Motivation to Pursue Dreams and Hopes: Understanding the Brain's Reward System

this program is a presentation of university of california television your support makes you see tv's programming possible contribute online at UC TV TV slash support check out our youtube original channel you see TV prime at youtube.com slash you see TV prime subscribe today to get new programs every week my name is de Carli and I'm pleased to share this UCSF mini-medical school series science of the mind and I'm very pleased to be introducing our this evening speaker why are you all here today that's a rhetorical question because dr. Johnson is going to tell us about motivation and why we do what we do so we're gonna find out actually you're gonna find out why we're here and dr. Johnson is a professor of psychology and at the University of California Berkeley and a visiting professor at the University of Lancaster she's conducted research on psychosocial facets of bipolar disorder over the past 20 years and she directs the Cal mania program at UC Berkeley she has edited and or co-authored six textbooks including emotion and psychopathology in 2007 and the psychological treatment of bipolar disorder she has published over 100 articles and chapters and her findings have been published in several leading journals such as the Journal of abnormal psychology and the American Journal of Psychiatry she is a fellow of the American Psychological Society and the academy of behavioral medicine research and she has won the award for excellence in graduate teaching in the Department of Psychology University of Miami she's an excellent speaker I'm really happy to have her here with us today I've known her for a while myself she's been interested in the effects of trauma and positive emotions in psychopathology and she's going to talk to us this evening about motivation and reward the motivation to pursue dreams hopes and understanding the brain's reward system so please join me in welcoming dr. Johnson thank you for that really lovely introduction Descartes and it's just great to be here this is another moment in my life where I think San Francisco is where I was meant to live because look at you all showing up in the evening to learn more this is my town I can't believe how many of you are here just to kind of find out new things about how the brain works that's really great join me in a minute join me for a minute in a little bit of a thought experiment you can close your eyes if you want whatever you need to do I want you to kind of sit still and imagine a scenario so imagine I walk in here tonight and you have every reason to believe me and I say to you there are three million dollars and and they're the they're yours to grab if you're the first person to get there okay there are three blocks away I'm gonna give you a little grid for how you get there and it's up to you to be the first person there and so I begin to give you instructions that you're gonna head out the front door of this building and you're gonna go down to the left two blocks and then you're gonna run downhill one block and it's they're gonna be hidden but it's gonna be inside a box that's yay big now if this were true and I'm sorry to say it's not I'm already gonna let you down this evening but if it were true imagine what you need to do to pull this off being the first person down the street three blocks what are you gonna be doing okay so bunches of you're gonna be running now wait a minute there's a whole lot of people gonna be running so what else you gonna be doing you're gonna be strategizing a lot I'm guessing right you're gonna have your eye on the ball what's gonna be happening in your brain what are you gonna be thinking about yeah so your your drumming through the alternatives now what about distractibility if a friend is texting you with kind of hey do you want to get a burger are you gonna be writing back probably not so all other things go out of mind your brain gets you focused you get a roar of energy your mind is going a million miles an hour with how am I gonna do this and you're probably feeling pretty inspired pretty miraculous that your brain does all this in pursuit of any goal and yet every day every hour your brain does this for you right I mean we all do things every day because we want to because it's gonna be good because it's possible because it's a dream because it would be nice and somehow our brain gets us on task gets us to that mission and when you think about what you have to do to do that it's really kind of a small miracle of orchestration and I find this just a great mystery how your brain pulls that off for you I'm not a neuroscientist I'm not a biologist I'm not a psychiatrist I'm a clinical psychologist who got interested in this because I think there's certain groups with mood disorders where this becomes really an important part of the puzzle and the more I started chasing that puzzle the more I just had to know okay well what the heck how does the brain work how do you pull that off and so I'm gonna try and tell a story tonight of what your brain is doing when you go after those rewards and those hopes and those goals now I'm gonna make it a little bit simpler than it is and during the question period I'm happy to highlight for you how I've simplified but I'm gonna start by trying to draw the big picture and then we can kind of hone in bit by bit on the different layers of complexity so bear with me for a minute and just imagine some different great things that could come true imagine you want to eat some chocolate maybe you want to earn a million dollars maybe you want to be a pop star I don't know if we have anyone in the room who's already been a pop star probably we have chocolate eaters in here I'm guessing maybe you want to raise a happy family maybe you want to fall madly in love and have a terrific relationship okay they're all rewards okay there's life's rewards and they're all things that take a lot of motivation energy and effort to get there some of them much more energy and effort whatever your dreams are in life you need a motivational system that helps you get there and so the question is how's your brain help you get there or even figure out your goal why is it that some of us are chocolate holics and others of us you know have other dreams and other favorite foods or other things that organize our day and then how does your brain help you pursue that goal and if you start to think about that question you start to think about all the many many many things your brain has to effectively do to help you pursue that goal so I have a lot of goals I want to define what people think of as being the reward system how many of you have heard this kind of phrase the reward system Wow okay so this is a great audience and you can kind of wave me on if I'm going over stuff that you all know fine we'll go faster and we'll have more fun I want to break down some of the processes involved in effective reward pursuit I want to talk about some of the brain regions guiding those processes and how what we're beginning to figure out about how those work and then I want to talk about individual differences in this reward system and what those might look like and where the system might break or become dysregulated and then what that might mean for psychological symptoms and for psychological disorders like mania and depression so we're going to kind of do a really broad sweep here and then I'm gonna save a lot of time for questions so big picture before we get too immersed in reward most psychologists and neuroscientists think about two different kinds of motivation that you need to really be effective whether you're an animal or a human you got to move towards certain things and you got to move away from other things okay so people talk about approach approach or activation system you'll hear this called or reward system those are all kind of synonyms and there's no one term that people like best in the field which is really bewilderingly sweat to a panel of 40 scientists at the government all fighting over which was their favorite word no one won they decided to put them all in the title and then there's an avoidance or an inhibition system so if you think about it approach is about moving towards all those goodies right all the things that are delicious and wonderful and positive and avoidance is about moving away from threats so if there was a bear in the room it would not be about your reward system it'd be about your avoidance system it'd be about getting away from bad things if you were going to be shocked and be about your avoidance system and to be sure these overlap a little bit there are moments where there's something that's good and bad and they're both probably operating all the time just at different levels depending on what's in front of you if you are contemplating a bear the avoidance system is in full boar going strong and fear contemplating the million dollars three blocks away it's the approach system it's gonna be overriding any other consideration of threats and people think about these in a lot of different ways and one of the ways they think about these is that there are strong individual differences in propensity towards these systems okay so my favorite cartoon character can anyone guess what a reward person would think is the best cartoon character in the world yeah Tigger I'm gonna go with Tigger okay Tigger is all enthusiasm going after things and people like to think