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Medical Psychology and Sociology: Motivation

What motivates you to study for the preliminary examination in medicine? Why do you stay in the library instead of having a nice afternoon? For whatever motives, and with whatever degree of intensity we pursue our goals, is what the psychology of motivation deals with. The term motivation derives from the Latin word motivus = "triggering movement." In the following article, read all about the topic motivation that closely follows the study guide for the preliminary examination and has been optimally edited.

Last updated: 8 Mar, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

The Neurobiological Basis of Motivation

Motivation is closely linked to the neurotransmitter dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS and the dopaminergic feedback system known as the mesolimbic dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS system which works as the amplifier pathway in a reward system where activation of the system leads to dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS release Release Release of a virus from the host cell following virus assembly and maturation. Egress can occur by host cell lysis, exocytosis, or budding through the plasma membrane. Virology and reinforcement of the behavior. The system originates from the tegmental area and innervates the nucleus Nucleus Within a eukaryotic cell, a membrane-limited body which contains chromosomes and one or more nucleoli (cell nucleolus). The nuclear membrane consists of a double unit-type membrane which is perforated by a number of pores; the outermost membrane is continuous with the endoplasmic reticulum. A cell may contain more than one nucleus. The Cell: Organelles accumbens.

  • Hunger: The  hypothalamus Hypothalamus The hypothalamus is a collection of various nuclei within the diencephalon in the center of the brain. The hypothalamus plays a vital role in endocrine regulation as the primary regulator of the pituitary gland, and it is the major point of integration between the central nervous and endocrine systems. Hypothalamus and parts of the  amygdala Amygdala Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the temporal lobe. The amygdala is part of the limbic system. Limbic System: Anatomy form ‘the center of saturation and eating.’
  • Social interaction: The peptide hormone oxytocin (released during birth, lactation Lactation The processes of milk secretion by the maternal mammary glands after parturition. The proliferation of the mammary glandular tissue, milk synthesis, and milk expulsion or let down are regulated by the interactions of several hormones including estradiol; progesterone; prolactin; and oxytocin. Breastfeeding, and orgasm) promote feelings of bonding and trust Trust Confidence in or reliance on a person or thing. Conflict of Interest.
  • Amplifier pathway: The mesolimbic dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS system controls amplification, the reward system.

The Theory of Motivation: Subjective Orientation

Motives are divided into primary and secondary groups. Even though sexual motives belong to the primary group, they do not serve to maintain homeostasis Homeostasis The processes whereby the internal environment of an organism tends to remain balanced and stable. Cell Injury and Death.

Primary motives Inherent motives: maintaining homeostasis Homeostasis The processes whereby the internal environment of an organism tends to remain balanced and stable. Cell Injury and Death, and sexual motives Hunger, thirst, sleep Sleep A readily reversible suspension of sensorimotor interaction with the environment, usually associated with recumbency and immobility. Physiology of Sleep, exploration, freedom from pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, breathing (oxygen), and sex Sex The totality of characteristics of reproductive structure, functions, phenotype, and genotype, differentiating the male from the female organism. Gender Dysphoria
Secondary motives Learned motives, which are not needed for homeostasis Homeostasis The processes whereby the internal environment of an organism tends to remain balanced and stable. Cell Injury and Death (lower biological significance) Power Power The probability that a test will correctly reject a false null hypothesis. Statistical Tests and Data Representation, performance, prestige, and connection

Theories of Motivation

Five major theories try to explain motivation and they are applied to help one increase productivity at his/her workplace. The theories largely apply the basic forms of motivation.

  • Intrinsic motivation: inner, ‘self-motivation’ to do something
  • Extrinsic motivation: motivation based on outer amplifiers, rewards (i.e., money)

The ethological model: the instinct theory

This approach supports the position that most of the animal and human behaviors are based on genetics Genetics Genetics is the study of genes and their functions and behaviors. Basic Terms of Genetics. The central question of the study of instinct (ethology) is:

Which parts of the behavior are inherent and which are learned individually?

The motive here is a state of deficiency, and the individual searches for stimuli to eliminate this state of deficiency. K. Lorenz observed various species and concluded that specific instinctive acts take place in a way that is standardized to the maximum extent.

Table: The sequence of the instinctive act, according to Konrad Lorenz (1937)
1 The impetus elicits appetitive behavior
2 A key stimulus or a dummy appears
3 A fixed action pattern ( FAP FAP Familial adenomatous polyposis (FAP) is an autosomal dominant inherited genetic disorder that presents with numerous adenomatous polyps in the colon. Familial adenomatous polyposis is the most common of the polyposis syndromes, which is a group of inherited or acquired conditions characterized by the growth of polyps in the GI tract, associated with other extracolonic features. Familial Adenomatous Polyposis) is elicited
4 An orientating response occurs
5 The final consummatory act is initiated and the lacking need is satisfied

Detailed definition of important terms regarding the ethological model

Learned key stimuli that are not present at birth are called imprinting Imprinting The variable phenotypic expression of a gene depending on whether it is of paternal or maternal origin, which is a function of the DNA methylation pattern. Imprinted regions are observed to be more methylated and less transcriptionally active. Epigenetic Regulation. This imprinting Imprinting The variable phenotypic expression of a gene depending on whether it is of paternal or maternal origin, which is a function of the DNA methylation pattern. Imprinted regions are observed to be more methylated and less transcriptionally active. Epigenetic Regulation that takes place during the short, learning-sensitive phases is irreversible.

Inherent key stimuli are, for instance, a hungry infant’s appetitive behavior and the schema of childlike characteristics with its corresponding behavior of affection and protection. With this schema, you can also illustrate the term dummy very well: we react to stuffed toys with big eyes, small noses, and round faces in a similar way that we react to a cute baby face—we pick them up and caress them.

Final act The final act of consummation leads to a loss of motivation to act according to a defined behavioral program Blackbirds: open beak, swallow the food, and satisfaction of need by saturation
Displacement Displacement The process by which an emotional or behavioral response that is appropriate for one situation appears in another situation for which it is inappropriate. Defense Mechanisms behavior The tension between 2 action tendencies leads to behavioral inhibition and new action, which is different from the 2 tension producing actions Scratching one’s head, gnawing one’s nails, and cracking one’s knuckles
Vacuum activity The motive is so strong that it is triggered without a key stimulus The hunting behavior of a bird (according to Lorenz’s experiments). Despite the absence of insects, the entire process of catching flies is carried out.

Maslow’s Hierarchy of Needs (1971)

Maslow assumes that primary needs have to be satisfied 1st before secondary needs can become relevant. Thereby he supports a humanistic image of humankind.

Only the extended motivations represent man.

Every human being potentially strives for self-actualization.

The need for self-actualization (transcendence) can only be satisfied in a small fraction of people. Transcendence means to give life a higher meaning, to feel in harmony with the whole.

Hierarchy of needs by maslow

Maslow’s hierarchy of needs

Image: “Maslow’s hierarchy of needs” by J. Finkelstein. License: CC BY-SA 3.0

The hierarchy is made up of 5 levels of needs as:

According to this theory, you must be in good health, safe, secure and in meaningful relationships, and feel confident before you can be the most you can be.

The Learning Theory Approach

The learning theory approach is based on the learning process according to the principles of operant conditioning Operant conditioning Learning situations in which the sequence responses of the subject are instrumental in producing reinforcement. When the correct response occurs, which involves the selection from among a repertoire of responses, the subject is immediately reinforced. Psychotherapy.

Expectancy-value Theory

The motivation consists of the results of 2 basic questions:

  • How attractive or valuable are the task values/task goals?
  • How high is the subjective probability Probability Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially. Basics of Probability that this result happens? How high is the associated expectancy?

The Evolutionary Psychological Approach: Voluntary Actions

You would rather go to the lake now instead of studying in the library for the preliminary examination. Your will makes it possible for you to pursue important goals even though there is no motivational basis at the moment.

The tendency (intention) is the basis for voluntary actions. The volitional (volition = will/will power Power The probability that a test will correctly reject a false null hypothesis. Statistical Tests and Data Representationprocess here is stronger than the motivational process (i.e., fasting despite hunger). The Rubicon model summarizes the action phases.

The Rubicon model of action phases (Heckhausen et al AL Amyloidosis., 1987)

Strategies for the evolutional action control:

  • Motivation control: targeted increase of motivation with a renewed focus Focus Area of enhancement measuring < 5 mm in diameter Imaging of the Breast on the goal (‘I want to pass the preliminary examination!’)
  • Environmental control: change in the environment, to achieve the goal more easily (learning in the library instead of at home with a view of the park)

Trip to the Clinic: The Transtheoretical Model

The transtheoretical model (TTM), according to Prochaska and DiClemente, should enable therapists to better evaluate and influence their patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship‘ behavior. This is especially important in patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with dependency issues (see below) as it helps for therapeutic decisions. The TTM consists of 6 steps:

1 Purposelessness/carelessness pre-contemplation
2 Contemplation/realization contemplation
3 Preparation Preparation
4 Action action
5 Maintenance maintenance
6 Termination/permanent maintenance termination

The therapeutic approach: it is important to work in synchronized phases! How do you, for instance, convince a patient to stay sober, if he is not even aware of the health risk of substance abuse? The following table summarizes which main strategy to follow in each phase:

Precontemplation Creation of awareness of the problem
Contemplation Resolve ambivalent thoughts
Preparation Precise focus Focus Area of enhancement measuring < 5 mm in diameter Imaging of the Breast on the goal with the step-by-step plan
Action Boosting one’s trust Trust Confidence in or reliance on a person or thing. Conflict of Interest in one’s strengths
Maintenance Preventative behavior against a backslide
Termination The behavior to achieve the goal has become ‘normal’

The Motivation Conflicts

There is rarely just one motivation or one tendency toward need. On the contrary, often there are simultaneous different motivational tendencies in us, and we have to decide on the one to follow. Hereby, conflicts arise.

The 3 conflict typologies by Lewin (1931):

  • Appetence: Tendency, which aims to satisfy a craving by doing a certain action
  • Aversion: Tendency to avoid action for fear that it will not accomplish the desired effect

Appetence-Appetence conflict: The approaching conflict

In an appetence conflict, the affected individual has to decide between 2 positive alternatives.

Example: You have been admitted to study veterinary medicine as well as human medicine and now have to decide on 1.
Aversion-Aversion conflict: The avoidance conflict

In an aversion conflict, the affected individual has the choice between 2 negative alternatives, in other words choosing the ‘lesser evil’.

Example: You contemplate working 2 hours overtime in the evening versus getting up earlier tomorrow to finish writing the discharge letters.

Appetence-aversion conflict: The ambivalence conflict

In an appetence-aversion conflict, the individual’s goal has both negative and positive aspects at the same time (‘2 sides of a coin’). He is disgusted and attracted simultaneously to fulfill the tendency toward the need.

Example: A depressed patient would like to undergo therapy with antidepressants but fears the side effects of gaining weight.

Double appetence-aversion conflict by Miller (1944)

The 4th type of conflict extends Lewin’s simple typology by adding the double appetence-aversion conflict. Here, the individuals have to decide between 2 alternatives, each of which has positive and negative aspects.

Example: Do you choose the low paying residency in your favorite city over the highly paid job at a rural hospital in the periphery?

The Achievement Motivation

One’s desire to want to beat themselves or others in their achievements is called achievement motivation. People with high achievement motivation choose tasks that are always a degree more challenging. Only if failure or success can be the result of a task, is it possible to assess a quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement standard. Aside from positive responses like joy and pride, one is motivated by the desire for increasing efficiency: The road to success is optimized more and more in variations.

The Risk-Preference-Model by Atkinson (1957): Expectancy x Value

You want to get a B on your preliminary examination while your fellow student is completely satisfied with a D. The basic question of the Atkinson model is:

Why do people set goals at different levels?

Choosing a goal (choosing the difficulty of the task) = the probability Probability Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially. Basics of Probability of success (expectation) x appeal of success (value).

  • Moderately difficult tasks provide information about one’s efficiency because success or failure is possible.
  • Easy tasks are executed without any problem and do not lead to positive effects.
  • Difficult tasks have a low probability Probability Probability is a mathematical tool used to study randomness and provide predictions about the likelihood of something happening. There are several basic rules of probability that can be used to help determine the probability of multiple events happening together, separately, or sequentially. Basics of Probability of success. If success occurs, however, the positive effects are that much greater.
  • Success-motivated individuals choose moderately difficult tasks.
  • Failure-motivated individuals choose very easy or very difficult tasks.

The Attribution Theory

Depending on one’s explanatory style, people justify their successes and failures. These causal attributions are divided into different attributional dimensions: internal/externalstable/unstable, and specific/global

The fundamental attribution error Error Refers to any act of commission (doing something wrong) or omission (failing to do something right) that exposes patients to potentially hazardous situations. Disclosure of Information: Actor-observer bias Bias Epidemiological studies are designed to evaluate a hypothesized relationship between an exposure and an outcome; however, the existence and/or magnitude of these relationships may be erroneously affected by the design and execution of the study itself or by conscious or unconscious errors perpetrated by the investigators or the subjects. These systematic errors are called biases. Types of Biases

The observers’ attitude to relate one’s behavior primarily back to human behavioral traits and putting situational factors aside (i.e., aggressive behavior), is called fundamental attribution error Error Refers to any act of commission (doing something wrong) or omission (failing to do something right) that exposes patients to potentially hazardous situations. Disclosure of Information. The actor would explain his behavior exactly the opposite way and primarily blame the situation for his actions.

Addiction: Looking for More

Definition of addiction Addiction Substance use disorders are a significant cause of morbidity and mortality, especially among adolescents and young adults. A substance-related and addictive disorder is the continued use of a substance despite harmful consequences; these include significant impairment to one’s health or relationships or failure to fulfill major responsibilities at work, school, or home because of substance use. