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Behavioral Science, Mental Health, Neuroscience, Stanford News

Decisions, Decisions: How mental-health issues alter decision-making

Decisions, Decisions: How mental-health issues alter decision-making

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. 

Here’s something truly unfair. People with mental-health issues have changes in their brains that make it harder for them to make decisions that will benefit their health.

Just when you need good decision-making the most, it fails you.

Child psychiatrist Kathleen Fitzpatrick, MD, works with kids who have anorexia. She said that in those people, their risk/reward pathways are aligned so that not eating is rewarding and eating is cause for anxiety. And, like anyone, they decide in favor of the rewarding experience.

Fitzpatrick put it like this, “I will work for the reward of a cupcake. They will work for the reward of removing all cupcakes.”

In my story I also talk with psychiatrist Manpreet Singh, MD, who says people with depression face similar issues. That’s in part why mental-health conditions are so hard to treat. They change a person’s brain in ways that make it even harder to recover.

Previously: Decisions, Decisions: How emotions alter our decisionsDecisions, Decisions: The way we express a decision alters the outcome and Decisions, Decisions: How decisions change with age
Video courtesy of Worldview Stanford

Behavioral Science, Imaging, Neuroscience, Stanford News

Decisions, decisions: How emotions alter our decisions

Decisions, decisions: How emotions alter our decisions

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. 

emotionWhen it comes to charitable giving, the cold hard facts suggest hanging on to our money. But people routinely give their support to environmental or other causes.

Nik Sawe, a graduate student in environmental resources, wanted to know why. So he put people in an MRI and recorded their brain activity while showing them photos of iconic spaces and proposed destructive uses of those spaces.

In my story I describe their findings:

As expected, iconic images activated a part of the brain’s reward pathway involved in anticipating good outcomes, like getting money or food, and images of destructive land uses triggered a part of the brain that is often associated with response to bad outcomes, like experiencing pain or losing money.

The people with the biggest negative response to land destruction were the most likely to give money. Sawe said, “My hunch is that people get outraged over the proposed negative actions of a third party and that’s what drives donation. It’s punitive.”

This negative emotion driving environmental donation is the opposite of what people find with donations to charities or orphans, Sawe pointed out. There, people who anticipate the warm glow of giving are most likely to give. But, as I write in the piece:

In each case, he said, it’s our emotions that often override the pure cost-benefit analysis that goes into deciding which cause to support.

Previously: Decisions, decisions: The way we express a decision alters the outcome and Decisions, decisions: How our decision making changes with age
Photo by Shutterstock

Behavioral Science, Neuroscience, Research, Stanford News

Decisions, decisions: The way we express a decision alters the outcome

Decisions, decisions: The way we express a decision alters the outcome

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. 

expression

Given a choice of possible snacks, you’d think that you would make a decision and that would be that: Twix or banana. Done.

But Jonathan Levav, PhD, an associate professor of marketing in the Stanford Graduate School of Business, has found that the way we express our decision changes the very nature of what we decide. In my story about his work, I describe the findings of Levav and his collaborators:

Confronted with a well-stocked vending machine, your brain may say “Twix,” but your hand is more likely to push a button associated with the healthier fruit snack. Your hand reveals your good intentions, but if asked to state your preference, your mouth is more likely to name your impulse – the candy bar.

When the researchers had people speak their preferences into a vending machine, people consistently chose higher calorie snacks. This finding held true when people were asked to either speak or push a button to choose a dessert in a restaurant.

Levav also found interesting differences between choices that people make on a computer versus on an iPad. It turns out we are all more hedonistic when on an iPad.

If you want healthier snacks, make your selection manually. And if you want to spend less, customize your new car on a computer – not a tablet.

Previously: Decisions, decisions: How our decision making changes with age
Photo by Shutterstock

Behavioral Science, Neuroscience, Research, Stanford News

Step by step: Study pinpoints brain connection required for performing serial tasks

Step by step: Study pinpoints brain connection required for performing serial tasks

one step at a timeA journey of a thousand miles begins with the first step, as the Chinese philosopher Lao-Tse is reported to have said 2,600 years ago. People have been saying it ever since. But you never hear much about the second step.

Think about it: That second step is taken by your other leg and requires the coordinated contracting of a completely different set of muscle groups, each of them on the opposite side of your body from the ones you used on the first step. There has to be some kind of switch in your brain that unconsciously transitions your exertions from one set of muscle groups to the other set. (Caution: Do not think about this while you’re walking. You’ll trip.)

It’s not just walking that involves such “serially ordered” actions: You’d certainly want to precede that long journey by putting your pants on, a performance best executed one leg at a time. In fact, pretty much everything we do is actually a sequence of seamlessly switched component actions, carried out under the command of brain circuitry about which we know next to nothing.

And that’s fine, until some aspect of said circuitry isn’t working right, as occurs in various movement disorders. That’s when we want to look under the hood, so to speak, at the brain’s immensely complicated mesh of interwoven nerve-cell circuits, in the hopes of ferreting out and fixing the wiring that’s relevant to the disorder.

The brain doesn’t make this easy. Unlike the snaking bundles of insulated wires in the gizmos we humans devise, the brain’s circuits never come color-coded. Only in recent years have advanced laboratory techniques allowing precise explorations of individual brain circuits become available.

In a study just published in NEURON, intrepid Stanford neuro-spelunker Rob Malenka, MD, PhD – who’s teased apart brain circuitry involved in motivation, depression, friendship, addiction and more – and his Stanford colleagues applied these state-of-the-art techniques to mice.

Mice’s brain wiring diagrams are remarkably similar to ours as long as we’re not talking about high-level skills required for reading, doing arithmetic, telling lies and so forth. But, being four-legged creatures, mice aren’t ideal subjects for studying the order in which they put on their pants.

So Malenka and his team tried a more mouse-adapted approach. Using chocolate pellets as an incentive, the team trained the mice to first poke their noses into one of two recessed ports in a wall, and then to press one of two levers. Only by performing the two tasks in order, and making the correct choices in each case, did a mouse earn a pellet paycheck. Via a combination of highly selective brain-circuit manipulations and electrophysiological and behavioral tests, Malenka’s group was able to pinpoint a specific set of neural connections (running from the motor cortex to the midbrain) that was essential to the mice’s proper execution of these serially ordered tasks.

The findings will help guide research into the brain malfunctions that underlie conditions such as Parkinson’s disease or Huntington’s disease. But of course, this is just one step in a long journey.

Previously: Obscure brain chemical indicted in chronic-pain-induced “Why bother?” syndrome, “Love hormone” may mediate wider range of relationships than previously thought, Revealed: the brain’s molecular mechanism behind why we get the blues and Better than the real thing: how drugs hot wire our brain’s reward circuitry
Photo by Elliott Brown

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.

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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

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