about if you have this underlying dimension of reward and approach some people have that system in kind of more Full Tilt than others but it's also gonna kind of change around situationally so if you're in the wrong context there's little reason to have that kind of approach system going full-tilt so for example if you I'm a pretty high reward I approach kind of person but if you threw me in prison and all I had to look forward to was getting a cup of water every four hours I wouldn't have a whole lot of joy and excitement but the idea is that when that system is going and you're doing well in moving towards rewards and goodies in life then you're going to experience excitement and joy okay this is a system that we think promotes not just happiness but that high arousal high energy kind of happiness but that when it's going badly and you're not getting a chance to have the love of your life or somebody else just ate the last chocolate right in front of your eyes you might feel sadness or loss or even anger okay but if we talk about the threat and avoidance system how you're doing on that system may drive different kinds of emotion states and in different kinds of emotion tendencies so if you're doing really well in avoiding threats in life so you didn't get your pink slip you've escaped from the bear and and you've gotten away from all these kind of nagging threats what you're going to likely feel it's also a good sensation but more of a few a relief a calm okay serenity perhaps and when you're doing badly in escaping from threats then you're going to experience more anxiety and fear does that kind of heuristic make some sense so what we're going to be talking about is more of this kind of dimension of excitement and joy or the failure to get excitement and joy leading to kind of a sense of sadness and loss so one way people think about this system is that there's this concept of reward responsiveness so we vary as individuals as human beings in our level of how much we tend to respond to rewards some of us it takes very little to have us kind of be very very enthusiastic how many of you know somebody that you know you're kind of amazed at their ability to feel joy over a small moment or a small goodie all right now how many of you know somebody who's just the opposite that no matter what you dangled in front of them that seems pretty amazing they're like okay they're pretty flat it's hard to get a rise out of them okay so there's self-report scans where you ask people questions about okay how reward responsive do you tend to be Chuck Harbor who's one of my really close collaborators wrote probably the most well used of these scales and he just wrote out questions like when I get something I want I feel excited and energized or when you have an opportunity for something I like I get excited right away when good things happen to me it affects me strongly if you're curious about your own profile you can go to Chuck Carver's website download it take it and get your own score on are you reward responsive or not compared to other people which is kind of fun you can also find out if your have a high-threat system but most people now I mean there have been probably hundreds of studies on these kind of self-report scales and now the big push in science is let's understanding the neural let's get to the neural underpinnings what's happening in the brain for the person who's having those kinds of responses and it's pretty thought it's pretty well-established that there are different parts of the brain involved in this system then would be involved in say sensory perceptions or other kind of key motor regions and the chase is on to understand these parts and how they work and how they work together and then how the combination of those things might actually lead to something like joy like what is firing off in your brain when you have this moment of joy okay so two big regions you're gonna hear about again and again and again tonight sometimes called the VTA this and the nucleus uncommon so an accumbens or you'll hear this abbreviated nak is kind of down here in the middle of the brain sometimes you'll hear people use a word striatum for that that's the broader region that this part of and then the nucleus accumbens is getting messages from the ventral tegmental area which is too much of a mouthful so sometimes people call it ventral tegmental sometimes they call it VTA neuroscientists even have a way of creating creating an acronym for everything so I'm gonna say those now because I may slip into acronyms here which is really bad I'll try not to but so nucleus accumbens in VTA so two big regions but this is one way in which this is a cartoon this is actually much more of a picture of what the reward system looks like and we can come back to different pathways and aspects of this but I want to start with some of the basic core regions and then we can talk about how it gets more complex from there there are a lot of different brain regions involved in reward we're going to talk about some of them today we won't kind of define all of these but nucleus accumbens ventral pallidum ventral tegmental area substantial and I grow all playing key roles and then so subcortical meaning below the cortex and then cortex would be kind of the exterior kind of regions of your brain you've got the ventral medial prefrontal cortex anterior cingulate medial prefrontal cortex and we'll point these out on pictures as we go through all I want to say right now is there's a lot of pieces to this and so I'm gonna simplify but we can come back to different different aspects of this there are also a lot of different neurotransmitters involved in this system so how many of you guys have heard about dopamine oh okay this is great how many of you have been reading anything about opioid neuropeptides okay alright and hormones also play a critical role in this and already tonight somebody asked me a very savvy question about serotonin which also plays into this system and so layers and layers of brain regions and chemicals and we'll talk about key features and then we can come back to those that you're interested in hearing more about ok so how did people get so fascinated by this probably one of the first studies that kicked off an amazing spurt of interest in this was by olds and Milner in 1954 and what they did is they inserted a wire into a rat's brain you know in such a way that if the rat pressed a lever it could set off a sort of stimulation into that part of the brain the rat could trigger different regions of the brain and what they discovered I mean you know they experimented a lot with this kind of paradigm of self stimulation but what they discovered is that if they put a little probe down into the nucleus accumbens the rat would begin to press the lever like crazy okay more than 2,000 times an hour in fact that rat would press the lever so many times that if they didn't kind of stop it it wouldn't eat it wouldn't drink it would kill itself just pressing this lever so better than food or water they figured they must have hit something pretty darn good here and you can actually watch videos okay so what we've learned since olds and Milner okay so this set off just a fury of research right I mean how fascinating is that that an animal would actually prefer that over food water you could shock it was unstoppable now people look back on Alton Milner and they sort of say well that was old-school scientists science despite the amazing narration I love the accent and the kind of like it sounds like something just great out of a fabulous documentary and they say well okay it doesn't really work like that look the brain is much much more complex there's a lot of pathways there's a lot of regions that was oversimplified but it certainly spurred a lot of interest and so yes psychology of reward is complex and there's a lot of pieces but now the question is okay what are those pieces how do you break it down how do you disassemble it and the other thing I want to just say up front is that it now looks like almost all of these pieces have both conscious parts so whatever the part of the reward system that's firing off you probably have some awareness of it but there's also ways in which it can operate outside of our awareness not unconscious in a deep dark Freudian way but unconscious in that your brain just takes care of it automatically without you having to kind of consciously chew on things and keep it in your mind's eye there's a lot that happens swiftly naturally without kind of an obsessional kind of stare at it and hammer over it so what do you have to do when you're thinking about going after a reward well one of the first things you need to do is that you'd need to learn to recognize a cue for reward okay and then you have to mobilize and go after that reward and then you have to or you don't have to actually and some people don't but you hope that you savor that reward and so people have started to say okay how do you look at these kind of separable pieces like this and in doing that they put a lot of focus on dopamine and on the VTA or ventral tegmental area nucleus accumbens and then this region of your cortex right up here in the front called prefrontal cortex so it's a silly name because there is no before the front it is the front of your brain but for whatever reason it's been dubbed prefrontal now the ventral tegmental is largely sending signals to the nucleus accumbens through dopamine neurotransmitters and neurotransmitter ends and also to the PFC through dopamine so that's part of why people talk so much about dopamine in this system so let's let's backtrack a little bit how many of you are familiar with kind of neurons and neurotransmitters okay fabulous alright so I put a picture of a neuron up here just in case so these are the brain cells and as the brain cell fires the signal comes down here to the terminal buttons which are storing neurotransmitters and here's a close-up of that kind of end of the neurotransmitter so here's a button and inside that button there are vesicles that are carrying little capsules of the neurotransmitters and when when the neuron fires this is released into this cleft and the chemical carries across the cleft to the receptor any given neuron may have more than one kind of receptor but if this dopamine is released it should fit like a kind of key into a lock into this dopamine receptor and then that starts if there's enough dopamine received that starts the signaling this next neuron so the neurons we're talking about largely involve dopamine and I'm gonna talk about a lot of different noir neuroscience kinds of paradigms tonight and some of it will be animals some of it will be human but one of the things that animal studies have allowed us to do is tap into specific cells in the brain and measure their activity and then say when do those specific neurons fire off when are they going and so that's a paradigm called single-cell recording so you're inserting a small probe to record activity in a specific region so we can do things like put a probe down into the nucleus accumbens and ask when do different even different parts of the nucleus accumbens fire and you can put the animal through all kinds of different kind of tasks and see when you get the strongest firing so let's break this up a little bit I'm going to start with the ventral tegmental and I'm going to start with something that actually was modeled after Pavlov's in original studies where he had trained a dog to salivate to a bell if you guys remember those kinds of classical conditioning so if that's a that's an amazing kind of reward learning paradigm that's influenced science even to this day because what you're doing is you're teaching an animal that something is a signal for reward so remember what Pavlov did he rang a bell before he gave the dog food the dogs gradually began to associate the the bell with food so strongly they would salivate any time they heard the Bell okay if you have pets you're probably used to them kind of doing this as soon as they see the can opener or whatever you're you know kind of food cue is well from Schultz use this with monkeys and what he was due in teresting in is what happens as the animals learning that this neutral cue is a signal that it rewards about to happen and and where would we see that happening in the brain where does the animal learn that reward is about to happen and it can seem kind of cold and dry but think about it every of your life you need to be able to kind of judge behind door number one two or three is it going to be more rewarding which person in this room do I want to most talk to who's gonna be the most fun which thing do I want to learn about what's gonna be juiciest here which book do I want to choose at the library you're thinking about all these things that on the face of it seemed a little neutral but you've learned nope that one's a good predictor of what's gonna be rewarding now so what sets the VTA off the ventral tegmental this is interesting when you are first pairing the kind of cue with the reward the VTA fires off only as you're learning about a new cue okay when that cue is a new cue signaling to learn about reward in that early process you had a lot of firing and so the firing is kind of initially associated closer and closer to the reward but as you're learning more the cue itself will fire off the VTA and then if you stop if the cue stops being predictive the VTA activity stops and so it's got this really exquisite relationship of getting transferred from the reward back to the cue and so it seems to be chasing kind of what's a signal that something's about to be rewarding and so with research like that people begun to think that the VTA is where all seems to be in helping you learn to to recognize a new unexpected reward is going to happen when I see or get this cue okay it's signaling for you go down that path that was good last time turn left talk to that person there they're kind of helping you the system is helping you learn that's a good option to pick and it continues to help fire when that cue has predicted reward in the past so it's a learning system a reward learning system and now there are probably hundreds and hundreds of studies being done on reward learning and and the kind of temporal contingencies the timing the kind of parameters that influence how well reward learning happens but let's say now you've started to learn that a cue means rewards so if you're a Pavlov's dog you hear the bell and you're thinking oh food and you're salivating but okay the VTA is gonna fire off it's got this kind of learned message that this is a signal for reward but then what happens that's hardly gonna get you there right I mean so yes part of your brain fires where does it go from there and the VTA sends a huge amount of its signal downstream to the nucleus accumbens this nack so let's talk about what the nack seems to do and actually I should highlight the VT is pretty hard to pick up on in imaging study so a lot more of the human imaging studies focus on the neck we have an easier time finding it in the signals so human imaging of the neck usually what people are using is functional magnetic resonance imaging or what we call fMRI this is a picture of an fMRI so you would lie down and you would be shuttled into this machine on the tray and it's actually a magnet it's a large magnet and what it's measuring is blood flow in the brain and the reason it's able to pick up on blood flow is it's measuring oxygen rich versus oxygen poor blood because of the kind of hemoglobin so why would blue foam matter well when your brain fires off in a given region it expends its resources and it needs new blood flow in okay it needs to be replenished and so what we're really measuring is which regions need to be replenished okay and when they're getting more blood it's a signal that okay you've been using that part of the brain okay and what we're looking at is changes across conditions and how much blood flows to different regions of the brain so it's not actually as exact as it seems I'm going to show you lots and lots of pretty pictures that make it look like aha that's the neuron firing off it's actually not quite that precise you know there's a range of error because skillett flow to a specific area but fMRI has been a pretty amazing tool so I brought some pictures here this is during a visual task we know that a lot of your visual processing is happening back here and then except at a lobe and if we show you pictures and ask you to kind of focus on those pictures we're going to get greater activations in the occipital cortex so you get these beautiful kind of graphs of the region that seems most busy during that period huge motor regions and if we ask you to do something like process a motor sensation or plan a motor activity we're going to get activation there compared to a neutral baseline pretty nifty so we can use that same kind of paradigm to look at what part of the brain is busy when we ask you to imagine a reward happening or we'd say to you hey you're about to get a reward okay so the nucleus accumbens which is the largest recipient of Frant of dopamine in the brain does lots of things so Helen Fisher a few years ago got huge amounts of press because she'd found the love center in the brain you guys remember reading anything about this so your nucleus accumbens lights up if we put you in that scanner put you inside the tube and show you a picture of somebody you love your nucleus accumbens is gonna light up okay pretty nifty so Helen Fisher got written up in vogue for the love center but it turns out that the nucleus accumbens does much much more than that and even the things I'm going to talk about today aren't even the beginning in the list your nucleus accumbens is a really really busy center in your brain it fires off to lots of stuff but if you show mom's pictures of their babies the nucleus accumbens fires off if we show you sexy pictures your nucleus accumbens is gonna light up that's actually a really good way of getting the nucleus accumbens to light up and an interesting thing about this is men will say oh yeah that was sexy women I'll say no that wasn't that wasn't so good for me but their nucleus accumbens fires up just as much as men's does this got a lot of press about a year or two ago revenge lights up your nucleus accumbens says somebody does you're wrong and you say now you have a chance to pay him back same region as eating chocolate so the nucleus accumbens seems like it's really responsive to reward now we can talk later to about other things that fire off your nucleus accumbens but this is some pretty good evidence that it's doing something when there's a chance an opportunity for future reward so the VTA sort of fires off the signal and says though you learned this in the past that was good that was yummy and nucleus accumbens ago so yeah I'm coming online but ok it's coming online it's getting blood flow but what the heck is it doing right it's activating two rewards or cues of potential reward but what does that allow us to do what's the downstream kind of consequence of that so what if it's firing off at some level it's helping us process rewards but even that feels kind of vague and circular so what else correlates with it is a kind of key question so it's lighting up so what you know fMRI is fascinating cuz you I see some part of the brain light up and you kind of go oh my gosh look at that it's finding because it looks pretty because there's always some part of your brain lighting up so what behaviors or thoughts or emotions happen when the nucleus accumbens is going strong an animal studies have actually helped us there again in some ways we get better kind of traction now I'm going to talk some about animal studies where we're manipulating parts of the reward system so we can kind of put probes down into the nucleus accumbens and intensify its activity we can drip dopamine into that system and have the system kind of come online more strongly and watch what changes in the animal's behavior we can't do that with humans so Salamone is one of my major heroes and this kind of set a paradigm since Salamone has done a lot of different testing and kind of said really spent years trying to treat well what's the behavior that seems most correlated with you bring this nucleus accumbens online and he does a lot of testing of very hungry rats and what he finds is that no matter where the nucleus accumbens is on or not if the food is easy to get to the rat will eat it and if all things being equal there's sugar versus some yucky rat chow they'll eat the sugar time and again okay the difference in the nucleus accumbens isn't whether they like sugar whether they'll eat food when they're hungry it's about how hard will they work for better food okay so these tests are called effort for reward and usually it comes down to look you could have the rat chow if you don't want to move but if you're willing to work harder you could have a really high sucrose rat dessert okay and what dopamine and the nucleus accumbens seems to do is tune up how hard you're willing to work for the rat dessert and if you block dopamine in the nucleus accumbens so you give something like haloperidol which blocks the kind of receptors there they will stop being as willing to work for the reward and there's two kinds of paradigms they use for this one is they'll see how many lever presses a rat will do to get a little bit better food and the other is they look at kind of how steep of a ramp the rat will run up so you know an an animal with an incredibly high level of dopamine in the nucleus accumbens would run up a very steep ramp to get to the better reward and an animal with a really low level of dopamine in the nucleus accumbens will be like oh whatever I want to be the couch potato give me the rat chow I know that food up there it's really really good but that's a steep ramp so this is just a graphic from this person Treadway who's written really nice articles about this how much effort you how much effort how much of a barrier you'd scale to get the larger reward versus such with the smaller reward is kind of what it seems like the nucleus accumbens is doing and so in this way people are fascinated by this region because it seems kitu motivation cuz think back to the example I gave of okay there's like there's millions of dollars down the street what you were all talking about is running okay and think about it that's I mean it's a willingness to put in effort and energy and that's this kind of central function that people think the nucleus accumbens is helping to kind of mobilize so if you want to be able to kind of spend a lot of effort and energy and motivation to go after these kind of dreams and hopes what you really want then is your neck to come on Full Tilt full of dopamine roaring and that would give you a higher willingness to expend energy and effort so it wouldn't be the question of would you like chocolate more or less it wouldn't be the question of which would you prefer it would be which one would you work harder how hard would you work for the extra goody does that make sense and they do lots of different studies of kind of different kinds of behavioral paradigms where they're depleting dopamine or increasing dopamine and they're looking at rates of lever pressing or delays and lever pressing to see what will the animal tolerate to get to the kind of better food boy that doesn't sound like much fun though if you think about it right we're all talking about work how hard would you what what what kind of ramp would you run up that does not sound like joy right so somehow psychologists get their hands on something and before you know it the whole reward and joy system is sounding like well how how much would you climb a mountain to get where you want to go there's got to be something better than that right I mean this is you know supposed to be your joy system maybe so we've talked a little bit about learning that you're learning to kind of predict we're going to be the good rewards and what's your experience of rewards we've talked a little bit about mobilizing energy and effort and so people talk about that is wanting the reward or desiring the reward as your and your index of that would be okay how much energy would you spend for it but there's also then business of liking your reward so one of the key thinkers in this field is somebody named barrage and barrage has done this great job of sort of saying there's learning there's morning and there's liking and those may not go hand in hand which is this really puzzling thing and we'll talk about when those maybe don't fit well together but liking would be okay now you have the chocolate you ran up the mountain to get it and do you savor it do you enjoy it does it give you bliss the kind of hedonic quality of achieving these rewards okay and that turns out not to be orchestrated by quite the same system so it's different parts of the nucleus accumbens involved but they're parts of the nucleus accumbens that are triggered by your own internal opioids okay so if you think about some of the steps in the process and this is still kind of a cartoon image there's a lot more to it than this you've got to learn to recognize the cue for reward mobilize and go after that reward and then hopefully like that reward and sit around and enjoy it and savor it three different very different pieces different parts of kind of the brain firing off to support those but then you have to think okay would I go after it more and you know we'd like to think that reward once rewarded we're going to just keep chasing the reward right like why wouldn't you go after more chocolate why wouldn't you go after more of this but in fact that's not really a very adaptive evolutionary strategy because what happens while you're finishing off that box of chocolate is other opportunities come and go other threats may come in the room and so you need to be able to kind of juggle the pursuit of any one reward against the possibility of other kind of goal constraints and other kinds of opportunities lost in other kinds of threats and how do you how do you juggle that kind of more complex multitasking so yeah tasted good why not bury yourself in that well okay you have to kind of pause and think well what are the costs of pursuing this even more or otherwise wouldn't we all just be sitting around eating chocolate listening to music and doing other hedonic activities all darn day long right something stops us so you usually have to pay something and that's the problem right so it's not caused free to stick with any one reward and so we have to kind of think about what are those costs and costs come in a lot of forms you might have to spend energy to get what you want you might have to spend time you might have to endure threats shocks punishments risks loss and so somewhere you need a calculator that sort of says okay relative weight of all these different kind of potentials and and a good goal regulator a person who's good at balancing life's pros and cons is attending to all of that pretty fluidly and pretty automatically and to do that you got your prefrontal cortex where kind of the larger kind of calculations are coming into play and there's a huge amount of research here or two on the cost of reward and what people are thinking about is decision making so weighing a person doing pursue one reward path versus another or discontinuing that action it's an exploding area of science lots and lots of stuff where people are manipulating okay you know there's this a reward out there so how much would you risk how much pain would you tolerate and how much delay could you endure all in the hopes of gaining a reward so how do different people do those kind of calculations and what influence is how they do those calculations I'm gonna give you a quick snapshot one of the things that people have done a lot of work on is how much time would you wait for a reward so they call this delay of gratification think about your investment plan okay you willing to wait and let it grow are you gonna take all the money and go ahead and spend it on the goody you know and people really vary on how much they're kind of savers versus spenders and so people have their own delay of gratification profile and one of the ways that Walter Mischel first started testing was he said to kids look you have a choice you can have one cookie now or if you wait you can have two cookies later okay have you guys seen these paradise okay so waiting usually involves a bit of the prefrontal cortex because if you're a kid and you're kind of trying to decide whether to eat the cookie or the goodie that's right in front of you it takes some kind of strategy so just to show you a little bit of a clip from this okay all right you're still marshmallow three you can either wait and I'll give you another one if you ate or you can eat now when I come back it up same here anyone know the good strategy for a kid to take it's a matter of minutes it depends on the age group um so as they get older you know the task gets a little more challenging but a good strategy is actually to distract yourself which takes you know kind of thinking up kind of get away from the thing that you're staring at and go do something else and you know as adults we do that pretty fluidly we're used to the drill but kids really vary in whether they can kind of think up that kind of strategy so and the ability to think up those strategies and to kind of remind yourself of the threats and the kind of promise is PFC that's prefrontal cortex in action for you and so that part of the brain huge huge role in kind of how effectively you do in managing strategies for pursuing your goals and avoiding threats and balancing it all out and we can talk more about the different calculators in your PFC but it's a huge part of this so the PFC prefrontal cortex is actually a whole set of Regents regions that are getting a whole lot of attention our orbital frontal and insula and medial prefrontal cingulate cortices and people are studying how these different pieces work together but we know that they're coding kind of for your appraisal and your experience and your memory and kind of bringing these pieces together along with the costs and likelihoods so your estimates of okay would it come true and how much would it cost me in terms of time energy patience all that sort of stuff without it you want a nice prefrontal cortex okay so you know even at a kind of snapshot level we're talking about a lot of different functions when we start to talk about the reward system and that's why people use the word system because there's a lot of pieces to the effect of pursuit of rewards and there's a lot of parts of the brain that seem to be involved so learning about the potential cues for reward mobilizing your effort and motivation considering the costs and risks of reward pursuit and savoring and enjoying those rewards would be kind of functions that most people would think you could pick a part of it sure they're all going to play a role in the kind of symphony of how it goes together but they're different functions that we can pull apart and we're beginning to see that they seem to map onto activity in different regions to some extent now that's a simplification because this is a circuit so when the VTA or the ventral tegmental area fires up the nucleus accumbens fires off the prefrontal cortex fires up and guess what it sends signals back down to the nucleus accumbens in ventral tegmental area so it's like a giant cycle that's going on every second you know it's a feedback loop working in concert now we haven't even begun to think about things so like well why do certain people get driven by certain rewards and other people by other rewards and that's also this really fascinating area of research and by far we don't know anywhere near as we would hope to with this because think about human beings and how many different rule rewards we go after but there's some really really interesting work on this front so for example it turns out that you can ingest oxytocin and there are experimenters who are doing that with humans it's a hormone that seems to play a major role in kind of social pair bonding and if you are treated with oxytocin then the amount that your nucleus accumbens is going to kind of come on for social stimuli like pictures of faces is magnified so oxytocin seems to have some role in magnifying the value of social rewards and social connectivity now it's much more complex than that because it doesn't intensify the reward value of all social cues but certain social cues it seems to work with which is kind of fascinating testosterone testosterone I mean it's throughout your body it also plays a role in different brain regions but there are testosterone influences strain into the nucleus accumbens and it turns out that your testosterone system is turned up like the level of testosterone that you're releasing is turned up when you win a contest with another human whether it's a chess match or a tennis match and that that then amplifies activity in the nucleus accumbens but it also turns out that people who have high testosterone levels tend to value the kind of reward of obtaining power more so people are doing all kinds of work on that which I find really really interesting and then there's a hormone called erection which seems to play a critical role in appetite and again seems to amplify kind of appetite for food so these are kind of cartoon simplifications but there are ways that people are beginning to chase a little bit about okay well why would one reward end up being more powerful than another and where would some of the individual differences in that begin to start because there are really powerful individual differences I mean think for a minute about you know the people in your family the people in your Friendship Circle and where they stand on kind of how much energy they put towards goals how much they save or different goals what are their favorite goals we're all really pretty varied on that front and there are a lot of different factors that go into shaping how the reward system functions and there are a lot of people studying this but one actually is age and you're not going to like what I have to say here your dopamine function declines slightly just slightly but it declines as you get older you already knew that think about how much joy a kid can get from jumping up and down on a tree trunk you know I was in the park a couple weeks ago and there was a kid singing out loud with joy over just jumping you know I haven't done that in a while it'll look tempting but it couldn't couldn't mobilize it and so age is a big part of this and it's not just dopamine's function that's changing there's more and more evidence that your prefrontal cortex doesn't fully mature into until well into your 20s okay so now you have this system that's kind of calculating risk in the middle of the reward pursuit and it's not as refined okay and so there are a lot of people studying sensation-seeking and risk-taking in adolescence when they're in high reward context its challenges and thinking about that as challenges to the prefrontal cortex and all kinds of fascinating research coming out there that we couldn't talk about stress you want to kind of dampen down your reward system well stress will do it for you if you are short term stress may not do this so much actually short term stress may have sometimes very different effects but chronic long-term severe stress seems to turn down the volume of your nucleus accumbens okay so do bad moods for that matter and good moods turn up the activity a little bit so let's go back to the neck for a minute in the context of thinking about individual differences we've talked about it's mobilizing effort willingness to expend effort to obtain desired rewards and imagine for a minute that people are really different on this you know that your baseline kind of how easily that system is kind of amplified and turned on differs a lot between individuals what might that mean for what behaviors look like across individuals what would it mean to have a weak reward system or a weak knack so it'd be harder to feel motivated to go after something to spend the effort and the energy for something and a lot of people think that this is a big piece of what's happening with depression okay with clinical depression there's a kind of yeah it could be good but I don't know I don't really feel like getting out of bed I don't really feel like kind of chasing that and so you can show this in kind of laboratory experimental tasks that it's harder for people to mobilize effort and energy towards a reward and you can also show that there's interactions between genes and environmental experience that it may be contributing to lower dopamine function in depression but it's not the case that all parts of the reward system are broken and this is what starts to fascinate me so if you take a depressed person and you put them into a middle of situation that's a good situation they'll enjoy it more than they anticipated that they would if you say to them beforehand tell me if this is going to be good and if you want to work toward it uh I don't think it's gonna be that good and I'm not gonna I don't think I have the energy for that and they will really feel that they don't have the energy for it because their nucleus accumbens is not doing as well a lot of times but then put them in that context in the hedonic kind of pathway the kind of liking system actually functions much better than they thought it would so a disjunction between the motivational and the liking system seems like it may be at play here yeah that's this fascinating thing so that requires nucleus accumbens to get the energy right so even alert so the learning seems like it's intact at some level but the motivational system so yeah it was good last time you did it you learn that you think you're okay and yet it feels like all too steep of a ramp and so the depressed person will often say to their therapist you know I hear you but that's just too much effort that's too much energy I don't think I can do it I don't feel like I got that in me and and if that's a specific motivational deficit it helps explain kind of the psychology and well why is it so darn hard for them to mobilize maybe the neck and a lot of people trying to study this what's interesting is that there's now one of the more effective cognitive behavioral therapies this behavioral activation therapy that involves structuring things so that people don't have to rely on their internal motivation to go after rewards so you go ahead and get it on a calendar make it attainable put the supports in place so that people can kind of keep tackling small rewarding activities that they wouldn't go after if they have to kind of mobilize their nucleus accumbens in their own motivation system and get them in that context get them in that rhythm and it's got a profound effect and helping people get over depressive symptoms it's kind of nifty because it's a very simple kind of kind of switch that seems to be working it's hard to do it's hard to kind of counteract the motivational deficit but if they can do it and if you can give them enough structure to work through it a lot of people experience significant improvement in their clinical depression take some skill on the individuals part and the therapists part I don't want to downplay that part yeah the problem is that a lot of our drugs are muddy so we might amplify dopamine in many different regions of the brain and so that wouldn't be maybe what you want to do because dopamine is actually distributed throughout your brain and there's a lot of the after-effects of kind of amplifying dopamine that you might not want so it's it's hard for us right now to kind of just target ok BAM we're going to hit that region with that drug yeah I mean that's the big hunt is to find things that tap into a kind of more specific regions and receptors and things like that but that's really hard for a lot of different reasons okay so let's talk about the flip side so now we're all thinking okay I don't want to have that I don't want to have that experience whatever if I had a really super powerful nucleus accumbens would give me more energy I'd be the person out there who is charismatic aleef fighting for every dream and hope and I'd have boundless amounts of energy and I'd inspire other people to join me in the pack and we'd all kind of go conquer the world and certainly you know it'd be nice to have that enthusiasm and vigor and a lot of people think that that's one of the things that's really involved in extraversion so a scientist named de PUE is written a lot about how that might be at the root of extraversion think about what extraversion is everything interpersonal seems super juicy I'm gonna love being at that party there's gonna be 13 15 16 people that I can talk to and who knows what all unfold maybe they'll be dancing and for the rest of us or people like me who are kind of you know more withdrawn that's not the first thing that's rolling through my head so some people think that extraversion is a kind of form of reward sensitivity where the interpersonal rewards just feel magnified and they feel kind of terrific but on the darker side I study mania and I you know I'm part of a small group of scientists who think that this has a role to explaining mania that people with bipolar disorder will say yeah I respond more intensely than other people do to rewards I get more excited than other people do I get more mobilised and you can show in a lab if you're giving people a chance to earn a reward people with bipolar disorder will actually work harder for it than other people will which may have something to do with why we see such incredible accomplishments and their family members and it seems like they'll always do that it doesn't take being symptomatic so people with mania the mania comes and goes and even during their well periods don't work pretty hard for a reward that's hard but that kind of willingness to get really really mobilized for rewards people who say who have this in their family history and who are showing mild symptoms already that that reward sensitivity there's early early evidence that it's one of the things that helps us predict who's going to who's going to develop more severe symptoms over time and we also have some evidence that dopamine systems are dysfunctional or you know our dysregulated in mania and that parts of the brain like the nucleus accumbens seem to be structurally a little bit different what about addictions okay think about what cocaine does cocaine stimulants they are releasing dopamine into the cleft okay when you take a stimulant or cocaine if you were to do that it's going to really give a huge surge and there's gonna be a huge surge of dopamine in the dope in the nucleus accumbens that's gonna outweigh anything that we get natural real life rewards it's a huge jolt okay other rewards yeah you're gonna get a little bit about activation there and what's interesting is that some people seem to be primed to be particularly responsive to that and other people also seem like there there's now some evidence that for people with addictions the kind of responsive 'ti of the nucleus accumbens to everyday life rewards is a little flatter okay so now you have a way of jump-starting that system and giving it a huge jolt and it feels great and it's not something that you're being able to do as effectively in day to day life okay so the differential between the drugs and the everyday life may be larger in what it feels like alcohol abuse Howard fields here at UCSF just in the last few weeks had a great finding that got written up in the New York Times and all kinds of media outlets that people who are susceptible to alcohol abuse look like they have a dysregulation of some of the opioid receptors that are involved in the reward system so it may change a little bit about what alcohol feels like and and the contrast for that the other thing that people are really studying in the addictions is that wanting is not the same thing as liking so we if you think about what people with addictions will do they'll do they'll spend a lot of energy to go after the drug of their choice but we all know people who are non happy drunks and that's always a bit of a puzzle right like so much energy going and drinking or drugs and then at the same time the person doesn't look like they're actually having such a huge hi anymore and so people are studying kind of what happens with wanting systems what happens with habit establishment and is that there at the same time a kind of deadening of the liking system so to these kind of drugs and chemicals so that there's a disjuncture between what the person is chasing and then how much they're enjoying what about other kind of natural addictions so or you know addictions to things other than substances gambling eating problems lots and lots of work on the reward pathways with many different conditions so just backing up to recap for a minute if you think about some of the best things in life they really involve rewards so some of our biggest rewards our Joy's our dreams I mean those are things that are kind of the essence of what we talk about when we talk about what is the meaning in our lives you're usually going to hear people talking about those kinds of themes and whether we like this at a philosophical level or not those are probably somewhat shaped by our brain systems what we find intrinsically naturally appealing and how we pursue those dreams and if you really step back for a minute and thought about the kinds of steps you've had to do to pursue your life dreams and rewards you know how much complexity and effort and focus and cognitive resource it took and it's sort of a small masterpiece that your brain mobilizes all those different processes to make that happen it's really no small wonder that sometimes we hit barriers in those pursuits and so the trick I think of what neuroscience may help us learn more about is how those systems are balanced and regulated so that we kind of most successfully pursue those dreams and hopes and goals in way the kind of probable costs at the same time so it's all I think about balance in the brain and the question in the mental illnesses and psychological disorders is about where we see imbalances or dis regulations and in which systems and what that tells us about which processes and which moments are going to be most vulnerable for people with those conditions so how do these different pieces become dysregulated and what does it look like when they are dysregulated I think is really this fascinating puzzle that I'm sure we're gonna be working on for the next 5-10 years longer but I find it just a fascinating one so I'm happy to answer questions about any of this that was my kind of brief detour and now we'll we'll take the kind of heart of what you guys want to hear about yeah I think so okay so the question is okay we already a lot of this is already implemented in different self-help books a lot of people already are implementing fixes for this so where is the future and I think the future is a better understanding of where how