Published by
Stanford Medicine


Behavioral Science

Aging, Behavioral Science, Neuroscience, Stanford News, Videos

Decisions, decisions: How our decision making changes with age

Decisions, decisions: How our decision making changes with age

Research in neuroscience, psychology, business and economics tells us that a plethora of influences can alter the decisions we make. The author explored some of these factors in a Worldview Stanford course and wrote about them in a Stanford story package, Decisions, Decisions. This post is part of a series on what she learned. 

Without revealing my age, I will simply say that I am beyond the teenage years, when risks fail to register and decisions are dominated by reward. But it turns out the person I was then shaped how my brain makes decisions today.

Kathleen Fitzpatrick, MD, a child psychiatrist, says that during our teenage years dramatic changes take place in the brain. Wiring we don’t use dies off and wiring we use heavily flourishes and multiplies, creating new connections and with it new behaviors.

In my story about how age alters decision-making I write:

During this time of brain circuit upheaval, adolescents weigh the pros and cons of decisions differently from adults. They overestimate the rewards of a decision (Fun! Friends!) but don’t accurately estimate possible risks (grounding, police).

Our teenage behaviors shape which of those new connections remain. If a behavior is rewarded, those pathways are strengthened. A failed behavior fades into a distant, embarrassing memory.

Read the story for more about both the teenage brain and also the way our decision-making shifts as we get older. Hint: we become less worried, which is something to look forward to.

Previously: Exploring the science of decision making and Exploring the intelligence-gathering and decision-making processes of infants
Video courtesy of Worldview Stanford

Behavioral Science, Chronic Disease, Health and Fitness, Medical Apps, Technology

Can cute cat texts motivate patients to take their medication?

Can cute cat texts motivate patients to take their medication?

Sammie resizedThe right kind of motivation is key when you have a difficult or mundane task at hand. For example, when I wanted to learn Spanish, I tried several top-rated, online language tools to no avail because they felt like work to me. Then, half as a joke, my boyfriend suggested an app that associates Spanish phrases with images of cats acting out the meaning of the words. The app was so silly I used it often, and — to our amazement — it actually worked.

So when I saw this story on MedCity News about a company that plans to use cat photos to motivate people to take their medicine, I knew they were on to something. As the story explains, the texts are part of an online assistant that will pair irresistibly cute cat images with health prompts so the reminders are memorable and fun.

The company, called Memotext, plans to pilot test this tool on Type 2 diabetes patients (followed by patients with other chronic illnesses) to gain insights on the patients’ state of mind when they skip or forget to take a medication. They also hope to learn more about what can be done to change patients’ behavior so they’re able to follow their medication regimen better.

“We’re not only asking whether you did something, but why did you do it,” said Amos Adler, the company’s founder and president. Based on what I’ve learned about motivation so far, I think a cute cat text or two probably can’t hurt.

Previously: “Nudges” in health: Lessons from a fitness tracker on how to motivate patientsStudy offers clues on how to motivate Americans to change and Understanding the science and psychology of how habits work
Photo courtesy of Anna MacCormick

Addiction, Behavioral Science, Genetics, Neuroscience, Research, Stanford News

Found: a novel assembly line in brain whose product may prevent alcoholism

Found: a novel assembly line in brain whose product may prevent alcoholism

alcohol silhouette

High-functioning binge drinkers can seem charming and stylish. The ultimate case in point: Nick and Nora of the famed Thirties/Forties “Thin Man” film series (you can skip the ad after the first few seconds).

But alcoholism’s terrific toll is better sighted on city streets than in celluloid skyscraper scenarios. At least half of all homeless people suffer from dependence on one or another addictive drug. (My Stanford Medicine article “The Neuroscience of Need” explores the physiology of addiction.) Alcohol, the most commonly abused of them all (not counting nicotine), has proved to be a particularly hard one to shake.

Alcoholism is an immense national and international health problem,” I wrote the other day in a news release explaining an exciting step toward a possible cure:

More than 200 million people globally, including 18 million Americans, suffer from it. Binge drinking [roughly four drinks in a single session for a man, five for a woman] substantially increases the likelihood of developing alcoholism. As many as one in four American adults report having engaged in binge drinking in the past month.

While there are a few approved drugs that induce great discomfort when a person uses them drinks alcohol, reduce its pleasant effects, or alleviate some of its unpleasant ones, there’s as of yet no “magic bullet” medication that eliminates the powerful cravings driving the addictive behavior to begin with.

