaking about cutting. Who knows?

On the other hand, one could make the case that if the person is socially reinforced for disclosing that he/she self-injures, the behavior could be maintained. I'm just not sure exactly why this person may be openly discussing engaging in self-injury.

As you can imagine, it is quite complicated!

Great question though. I've never been asked this.

To read more check this out: http://taradeliberto.blogspot.com/2011/02/why-do-people-cut-themselves.html

The Evolutionary Reason We Obsessively Check Facebook

Today's topic is how we're evolutionarily programmed to obsessively check Facebook.

Let's just say that you log on to Facebook and get a good laugh out of a friend's status. You log on a few more times that day, but nothing is interesting. But of course, before going to bed, you log back on one more time just in case. And lucky you - you get another late night chuckle.

First, in this little story, the funny statuses play the role of the reinforcer. Second, the fact that you never know when someone is going to write something clever makes the reinforcer intermittent - or, in other words, random. Put them together and what do you get? A little term us psychologists call intermittent reinforcement.

So the interesting thing is this: when we are intermittently reinforced, we tend to display obsessive behavior (e.g. gambling). Following the rule that intermittent reinforcement leads to obsessive behavior, in this example, never knowing when you're going to read something funny partially explains why we tend to check Facebook all the time as a species. [We also find humor, human interaction, and gossip particularly rewarding.]

So what may the evolutionary advantages to intermittent reinforcement be? Well, I'm not sure if there are too many evolutionary advantages to obsessively checking Facebook, but there certainly are for the underlying mechanism.

Specifically, I was thinking that animals may have evolved to become sensitive to intermittent reinforcement because if we become more persistent in the face of scarce reinforcement / resources, we may increase our chances of success.

Let's consider the definition of perseverance: steady persistence in a course of action, a purpose, a state, etc., especially in spite of difficulties, obstacles, or discouragement.

In that definition, if "difficulties, obstacles, and discouragement" is conceptualized as a lack of reinforcement, then "persistence in a course of action" can be viewed as the somewhat obsessive behavior seen when intermittent reinforcement is given.

While perseverance (with a positive connotation) is readily associated with success, before today, I never considered perseverance as the behavioral result of an environment that is intermittently reinforcing. I'm guessing that will power comes into play too... but honestly, who really knows?

Now, while being sensitive to intermittent reinforcement may be helpful for us to persevere when times are tough, this tendency likely shaped by evolution won't serve us well in every scenario.

There is definitely a darker side to all of this. For instance, if you're more sensitive to intermittent reinforcement, you might be more inclined to stay in a roller coaster relationship, become a compulsive gambler or get engrossed with more trivial matters to increase your mood (e.g. check Facebook more times than you'd like to admit).

We typically think about engaging in these types of activities as a means to avoid feeling negative emotions like boredom, sadness, etc. It may certainly be the case that we engage in behaviors like obsessively checking Facebook to both avoid life and gain pleasure. At the same time, the obsessive nature of Facebook checking may be attributed to the underlying process may be one of intermittent reinforcement.

On a related note, rather than viewing psychopathology in terms of reward sensitivity, I wonder if sensitivity to specific types of reinforcement (or "schedules" as we call them) matters. Namely, sensitivity to intermittent reinforcement may be at the root. Food for thought.

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[And some food for later thought: perhaps this whole idea of valuing one's own naturally persevering nature somehow relates to asceticism. Together they combine to a pretty intense personality that is sensitive to reward.]

Teaching a Little Guy to Recognize Emotion

Here on this rainy lazy Sunday in NYC, I was drinking my usual morning green tea and thinking about the cases I've seen of alexithymia - or the inability to recognize emotions - in children.  What do we do about alexithymia?  Well, definitely the usual stuff like playing games like emotion charades where we have to guess what emotions / feelings we're acting out, practice problems solving / acting out solutions to various conflicts, etc.  But what else?

Here's a made up case to illustrate my thoughts:

Let's say that I'd been treating a 8 year old boy with alexithymia with the usual techniques until one day his mother asked to talk to me womano-a-womano.  She says that he doesn't understand important feelings she has about a specific family situation and takes the opportunity to tell me about her emotions.  So I go into session and directly discuss what mom might be feeling in these tough family scenarios.  The boy is surprised to learn how she might be feeling and feels a bit badly about his behavior.  Then we discuss what he can do differently in the future that takes his mothers emotions into consideration.  During the next week's session, mother reports that the boy was appropriately attentive to her from the moment they left therapy and throughout the entire week.

Now, even though our hypothetical session - that is a hybrid of multiple sessions with various patients - apparently produced the most effective behavior change outside of session, it was probably the most (mildly) aversive session we ever had.  Compared to past sessions where I have been teaching through games, this was no walk in the park.

During a game like emotional charades, the emotions remain impressionistic by nature. So where do we go from there? Sure this may be a good starting point and we also spend some time discussing issues that are upsetting outside of the session, but what about evoking real emotion in session?

By discussing the feelings that his mom might have, a little light bulb went off in his head.  He first reported feeling sad, but after some pressing, he also reported feeling a little bit guilty about his lack of attentiveness to his mother. After all, we are talking about a very kind child, here.

Notably, those emotions of sadness and guilt were freshly created as a direct result of newly learned content in the session. These emotions were not re-conjured from past events outside of session, nor impressionistic. Something to think about.

Because this session was mildly aversive though, my concern for next week was that he would not want to come back. After all, in his mind, we typically just play games. (Sure, these techniques can produce some change, but it is my opinion that they remain surface.)

Flying in the face of my nagging worry, this little guy was actually quite eager to return to session the following week. I suppose that I'll never be sure as to why. We can only speculate that perhaps it was because of a long standing therapeutic rapport and a learning history that coming to therapy is fun. A second option is that he did not experience the sadness and guilt intensely enough for it to deter him longer term.

But what about the results of Walter Mischel's studies?  We know some children can appreciate something more aversive & meaningful in the long-term, but not a barrel of laughs in the short term. 

Maybe this little guy appreciated learning something new and subsequently having his environment change.  After all, mom did say things were much better at home following that session.

Who knows?

To summarize, there are three ways of dealing with emotion in session:
1) evoking then processing new emotion in session as a result of new information / insight
2) rehashing previously felt emotion
3) creating impressionistic expressions of emotions

Maybe #1 is preferable.  Something to think about.

That "Gut Feeling" is Actually in Your Gut

I'm spending this particularly sunny Saturday in Manhattan doing some literature reviews near an open window overlooking people eating at an outdoor cafe`on 3rd avenue. Unbeknownst to them, I've been watching and wondering about the connection between the food they're eating, their bellies, and their brains. I know I shouldn't get derailed from finishing my work, but I couldn't resist writing this post.

I just came across a review paper called "Gut feelings: the emerging biology of gut-brain communication." Cool stuff. Apparently, there has been talk since about 1850 of a nervous system I've never heard of before: the enteric nervous system (ENS). Technically, it is considered the 3rd branch of the autonomic nervous system, which I'm certainly familiar with, but still! The ENS seems a bit too important for me to have been enveloped in the field seven years before learning about it. It could just be me... but I'm guessing the folks in psychology are not all that knowledgeable of the ENS.

That being said: the ENS, - or the interaction system between the brain and the gut - is referred to as the 'second brain' because it is similar in complexity to the one we have in our heads. It turns out that the second brain may have a pretty big impact on emotions, motivation, and [get this] intuitive decision making. In other words, the gut is quite literally involved in making gut decisions.

Who would've thought? Actually, the guy who coined the phrase "gut feeling" may have.

Consider the fun little notion that maybe we have been able to identify that intuitive decision making comes from the gut all along, without ever having scientific evidence. I love the idea that purely being mindful of your own physiological sensations can be an accurate source of information. How incredible.

Another interesting piece of knowledge this article has to offer is this: disruption of the ENS is associated with inflammatory gastrointestinal disorders, obesity, and eating disorders. To me, this certainly makes a lot of sense!

Specifically relating to over-eating, the paper proposes that the underlying biological mechanism is the mismatch between the big expected reward from eating food, and the relatively small actual reward experienced. The idea is basically that people keep thinking they are going to really enjoy food, are left unsatisfied, and keep coming back for more. While this may certainly be a big part of the picture, I have some other ideas about this... Something to think about for later.

Reference:
Mayer, E. (2011). Gut feelings: the emerging biology of gut-brain communication. Nature Reviews, 12, 453-466.

Near Death Euphoria and the Link to Suicide

I was asked by a friend if I ever came across someone who attempted suicide not to escape suffering, but because they knew it would feel good.  Although not suicidal, the person asking the question was curious because he had experienced a near-death situation in which he was injured and felt euphoria.

I thought this was a really thought-provoking question. The link between near-death euphoria and suicide never crossed my mind before.

This was my response:

I have heard of people recounting similar types of experiences, but I had never considered the link between near-death euphoria and the intention to commit suicide.

A brief discussion of Thomas Joiner's theory of suicide is in order. The basic gist is that people may build a tolerance for the negative feelings associated with hurting / killing themselves by engaging in self-injurious or thrill seeking activities. While it is not necessarily intentional, the negative feelings about death may lessen over time.

Let's just say a person regularly sky dives. Then, for whatever reason, they become suicidal. If you're already used to jumping out of planes, the idea is maybe you won't be that scared to jump off of a bridge.

There is another relevant example to this discussion as well. Namely, if a person regularly cuts themselves (without intent to die) when they're upset, they may not be scared to make life-threatening incisions when suicidal urges come up.

While I formerly thought of this concept as similar to "building up the courage" to attempt suicide via repeated episodes of cutting / dare-devil behavior, this question has me thinking differently. Perhaps there is an additional component here that is consistent with Joiner's theory.

When people cut their skin with no intent to die, it is thought that endorphins are released. This would create reduction in the negative feelings that may prompt self-injury, like shame, anxiety, sadness, etc. Perhaps people also feel mild euphoria, or positive feelings, from the endorphins. This might suggest that for some, self-injury has at least two psychological functions - reducing negative feelings and increasing positive feelings - perhaps produced by the same biological mechanism (i.e. endorphin release).

In any event, a link between injuring oneself and feeling good is formed. Maybe this association generalizes to suicide in the sense that injuring yourself is linked with feeling good.

Now, getting more to the point of suicide, endorphins are not only relesaed during self-injury, but during a traumatic / near-death event as well. This is very interesting to me because a link can be formed between feeling good and death, specifically. In the sky diving example used above, an association is formed between feeling good and jumping from a height, but not necessarily death. In the case of a traumatic event, the link is formed between feeling good and specifically being near-death.

While people may not report chasing the feeling of euphoria that comes with being close to death, if they've experienced it, the drive for this positive feeling could theoretically propel future suicidal behavior. Whether or not the person is aware that they are driven to suicide because of past feelings of euphoria when close to death, it could be a biological function maintaining the behavior.

In short, while I had formerly thought of suicide as a behavior maintained by the function of wanting to escape pain, this point raises the question of whether or not people want to commit suicide to actually feel better. Again, while I don't think people would necessarily report wanting to die to feel that euphoria, it could influence their suicidal drive and behavior.

[For people familiar with psychology lingo on this blog, the function may not necessarily just be automatic negative reinforcement, but automatic positive reinforcement as well.]

Truly, a fascinating point. Thank you so much for asking.

For more posts, check out The Psychology Easel and follow me on Twitter at @TaraDeliberto.

Is There Anything to be Learned from Freud's Oedipal Complex?

Ever wonder if what happened between Oedpius and his mother could happen in real life? Well, apparently it can. And there is a name for it: genetic sexual attraction.

Genetic sexual attraction occurs when genetic relatives meet for the first time in adulthood and an attraction develops. Although it is a rare occurrence, there has been an increase in the number of reported cases in recent years, typically as a consequence of adoption (according to Wikipedia).

I'm no fan of Freud, but it kind of makes me think.

It should definitely be noted though, that for the vast majority of people, it is thought that living in close domestic proximity as children become desensitized to later attraction. This hypothesized phenomenon is known as the Westermark effect. It only pertains to children being raised together, and does not take into consideration whether or not they are genetically related.

I'm not so much wondering about whether or not there is unconscious attraction between members of domestically-cohesive family units in the way Freud talked about it, but how the concepts of both genetic sexual attraction and the Westermarck effect can relate to normative relationships.

Sure, there have been documented accounts of attraction in types of incestuous relationships, but this certainly isn't the norm. Nor do I think this is due to under-reporting! And no, I'm not so sure that a lack of awareness of unconscious motivations is the reason either.

I think it might go something like this:

The Westermarck effect occurs for most people, but there might be a genetic reason why it doesn't kick in for some. I'm guessing this might be the case for the people in a documentary I watched - two genetic siblings who were raised together, eventually developed a relationship and started a family. [What was your physiological reaction to that little story? That's your Westermarck effect in action.]

So while there are probably genetic components coming into play when we see a lack of Westermarck effect, I'm guessing there might be some environmental components at work as well. I'll spare you the details of my thoughts about this, though! Suffices to say that there is usually a mix of genetics and environment resulting in any behavior - normative or not. [Basically, I'm guessing certain conditions can prompt this behavior. I also think that a lack of development of the Westermarck effect could be observed in people who are attracted to people in roles similar to that of a parent (e.g. the classic example of women without a father figure dating a much older man).]

Ok, so while the Westermarck effect (and any generalization about attraction to people in parental roles) may be the norm, what about the genetic sexual attraction sometimes seen in some people who are adopted?

Well, despite the popular cliche` that opposites attract, I'm not so sure. I've certainly come across research saying that people tend to pair off who are similar across many different areas. As you've probably experienced, bonding can occur when you have similar thoughts to someone else. Sure it would be boring if you were exactly the same, but I'm guessing you're probably more similar to the people you're close with than different.

Basically, if you're genetically similar to someone that you meet in adulthood, you could actually be very similar to them, being that genetics play such an important role in personality formation. An account from an adopted woman about her eventual relationship with her genetic father, described a close bond forming because she was more similar to him than anyone she had ever met.

In short, I don't think that we all have suppressed genetic sexual attraction - probably due to the Westermarck effect developing (and most of the time generalizing to people in similar roles). I'd imagine that people are simply attracted to people who directly or indirectly validate them because of similar attitudes.

For more posts from The Psychology Easel, visit the homepage.

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As a side note: the problem of marriages or relationships going stale because more of a sibling relationship can develop, may be an interesting generalization of the Westermarck effect. I wonder if some have a stronger inclination for this effect (perhaps couples with a lack of sex drive). It may also have something to do with early development. Different types of effects could theoretically occur (e.g. quick forming attraction and then the Westermarck effect kicking in). Who knows? Something to think about.

Self-Injury as an Inborn Fail-Safe

Where do we get the idea to eat or have sex? Maybe we don't. As Pinker argues, we're not a blank slate. Perhaps the impulse to engage in self-injury when under extreme emotional distress is also inborn.

We are starting to understand the havoc stress wreaks on the body. We are also starting to understand the strong endogenous physiological calming effect self-injury prompts.  In this context, I wonder if self-injury acts almost like an inoculation - when given a small amount of manageable physical adversity, the body's soothing and contentment system is able to overcompensate and fortify itself. Maybe the body intuitively knows to default to self-injury under periods of stress because there are dramatic and sudden decrease anxiety due to increases in endogenous calming agents, being that stress is particularly harmful to the body. [There's something about stress triggering autoimmune diseases here that should be looked at. Perhaps it isn't a coincidence that Benadryl can be used both as an antianxiety as well as an antihistamine.]

After all, humans are not the only animals that engage in self-injury (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486411/). My first published study (cited in TIME here) mentions that a certain percentage of people report getting the idea to engage in self-injury from an outside source; however, the other side of that is that some people report never having learned the idea from anyone. Perhaps it is, in fact, an inborn impulse we have that is defaulted to in times of stress because it is protective to the body against stress. This is not to say, of course, that some people don't get the idea to cut from other people. Surely this must be the case. But what about the people who spontaneously start cutting without outside influence? How can that be explained?

I'm beginning to think that the impulse to hurt oneself is a hardwired fail-safe.

Is Multiple Personality Disorder Real?

Although it is very rare, early in my career I met two (different) people with Dissociative Identity Disorder (DID; formerly known as Multiple Personality Disorder). The first person I met with DID was a patient at a clinic in Harvard Square, where I was conducting research. Over the course of my two years there, I watched her slowly unravel from displaying one personality to many. By the time I left, she had the voice and demeanor of a seven year old child. Frankly, witnessing this was quite unsettling.

The second person I met with DID was in the psychiatric emergency room at Massachusetts General Hospital, where I was working on another study. I remember the conversations amongst the staff about her case well - some thought she was faking it, while some thought a diagnosis of DID was legitimate.

In short, this is what I think:

People with Borderline Personality Disorder, which is characterized by self-injury, suicide attempts, extreme mood swings, and stormy relationships also has another very important feature that is often less discussed - identity disturbance. Basically, very different personae are displayed depending on the situation. As Kiera Van Gelder describes in The Buddha and The Borderline, a memoir about recovery from this disorder, she would be a hippie one day and a goth the next if it would get her the sexual attention she wanted. In other words, she would drastically change her personality from day to day (in this case, it was for social approval).

The problem is this: A therapist looking at someone who is a goth one day and a hippie the next might conclude that these are just various forms of the self that need to be expressed. (Yikes!)

While chameleoning can be viewed as adaptive in a sense, the person with BPD / identity disturbance seems to be paying little attention to whether or not they actually enjoy a given activity they are engaging in for social approval. Often, people use these different personae as a tool - and a tool only. The who acts as a hippie today has no real affinity for hippie culture in itself. Expression of one's "hippie side" is resoundingly not to be encouraged.

Introducing certain types of therapy that emphasize different parts of the self to people who already have identity disturbance, may cause further polarization. The patient may be reinforced for behaving in certain ways and expressing themselves from various personalities. Hence, the development of DID. Without a question in my mind, this is what happened with the first patient with DID I watched unravel - she initially had a diagnosis of Borderline Personality Disorder (w/ the identity disturbance feature) - and in two years time (after "parts therapy") she had multiple personalities.

People with identity disturbances crave belonging and unity of their behaviors by definition. Slapping a label of DID on someone who is desperately trying to figure out who they are is dangerous. The person knows that a lot effort needs to be put in to establish a sense of self. These uncharted territories of not living for social approval are scary. This unifying label is an excuse to avoid all the anxiety that will come with establishing a sense of self. It is easier to exaggerate the different forms of self that already exist and diverge further.

In the effort to display many personalities, a unifying role of being an interesting patient is maintained.

While the presentation of someone having several personality disorders is certainly real, I highly doubt this is organic. It seems to me that this disorder is related to the same underlying identity disturbance seen in Borderline Personality Disorder. In fact, I'd be willing to bet that a very large number of DID cases are really Borderline cases gone horribly astray due to treatment with talk therapies that have not been supported by research.

I'd also like to add that after having worked with people who have schizophrenia, there is a definite psychotic flavor to DID as well. My gut feeling is that the core underlying feature is the identity disturbance seen in BPD on top of a psychotic tendency to believe what the mind is constructing. It is these two underlying features that combine to the expression of different personalities. In no way do I think there are actually two different personalities encased in one person. In short, I'd reason that DID is simply a specific form psychosis with the core BPD component of identity disturbance.

In treatment, instead of focusing on expression of various external presentations, focus should be on developing a sense of self. Figuring out what the person likes independent from the approval or opinions of others seems vital.

Lastly, unlike depression or anxiety, there is an ego-syntonic feel to multiple personality disorder. In other words, people like having the disorder to some degree and want to continue any associated dysfunctional behavior. Another example of ego-syntonic disorders would be anorexia, where people typically want to continue restricting food intake. In the case of DID, people want to keep their multiple personalities, as they are potentially useful in different circumstances. As such, the expression of different personalities should be particularly discouraged by all staff members at a facility once rapport has been developed and treatment is underway.

The Relationship between Negative Thoughts & Serotonin

I'm happy to be a member of an online community where some intellectual forum discussions are generated. In this setting, a question was posed to me pertaining to the relationship between negative thinking and serotonin from Scott in Auckland. Since other people may be curious about the same topic, I thought I'd post my response here.

Reply:
I absolutely love this question! The interplay between what we do as psychologists and biology is one of my favorite topics. How we are trained through all of our collective learning experiences to think - and more specifically, appraise, evaluate, and interpret - has a direct effect on our physiology and biology.

For those of you not familiar with Cognitive Behavioral Therapy (CBT) it involves very active Socratic questioning on the therapists part about thoughts the patient currently has. This type of therapy is in stark contrast to old-fashioned Freudian type therapies that mainly just involve combing over events of your past. If a patient comes into my office and says "I'm a loser," my response would be "Oh, yeah? It must stink to think that. But what is the evidence that you're a loser?... Have you ever won anything?... Even if you are a loser now - whatever that means - will you always be a loser?" etc.

After all this questioning, we usually end up laughing together about what I ridiculous statement "I'm a loser" really is and how true it can feel. Through this process, the rift between what our mind thinks and what is actually true is created. After the initial separation between thought and belief is fostered, we go come up with rational responses to these types of negative automatic thoughts like "I'm a loser" and practicing mentally rehearsing the rational responses as homework.

So, that is a brief description of the cognitive piece of cognitive-behavioral therapy. Interestingly, the behavioral piece has been shown to be more effective than the cognitive piece at changing the interpretation of thoughts. Let's take, for example, someone who has social phobia. You can tell them that their phobia of talking to other people is silly all you want, but they still may not believe you. The best thing to do is act.

We start small. I might grab the secretary into the therapy room and ask her to have a 5 minute conversation about something like traveling with the patient. After five minutes, the secretary says it was lovely chatting and leaves. Now, that wasn't so bad was it?

Then as homework assignments, the patient is to engage in social activities, starting with a small anxiety producing task, and working their way up to doing something very scary like public speaking, over the course of weeks. In this way, their own thoughts are directly challenged by the outcome of their behavior. They always think it will be worse than it ends up being. In this way, they engage in little "behavioral experiments" that directly test their maladaptive beliefs.

It is worth noting here that while the behavioral piece has been shown to be more effective, people may not be willing to engage in the behavioral piece without both a strong rationale for it. It is my opinion that going through the cognitive part of the therapy and disputing thoughts that automatically pop up is an extremely useful first step that must be taken with a vast majority of people before jumping into the behavioral piece. In fact, a client of mine expressed this sentiment completely of her own accord to me today.

While we have discussed both the cognitive and the behavioral piece at this point, there is a third very important piece that changes our relationship to our thoughts - Eastern mindfulness practice. Learning to be aware of our thoughts and release the less useful ones is extraordinarily helpful as well. As a side note, I practice letting go of thoughts every day during yoga, which I use as a moving meditation more than exercise. '

I'll talk more later about integrating these components of treatment, but for now, back to your question! There have been many studies showing that CBT is as useful as treating depression as antidepressants; however, CBT has the added effect of continuing to work even after treatment ends. In terms of whether or not it increases serotonin in the synapse, there are huge ongoing clinical trials in the U.S. examining this right now. So far the evidence points that learning to regulate your emotions through these types of treatments does effect serotonin.

Here's a link to clinical trial information.

The First and Ultimate Primary Emotion - Fear

A member of an online community to which I belong posed this very interesting question to me on a psychology thread: Could fear be the origin of the entire spectrum of human emotion?

My answer:
Very thought provoking question. Fear is certainly what we consider a primary human emotion (among other emotions, e.g. happiness, anger, and sadness). Thinking about fear as the first emotion to appear in living things evolutionarily though is interesting.

[When we talk about origins, there are two types: a single person's individual origins and evolutionary origins. Being that each person comes into the world with a complex nervous system, it doesn't make sense to think of fear as being each individual's ultimate primary emotion. Considering this question in an evolutionary sense is far more interesting.]

In an evolutionary sense, fear is - of course - vital. Fear as a threat detection and deflection system certainly seems to rank #1 in terms of importance.

In fact, earlier in the thread in which this blog post originated, I discussed Kandel's Nobel Peace Prize winning work on the "memory" of slugs. The response that sea slugs can "remember" to recoil after being pinched in the gill is certainly very interesting. While this borders on what may seem like a classical conditioning response, there could be the beginnings of fear like responses here. [In terms of fear and how it relates to memory, it may be interesting to note here that fear evokes a release of calcium in the brain that leads to highly ingrained encoding of information.]

Although Freud might have said that sex drive is more primary, I'm not so sure. Perhaps fear responses were actually first to develop evolutionarily and reproduction urges (which aren't really emotions anyhow) came about later. But sex, and it's relation to love, seem way more advanced than fear. As far as a sea slugs is concerned - it is a hermaphrodite so a drive to (at least) seek out sex probably isn't that developed.

Along with sex, maybe other positive emotions simply aren't as necessary from an evolutionary standpoint. In fact, maybe emotions from being comforted and soothed developed after fear as a way to reduce and control it. Paul Gilbert Ph.D. talks about the importance of the physiological Soothing and Contentment System - but soothing from what? My guess is anxiety / fear - which was on the scene first.

Along with positive feelings of being soothed, exhilaration or happiness might also be linked to fear. Just think about the last time you were on a rollercoaster. Since the feeling of fear seems more important than exhilaration, it may be the case that feeling exhilaration developed out of the fear system.

[Hm - just had a thought about bipolar disorder and the sadness and happiness responses being a result of a dysregulation of anxiety systems, one that leads to prolonged depression and the other that leads to constant exhilaration. Anyhow - back to the original question.]

After talking about some positive feelings and the link to anxiety, let's consider anger. We know that someone's "threat detection system" is activated when they're angry. In other words, they may feel anxiety, and anger is the motivator to act. Therefore, the argument could be made that anxiety is first and anger has developed secondarily in the more advanced fight or flight system. We now have two options in response to anxiety: fight (anger) or flee.

Ok, now let's shift from talking about fear arising first on the evolution scene, to fear underlying our everyday experiences now.

For fun, let's consider the link between fear and depression as a psychiatric disorder. When first reading this question, my mind immediately jumped to the link between these two things. Prolonged fear / stress releases enormous amounts of cortisol, which impairs the functioning of the brain (for the scientifically curious - along the Hypothalamic Pituitary Adrenal axis) and leads to depression. Therefore, prolonged fear / stress is experienced first, and we think this is one route to depression.

Now, I realize depression is a psychiatric disorder linked to sadness, but it is not sadness itself. Therefore, saying fear always prompts sadness would not be a logical inference per se. On the other hand, these symptoms may be intimately linked whereas fear sometimes comes first. For instance, one may experiencing horror at the loss of a loved one first, and then deep sorrow. Typically people don't go straight to sad. There is usually shock (perhaps an anxiety response) and then sadness kind of sinks in either seconds, minutes, hours, or days later.

Flipping back into evolutionary terms, it seems that sadness is quite an advanced emotion compared to fear. While I can imagine an insect having a developed reactionary response with the rudimentary beginnings of a fear system, I can't necessarily picture a sorrow system.

In short, I think the case can be made that fear (as it stems from stimulus / threat detection) may be the ultimate primary emotion.

The Next Evolutionary Step for Humans

by Tara Deliberto

Recently a friend asked me what I thought the next evolutionary step for humans would be. My answer: the ability to be mindful. Most of us go through life without being present in the moment. The ability to have awareness of our own thoughts opens the door for greater control. Afterall, medititation increases the very part of the brain that is newest on the evolutionary scene - the neo cortex.

A Remaining Thought on Control

by Tara Deliberto

Today my meditation and yoga teacher described that the point of the practice this: to use the mind to release the mind. I think that pretty much sums it up.

Yoga (and life) is learning to find the balance between effort and ease.

Control

by Tara Deliberto

While new Western treatments incorporating the use of mindfulness techniques have an emphasis on decreasing control, many practitioners and patients alike are confused by the apparent increase in control over thoughts and emotions it fosters.

By increasing one's awareness of the thoughts, bodily sensations, and interaction between the two, one creates distance between the mind and what is produced by the body. This naturally produces an increasing sense of mastery over the self, which in essence is control. If you are able to focus your attention on your left pinkie toe during a meditation, for example, you are absolutely controlling your thoughts.

Now, if meditation fosters control of the mind and has been shown by numerous studies to be extremely effective in treating psychological disorders, why is control generally considered to be a bad thing? Why do third wave treatments proudly claim to decrease control? Well, when people attempt control techniques such as forcefully suppressing thoughts or changing their environment in a service to avoid their emotions, it generally leads to more suffering. This type of control, which is likely mediated by absolutes or black and white thinking, is what I like to think of as ineffective control. It doesn't allow for the experience of emotions. This is what mindfulness-based treatments decrease. While people may actively try and control their experience by using alcohol to avoid emotions, for example, those who overuse this strategy and are labeled alcoholics are typically said to be "out of control." Used in this way, the phrase "out of control" implies a lack of mindful control over the attempts to ineffectively control one's emotions.

Conversely, learning to mindfully control one's attention has been shown to be a favorable strategy in coping with a very wide range of problematic behaviors. It also does not involve black and white thinking. There is an emphasis on being aware of one's thoughts, bodily sensations, and experiences, without actively trying to change what cannot be changed. The difference between trying to control one's experience through the suppression of emotions versus through active focus on present are extreme; however, (if you ask me) both are technically control strategies. The latter type of strategy though, leaves room for the experience of negative emotions and thoughts when avoiding them would lead to more struggling. This is effective and adaptive.

It should be noted, however, that avoiding negative emotions may be a very favorable strategy on some occasions - for example, a woman may avoid continuing to feel negative emotions brought on by an abusive husband by leaving. In my experience some mindfulness practitioners actually misapply the idea that one should experience negative emotion by encouraging clients to endure painful situations when in reality, their patients are actually avoiding another set of negative emotions such as loneliness or fear of the unknown. It is tolerance to this latter set of emotions that needs to be fostered. Eagerness in encouraging clients to experience any negative emotions must be curbed with reason and a careful examination of what types of emotions are functional to avoid. Strict adherence to any set of rules without individual reasoning is certainly not favorable.

In the literature and when discussing attempts to change one's experience from what it has been, I think techniques should be labeled as ineffective control strategies or mindfully aware control strategies on an individual and situational basis.

How We Value Money - Response to the Previous Post

A friend of mine recently had a very interesting comment on the last post:
You say that people assign a higher value to items once they own them. Could it be the opposite for status/striving items?

My response:
It makes complete sense that results could vary between studies where objects are earned versus given. My inclination is that some items without social status that are earned may actually garner more emotional attachment. For example, if a high school kid earned money to buy his own cheap car, he/she may be more emotionally attached to the car than a kid who was given the cheap car. On the other hand, it makes sense to me that if a person earns a particular object with the idea in mind that it will generate social status, they might value it less once it is attained. My quick thoughts on the reasons for this (that are actually clinical in nature) are that one may be jealous when seeing others with certain items and incorrectly assume that once they have these items, their jealousy will subside. In other words, there is an assumption that having certain items will create happiness (for example) because a lack of the items creates jealousy. Therefore, when the item is attained and does not provide the anticipated positive feelings, it may be emotionally devalued. At the core of the issue would be emotionality or perceived importance surrounding wealth. But I do realize that one can be goal oriented without jealousy. So if a person with a high desire for achievement were to attain a goal to buy a high social status item, they might be left feeling unfilled simply due to an insatiable drive for achievement. My guess is that people will have varying degrees of both jealousy and drive for achievement that will lead to different emotional valuations of both high and neutral status items.

In short, I would say that while emotional attachment might generally increase for items that were earned, perhaps it is a different story with earned items that an individual perceives to have social status when jealousy and drive for achievement are considered.

Monks & Money

by Tara Deliberto

The study of individual decision making is certainly incomplete without taking into account several elements of human psychology. Rather than thinking rationally about decisions to ensure a favorable outcome, people tend to make decisions without a rational foundation, often defaulting to a set of heuristics (Amir & Ariely, 2007). Without knowledge of these psychological components at work, risky or detrimental choices cannot be understood.

One of the most established phenomena in the psychology of human decision making is that people are generally loss averse. Not only do people feel negatively about loss, but losses tend to loom larger than gains (Ariely, Huber, & Wertenbroch, 2005). In other words, people view something as more valuable when they give it up than when they acquire it. Greater value is given to an item after it comes into one’s possession than beforehand. In a study conducted by Knestch (1989), the results showed that people were unwilling to trade the item they received, whether it be a mug or a candy bar, despite random assignment. While loss aversion has been found to exist with the exchange of goods in other studies as well (Kahneman, Knestch, and Thaler (1990), it has not been found to exist for the exchange of money or other goods that are used as currency (Heath & Soll, 1996, Thaler, 1985).

While a loss is inherently averse, it is subjective in that current endowment of both goods and money must be taken into consideration. For instance, the loss of a sandwich to a wealthy person is not felt as strongly as the loss of a sandwich to someone who is destitute. By the same token, the loss of $50 to a millionaire would be felt as less dramatically than a loss of $50 to a typical college student. This is known as the endowment effect.

Ariely et al. press the field forward by proposing potential mediators to both loss aversion and the endowment effect. First, emotional attachment goods may increase reluctance to part with them. In support of this theory, a study by Strahilevitz and Loewenstein (1998) showed that consumers adopt more ownership of items over time, providing support for moderation of loss aversion. Along with emotional attachment, Ariely et al. offer perspective change as a second mediator. While buyers are trying to minimize costs, sellers are trying to maximize gains. As a result, a price gap emerges. This gap is a product of the fact that people value items from different perspectives. In support of this notion, Carmon and Ariely (2000) have found that ticket sales to major sporting events depended on the manipulation of various benefits and opportunity costs, causing a shift in perspective about the purchase. In short, personal valuations of the monetary worth of products vary. Loss aversion could be mediated by one’s perspective of the good.

Furthermore, Dhar and Wertenbroch (2000) suggest that perhaps emotional attachment and cognitive perspective change could actually mediate the loss aversion for money. Although loss aversion has been seen to occur on a lesser scale than for money than goods, it is thought that cognitive allocation of money for certain goods could enhance loss aversion for currency. If the person’s perspective is that the money is to be spent on certain goods, feelings of loss over potential or intended goods may be felt.

While emotional attachment and perspective changes may very well mediate loss aversion and the endowment effect, another element of human perception of money particularly piques the author’s interest. Perhaps a mediator of the endowment effect for money could be the qualitative valuation differences of money. In other words, people place different levels on importance on money despite their current endowment. For example, the loss of $5,000 to a typical millionaire might be felt more dramatically than the loss of $5,000 to a hippy choosing to live on a commune who also happens to be a millionaire. The hippy may simply care less about money. Although their endowments are matched, they still may view the loss differently.

Perhaps this may partially be explained by a cultural overgeneralization of the value of the dollar. In other words, perhaps Americans tend to assume that other cultures may also highly value money. To demonstrate the point, an extreme example will be used: while many people in America strive to acquire wealth, Buddhist monks and people from communist countries, for example, place a very different personal value on currency. Although this concept is slightly similar to perspective change, Ariely et al discuss this potential mediator as short-term shifts rather than long-term persisting value differences. While they may be different constructs, perhaps perspective change and valuation are at opposing extremes of a larger unified construct of attitudes towards money. Furthermore, the construct of qualitative valuation differences of money is different than the idea of emotional attachment because it is not describing affection with a certain object, but a personalized concept of the importance of money. As previously mentioned, emotional attachment was only found with objects, not money. People who value money are not emotional attached to the money itself. An example of a group with a true emotional attachment to money might be coin collectors, while a group of people who think of money as important might be MBA students.

While it may be useful to utilize the example of Buddhist monks valuing money less than a typical American, it seems rational that varying degrees of qualitative valuations of money exist amongst Western people as well. The author thinks that differences in valuations are relevant because they have the capacity to highly impact decision making. Related to how one valuates money, may be irrational decision making. As a simple example, holding endowment constant, if one places importance on money itself, more of it may be saved rather than spent.

Other variables of interest might include the distinction between viewing money as a means to acquire goods versus a reward for work. It is the author's hypothesis that viewing money more as a reward than as a mean to acquire good would result in more conservative decision making.

An interesting study might assess differences in valuation of money amongst poker players and correlations to how they play the game. This particular subgroup was conceived as a sample for a hypothetical study because polarizations between placing high and low importance on money might be able to be studied in this population. Some may think of poker chips as directly relating to how many goods they are able to acquire, while other player may have more distance, and simply view the chips worth hefty amounts of money more as just small round discs of plastic. My guess is the players viewing money as chips may make more rational decisions in the game over time. While this doesn't exactly examine valuation of money, it may clearly depict how people make decisions based on how they perceive money.

Additionally, after this type of distinction is measured, a study might be able to code and quantify specific moves within a given set of games. Actual decision making regarding money could be observed this way. Perhaps there is a better way to execute the evaluation of the presence and socially relevant impact of varying valuations of money, but it is the author’s rough idea that poker players might be an interesting subgroup to study.

While the idea of individual valuation of money effecting decision making may seem reasonable, the author has not found literature on this topic. It was particularly surprising to find personal valuation of money was not mentioned anywhere as a potential mediator of the endowment effect. In short, research should be done in the area. First it must be determined if the phenomena exists. If it is found to exist, exploring it's role in decision making may provide useful insight into irrational and rational behavior regarding money.