when it breaks down and what strategies effectively compensate for when it breaks down I think we're still fairly and precise about where how when it breaks down I don't you know 10 years when I started this everybody talked about bipolar disorder just being elevated reward sensitivity I don't think there is such a thing I don't think that we're have global elevations of reward of every kind that we're we're mesmerized by every kind of reward and we learned cues more quickly and we're always motivated and we're always savoring no I you know I think now we're getting to this idea of okay no wait a minute there's got to be parts of the processes that break down and let's figure out what conditions trigger that and then if it's if a part of its being dysregulated what would be an effective strategy and so I think we could get much much more precise and it would really help people know kind of okay what are triggers for me and how do i modulate those in a much much more powerful way let's see in the brown shirt yes beautiful that's a beautiful question I'm not going to do it justice in the recap but the question is how do you think about the reward system cross-culturally if you hear about places like Denmark where happiness is really high and what Roald is advertising perhaps play in those kind of cultural differences there are huge cultural differences and I'm only going to begin to touch on those but one way that people think about this is they kind of try and classify more individualistic versus collectivistic societies and in individualistic societies like the US we have a kind of background philosophy that influences us to believe that our individual accomplishments are a very very important part of our kind of life goals and that how well we're doing and pursuing our own individual accomplishment is a big part of it in other cultures actually standing out from the as an individual driving your own achievement forward might not be seen as the most positive thing and that what might be more important is to be fluidly adapted to your pack and attune to signals from them and perhaps not doing things to make everybody jealous and envious of you so that you would kind of keep some of those instincts a little bit modulated in supportive kind of more interpersonal connectedness as a primary value I think that actually has a huge role in kind of shaping the goals people pursue I also think that media and advertising frequently give us images of unattainable goals so we are exposed everyday to images of people who have much much more than we do we have more than most people in the world and yet we're always seeing images of people who have more and it keeps the bar here so that I think we're a little bit more likely to keep peddling and not get the chance to kind of savor because we're never going to get there because the image is up here so yeah absolutely so two different ways that we know that that works and there's probably a myriad of others so the question is are there beyond the cues that signal reward or there are other kinds of cues that might turn the reward system activity down we know that chronic stress diminishes activation on the nucleus accumbens so that's pretty fascinating because that's certainly you know kind of okay that's one hard knock way that that's going to happen but there's also kind of second-by-second stuff that happens to turn down activity in the nucleus accumbens and so there's a paradigm called response reversal where we train you that okay press this button press this button it's good good good good good now the button stops working no more chocolate for pressing that button okay it's a response reversal paradigm and people look at kind of omission of reward and how quickly you learn about omission of reward and learn to kind of quit pressing that button and they do anything animals they also do it in humans and what they can show you is that regions the prefrontal cortex particularly like the orbital frontal cortex help you kind of notice quickly oh that's not working anymore and stop orbital frontal cortex sends an inhibitory signal down to the nucleus accumbens saying not so good anymore time to reverse course and there are people who don't seem to have any people really very and how quickly they learn on those kinds of lab tasks that you know what doing that isn't gonna work anymore and it seems super super easy to learn that because you think well wait I was pressing the button it was good it was good it was a good minute it stops come on I see it so but what we do to make those tasks harder is that we don't always get the reward because in real life there's really anything you do that works 100% of the time so you set up tasks and like 70 percent of the time you get a reward and 30% of the time you don't it's called probabilistic reward and in that kind of paradigm where the rewards kind of mostly they're sometimes not mostly there it's harder to notice when it stops being a good thing to do so they use probabilistic reward and then they kind of reverse kind of is this a good thing to do take away the kind of reward and watch how quickly people learn and huge individual difference is very driven by the prefrontal cortex and we know something of the pathways that then kind of send a signal back down to the nucleus accumbens so yeah I've been ignoring this side of the room let me come over there that's a great question so it's unclear in some ways I mean so it does look like an animal studies sometimes it looks to be a precursor for addictions but the other thing that's gonna happen your brain is an amazing amazing organ and so what happens is that if a part of the brain is firing off excessively then modulation is gonna happen you know so if a neuron is firing almost continuously it'll turned out and how easily its receptors you know how easily it's activated so think about what happens with a with a kind of stimulant hit you know if you're continuously kind of hitting the brain with stimulants and you're flooding dopamine receptors those neurons are gonna say wow something's wrong I'm firing way too often and they're going to kind of pull back on how many receptors they have so they're going to be much harder to fire off so there is a kind of after effect of the kind of stimulants and the cocaine that Tunes down activity in that system so it may be a little bit of a both it may be that it can set the stage for addictions but once the addiction kicks in it may kind of make the cycle worse and we're not really sure how long it takes for that process to restore to kind of baseline levels so it's a great question well yeah okay so the question is how much the genes influence probably a lot and there's a lot of research going on so for example we've identified a lot of different genes that influence dopamine function and people are trying to understand then how those kind of play out in influencing so there are studies where they look at kind of specific polymorphisms of a of a given dopamine gene and they look to see how that influences nucleus accumbens activity in the context of reward the findings are still a little bit mixed and part of that I think has to do with these systems are so hugely influenced by life experience as well and so on the one hand we know that there's huge genetic influences on the other hand we're gonna have to kind of find ways to map the genes by the environment to get to kind of okay and then for a given person why is their nucleus accumbens kind of lighting up at a given moment but that's that work is definitely going on and very promising so okay so the question is are there protocols that are standardized for delivering something like behavioral activation and then how would you know whether one therapist protocol was more effective than another so the beauty of behavioral activation is that there are manuals in fact the first manual was written by Beck and he put this in as I kind of he would it was part of his cognitive therapy manual to do behavioral activation and he thought it was just kind of a nice thing to throw in before you got to the meat of the matter it turns out that when they tested okay what if he gave behavioral activation versus doing all this others behavioral activation held up as well as doing all this other stuff which was a huge outcry in the field like I wrote is like what that can't be surely you need the 17 other things that therapists do in cognitive therapy and there's been more debate and more science and more testing of that but behavioral activation this very simple idea looked pretty good so Beck was the first person who wrote up a manual of how you would do it now when that got the kind of big attention grabbers then people went in hopko wrote another manual that's actually much more complex it gives a lot more strategies talks a lot more about the different barriers that you're going to hit if you're trying to kind of execute this other people have developed manuals and what they do is they test them you know so they'll put people through those kind of manual driven protocols as compared to giving them support and listening to them and being really kind and saying how was your week and let's talk about the things that are stressing you out and they can show that they're systematically more effective so how would you know if your therapist uses those protocols you could ask your therapist do you do cognitive behavioral therapy or D do behavioral activation and that's a kosher question a lot of people feel intimidated to ask their therapist something like that but you know you ask your car mechanic if they work on Nissan's I think it's fair game to ask your therapists what what tools they have in their toolkit so I highly recommend that that's a good question so yeah yeah I mean that is this is a great question the question is about how often are people doing things repetitively that we don't understand because they have a hidden motivation it's not a it's not a brain miss function it's not a it's not a misfire of the brain it's a kind of they want a certain reward and it's there for them in this context yeah I mean it has to be true right human beings are pretty darn complex of course we have motivations that are operating outside of our you know full conscious awareness we have motivations that we don't want to talk about with other people often we have motivations though for sticking with something that we actually can verbalize and that all too often we you know we're so busy chanting at some get out of that situation get out of that situation get out of that situation well then we haven't done a really nice assessment of okay well what is good in this what's holding you in there what are the moments that make you happiest what gives you hope what sustains you in there and sometimes people I should have a really good storyline that you have to understand to kind of think about well how do we help them move from that spot but those are really tricky situations I mean I don't work with you know kind of people who are stuck in abusive relationships as a therapist because I find it really hard to kind of help in that moment because it is complex and it is it's just it's got a lot of strings to pull them to kind of help people mobilize in that context so yes okay yeah so the question is okay we've talked about the idea that some rewards you get satiety to and they no longer haven't seen power is that also the case that certain threats stop having the same power and the answer is absolutely yes certain threats do lose their kind of power so in anxiety disorders what you have is somebody who's really terrified of something that they can look at and they can go I shouldn't be so afraid of elevators for example and it turns out that if you can put a person in that context if it really is a fear that's kind of too magnified I'm not saying that we should all climb in the mouths of sharks but if it's a fear that's kind of too magnified and the person is coming to you and saying okay look this is too big of a fear and I know I should be able to kind of conquer this situation how do I do it one of the number-one treatments is exposure treatment which would involve take that person and gradually move them closer and closer to being in an elevator and if they can get in the elevator and they can stay in the elevator and they can spend time in the elevator the elevator is going to lose its power it's no longer going to have the same threat the same fear kind of ability to invoke fear so absolutely there are some threats and some rewards that become less powerful over time which is kind of fun yeah okay so the question is what causes bipolar disorder and and so a couple of things I would highlight one is that the diagnosis of bipolar disorder is tricky to make and there is some some it is really one of those things that is worth having somebody really carefully sort through somebody who's trained really carefully sort through because sometimes it's a hard diagnostic process for people to go through what causes it well we know that almost that we know that bipolar disorder has a huge genetic basis okay so whether a person develops an episode of mania which is kind of the defining feature seems to be tied you know almost 85% genetic heritability estimates I mean that's really a hugely heritable condition on the other hand that doesn't mean that everybody who's carrying those genes develops the disorder so if you take somebody for example who has a parent with bipolar disorder oh that's our only you know 7% or so that the kid is going to develop bipolar disorder so just the genes on so the genes probably set the stage and then other life experiences probably kind of drive that biological vulnerability being expressed in a given moment or you know during the during the person's lifetime and there isn't a whole lot of trauma research going on in the u.s. about bipolar disorder but that's a really increasing area of science in Europe and there are some really good scientists who think that this has an important part to play in pushing the kind of genetic vulnerability towards symptom expression yeah that's a great question I can answer this so the question is are experts only available for the wealthy with insurance and I'm really really glad you asked that because I mean it's an important part of healthcare today so some therapists I mean it's part of some Pikul principles that therapist should do at least some consideration of pro bono work but those slots are often gone pretty quickly the other thing we do I know dick Hartley does this he's you know the director of this series and I do this over at UC Berkeley we will have training clinics for what we're doing is we're training our he's training his medical residents I'm training my doctoral students in how to kind of work using the techniques that you know we know about and those students will see people at low cost and most medical schools have programs like that where you can work with a resident most doctoral kind of therapeutic programs also have in-house training clinics so I'm glad you asked yes great question okay so did I actually mean it when I said that family members of people with bipolar disorder accomplished more what's that all about and what might be happening and why don't the bipolar share the same profile there are now six different epidemiological studies where will you go out and you get a nationally representative sample a sample that reflects who's living in a given nation you know so you match it on you know SES and gender and race and all those sorts of things and you capture people from every strata and when they look at how people do who have bipolar disorder and their families there is consistently in six out of seven studies and advantage economically among the family members of those with bipolar disorder now that's weird when you think about it because we don't usually think huh terrible mental disorder that comes with these crushing episodes helps the family get ahead but I think it has to do with this reward system stuff and I'm really fascinated by what that is and how that might operate now why wouldn't the bipolars themselves end up being super wealthy well some do actually I mean this is a condition where there is just incredible heterogeneity there's a huge range in how people do so there are many famous accomplished individuals who seem like they've had bipolar disorder and you go to the web for one second and type in famous bipolar somebody recently I was giving a talk and they said could we come up with a list of non famous bipolars or famous people who don't have bipolar disorder like it's like the the Venn diagram overlaps in a in a pretty significant way so so there's certainly people with bipolar disorder that accomplish a huge amount but there's also people who struggle a lot and I think that has to do with how well we do in helping people regulate the symptoms that a single episode of mania can wipe out a lot of accomplishment and a lot of promise you know people often lose many of their social resources and they're you know they may lose opportunities for promotion for connectedness in the kind of terrible aftermath of an episode and so the more we could protect people from having the symptoms expressed my theory would be the more we'd see some of this great accomplishment come to fruition yes one more okay you've got your hand up hi I'm going with you I don't know I you know the question is does non-compliance get explained by the reward system I think non-compliance is a pretty complex issue we tried to develop a scale on this and we found that there were actually six different major reasons why people said I'm not taking my medications and and they didn't link particularly well with reward sometimes the sometimes it was kind of not liking the side effects sometimes it was not liking the reminder that you were ill sometimes people had concerns about what those medications might do what I would say on the whole with non-adherence is the important thing is to understand for any given individual like why it's hard for them to take their medications and then you can kind of work from there but in doing that I think we all need to have some respect for that you know most of us don't take our medications that well when it's a long term thing if you're taking a cardiac medication or a kind of long-term thing most of us miss doses it's really easy to miss doses or to get tired of taking a long-term medication regimen and so it's hard for all of us and then there's reasons why it's probably harder for people with bipolar disorder well thank you very much dr. Johnson thank you for the terrific questions and for your attention and it's been a real treat to be here

Channel: University of California Television (UCTV)

Views: 114,185

Keywords: bipolar disorder, mania, psychology, reward system

Id: dD-eQ8Poc-k

Length: 87min 9sec (5229 seconds)

Published: Fri May 25 2012