But a study, just published in Science, by Stanford neuroscientist Jun Ding, PhD, and his associates, may be holding the ticket to such a medication. In the study, Ding’s team identified a previously unknown biochemical assembly line, in a network of nerve cells strongly tied to addiction, that produces a substance whose effect appears to prevent pleasurable activity from becoming addictive. The substance, known as GABA, acts as a brake on downstream nerve-cell transmission.

Continue Reading »

Behavioral Science, Mental Health, NIH, Public Health, Research

Developing certain skills may help you cultivate a positive outlook

34835574_9e61cfe6bb_zMany of us have heard that having a positive outlook on life can improve our mental and physical health. Yet, if you’re like me, you’ve noticed that it can be hard to focus on the bright side of things when you’re feeling anything but positive.

That’s why I was drawn to this article in the National Institutes of Health (NIH) newsletter. It discusses several NIH-funded studies on the topic and explains what it means to have a positive outlook and how a positive mood can affect your health. The really helpful information, from my perspective, is it also explains how developing certain skills, like meditation and self-reflection, can make you can feel more positive more often. From the NIH story:

Having a positive outlook doesn’t mean you never feel negative emotions, such as sadness or anger, says Dr. Barbara L. Fredrickson, a psychologist and expert on emotional wellness at the University of North Carolina, Chapel Hill. “All emotions—whether positive or negative—are adaptive in the right circumstances. The key seems to be finding a balance between the two,” she says.

The research teams used a variety of techniques to learn about the underlying mechanisms of positive and negative emotions and what it is that enables people to bounce back from difficult times.

Among those who appear more resilient and better able to hold on to positive emotions are people who’ve practiced various forms of meditation. In fact, growing evidence suggests that several techniques—including meditation, cognitive therapy (a type of psychotherapy), and self-reflection (thinking about the things you find important)—can help people develop the skills needed to make positive, healthful changes.

“Research points to the importance of certain kinds of training that can alter brain circuits in a way that will promote positive responses,” Davidson says. “It’s led us to conclude that well-being can be considered as a life skill. If you practice, you can actually get better at it.”

Previously: Navigating a rare genetic disorder with a positive attitudePromoting healthy eating and a positive body image on college campusesWhen life gives you lemons: Study suggests the benefits of a positive outlook are context dependent and The power of positive moods in improving cognitive function among older adults
Photo by: premasagar

Behavioral Science, Emergency Medicine, Health Disparities, Pain, Patient Care, Pediatrics, Research

Blacks, Hispanics and low-income kids with stomach aches treated differently in ERs

Blacks, Hispanics and low-income kids with stomach aches treated differently in ERs

crying-613389_1280When a child arrives in the emergency room complaining of a stomach pain, appendicitis is the last thing you want to miss, says KT Park, MD, assistant professor of pediatrics.

“The question is, ‘Does this patient have appendicitis – yes or no?,” he said. It is the most common immediate emergency that could bring a child into the emergency room with abdominal pain. If not treated in a timely manner, the appendix can burst, leading to infection or a host of other serious complications.

But kids arrive in the emergency room complaining of stomach aches all the time; most with perfectly healthy appendices. And what if you’re a doctor who has seen seven kids with more minor stomach problems one day? It might be tricky to spot that first case of appendicitis.

Unfortunately, misdiagnosis happens more often when the pediatric patient is black, Hispanic or low-income, according to a study published today in PLOS ONE led by Park and Stanford medical student Louise Wang.

“Our goal in this study is getting the word out about abdominal pain and appendicitis and the importance of the decisions made in the emergency room,” Wang said.

The researchers analyzed national data from 2 million pediatric visits to emergency rooms between 2004 and 2011 complaining primarily of abdominal pain. They found that blacks, Hispanics and low-income children were less likely to receive imaging that could help their physicians diagnose serious conditions like appendicitis. These patients were also less likely to be admitted to the hospital, but more likely to suffer perforated appendicitis, a clue that perhaps they didn’t receive adequate treatment in time, Park said. For example, low-income blacks were 65 percent more likely to have a perforated appendix compared to other children.

The study was not able to precisely determine why these disparities exist, Wang said. “What is the driving influence of these outcomes? Are these kids being mismanaged in the emergency department, or are they presenting at a later time in a more serious condition?,” she asked.

She and Park have a few ideas, based on other findings and their personal experience. Minorities and low-income families are more likely to use the emergency room as a first-stop for more minor conditions, rather than visiting their primary care doctor or pediatrician.

“This is a very delicate topic,” Park said. “Physicians are humans and there is potentially some intuitive thinking that goes on about the probabilities of various diagnoses more common in certain patient groups, potentially leading to differences in how clinicians perceive the acuity of a patient’s status.”

Appendicitis can be tricky to diagnose, a task made even harder when patients are young and unable to clearly describe their pain, Park said.

“The psychology of physicians is an area needing further evaluation,” Park said. “We have internal biases that we often are not even aware of. We want to be objective, but it’s never a black-and-white decision making tree.”

Previously: A young child, a falling cabinet, and a Life Flight rescue, New test could lead to increase of women diagnosed with heart attack and Exploring how the Affordable Care Act has affected number of young adults visiting the ER
Photo by amandacatherine

Behavioral Science, Genetics, Neuroscience

Wishing for a genetic zodiac sign: How much can genes really tell us about personality?

Wishing for a genetic zodiac sign: How much can genes really tell us about personality?

Brain MRIGiven all the recent news on how gene expression influences our brain, from Alzheimer’s to addiction and even our personalities, readers might come away thinking that we’re close to breaking the code and using genetics to understand why we behave the way we do. But, things aren’t that simple.

In a post on the science blog Last Word on Nothing, Eric Vance explores what getting your personal genetic sequence means for your personality – something he calls, tongue-in-cheek, “a genetic tarot card.”

Vance delves into an explanation of one specific mutation in the COMT gene. The gene creates an enzyme that neutralizes dopamine, a neurotransmitter. The gene comes in two forms, and the difference in these two forms is just one base-pair, the individual links in our DNA code. One version of the resulting enzyme is efficient at clearing away extra dopamine. But if the gene codes for the other version, “then the enzyme becomes a wastrel… Work piles up and the brain accumulates a bunch of extra dopamine.”

Because dopamine is such a powerful regulator of mood, and by extension personality, Vance then describes, in surprising detail, personality types he expects people with either version of the gene to have. But genetic information like this is meant to be used at the population, not personal, level. In fact, none of the people in his circle of friends who have had their genome sequenced turns out to be who he expects them to be (which begs the question, how many people does he know who’ve had their DNA sequenced?). Disappointed, he laments:

But that’s not how I want it work. While I don’t like the idea of boiling human emotions down to a couple squishy turning gears, I do like how tidy it is. I want to be able to look up my genome and make broad generalizations about myself. I want to have a genetic tarot card that I can inspect and say “ohhh, that’s why I always forget people’s names” or “that’s why I got in that fight in the third grade.”

Vance concludes, “But that’s not what nature gave us. Nature has given us messy, confusing and vastly complicated brains.” We are more, it turns out, than the sum of our base pairs.

Previously: New research sheds light on connection between dopamine and depression symptoms

Photo by deradrian

Behavioral Science, In the News, Research, Science

“Benign masochism” motivates common strange behaviors

"Benign masochism" motivates common strange behaviors

14674431439_be72558bd3_zI can recall many times I’ve offered something to a friend saying, “Smell this, it’s disgusting!” And more than once, the friend obliged. According to a National Geographic blog piece, the psychological motivation behind the appeal of stinky things is the same as the appeal of roller coasters, painfully spicy foods, and deep tissue massage. Likewise with reading sad novels or watching scary movies (though this last one is not something I personally enjoy). So what’s the common thread?

“Benign masochism,” a term coined by Paul Rozin, PhD, professor emeritus of psychology at the University of Pennsylvania, describes how humans enjoy negative sensations and emotions when they’re reassured that no harm will come to them. A “safe threat,” in other words.

The blog post is centered on our enjoyment of disgust, inspired by the massive audience at a recent blooming of a corpse flower at UC Berkeley’s Botanical Gardens. Valerie Curtis, PhD, a research director at the London School of Hygiene and Tropical Medicine and Psychology Today’sDisgustologist“, is quoted as saying the phenomenon is not dissimilar from kids playing war games in which they can “practice” their reactions to unpleasant situations.

“The ‘play’ motive leads humans (and most mammals, especially young ones) to try out experiences in relative safety, so as to be better equipped to deal with them when they meet them for real,” she says. “We are motivated to find out what a corpse smells like and see how we’d react if we met one.” Gross!

Previously: Looks of fear and disgust help us see threats, study shows
Photo by Dave Pape

Autism, Behavioral Science, Medical Apps, Nutrition, Stanford News, Technology

Stanford grad students design new tools for learning about nutrition, feelings

Stanford grad students design new tools for learning about nutrition, feelings

2789442655_1f5c33ac51_zMushrooms and tomatoes, veggies that are often reviled by preschoolers, star in a new app designed by a Stanford graduate student that aims to involve children in preparing, and eating, healthy meals.

“Children are more likely to try food that they’ve helped cook,” explained Ashley Moulton, a graduate student in the School of Education’s Learning, Design and Technology Program, in a recent Stanford News story.

Moulton’s iPad app, Nomster Chef, is one of several student projects featured in the article and accompanying video:

Before cooking, children receive an educational video about a food they’ll be working with – for example, a video on how mushrooms grow. The app also incorporates food information in the recipe steps, like the fact that tomatoes are actually a fruit.

After user-testing the app prototype, “I heard from parents that they noticed differences in how their kids are eating,” Moulton said. The app also kept kids engaged throughout the cooking process.

For her project, fellow student Karen Wang developed an iPad app called FeelingTalk that helps children with autism interpret facial expressions:

…[I]n the first level of FeelingTalk, kids choose the one face that’s different (a sad face) from the three happy faces on the screen. The app will then label the different face “sad.”

“My app will be utilizing learning mechanics that directly work with the autistic brain to help them work on something that they’re having difficulty with,” Wang said. “By leveraging something they’re good at, we’re going to teach them to get comfortable looking at people’s faces, examining the key features, and eventually understanding emotions.”

Moulton, Wang and other students will present their work this afternoon at the LDT Expo at the Stanford Graduate School of Education.

Previously: A look at the MyHeart Counts app and the potential of mobile technologies to improve human health and No bribery necessary: Children eat more vegetables when they understand how food affects their bodies
Photo by Peter Weemeeuw

Behavioral Science, In the News, Infectious Disease, Research, Stanford News

Irrational fear of contagion fuels xenophobia, Stanford study shows

Irrational fear of contagion fuels xenophobia, Stanford study shows

face-mask-98640_1280I have a very distinct memory of my grandfather dying from leukemia in an Iowa hospital. I peered in through a glass window, too scared to don the white mask and gown to visit him myself, even though the protections were for him, not me. Granted, I was eight. But fear of disease, and fear of those who have disease, makes perfect sense to me, even now.

But, that realization is tempered by knowledge of the harmful effects of irrational fear, the topic of a recent study by a team of Stanford researchers. As described in a recent Graduate School of Business story:

Throughout history, minority or “out” groups have been blamed for the spread of infectious disease. In medieval Europe, for instance, Jews and gypsies were among those accused of spreading the deadly bubonic plague. In 1793, during the yellow fever epidemic in Philadelphia, local officials singled out actors, vaudevillians, and artists for transmitting the disease. But what is it about the fear of contagion that makes otherwise rational people buy into rumors about those they consider to be outsiders?

Organizational behavior researchers Hayagreeva Rao, PhD, and recent graduate Sunasir Dutta, PhD, developed an online pilot study where one group was told a new strain of flu had emerged, then asked about their views on immigration. The control group was simply asked about immigration.

Not surprisingly, the group told about the flu was less likely to support immigrant legalization. Dutta said he is convinced the results would be even more striking in the real world:

Practically speaking, the implications are clear: “Don’t do immigration reform during flu season,” says Rao.

The study also demonstrates the power of rumors to spur fear, even ethnic violence, Dutta said. And it illustrates the need for proactive, responsive communications, particularly in the beginning stage of epidemics when irrational fears can germinate.

Previously: Fear factor: Using virtual reality to overcome phobias, Fear of recurrence an issue for some cancer survivors and Looks of fear and disgust help us to see threats, study shows
Image by Openicons

Behavioral Science, Medicine and Society, Men's Health, Mental Health, Research, Women's Health

Living with a partner boosts your health

lonely-273629_1280Partners help. They help with daily activities like dishwashing and dog-walking, but they also provide the all-valuable emotional support needed to cope with everything from a rough commute to the death of a family member.

And those without a partner, perhaps due to divorce, are more likely to suffer from depression or anxiety, according to a new study (in Spanish) in the Spanish Journal of Sociological Research. Women have it the hardest, says lead author Carlos Simó-Noguera from the University of Valencia, who is quoted in a recent Medical News Today article.

Women who have lost their partner “show poorer health than men with the same marital and cohabiting status, and are more likely to suffer from chronic anxiety and chronic depression,” Simó-Noguera said.

Men are also affected, however. Separated or divorced men “have higher risk for chronic depression than the rest of men,” he said.

The team gathered data from the European Health Survey on people between ages 25 and 64.

“The key is not marital status per se, but is found in the interaction between marital status and cohabitation status. Therefore, living with a new partner after the dissolution of marriage preserves the health of the people involved,”Simó-Noguera said.

Previously: Practicing forgiveness to sustain healthy relationships, “Love hormone” may mediate wider range of relationships than previously thought and Study offers clue as to why parents of daughters are more likely to divorce
Photo by cocoparisienne

Stanford Medicine Resources: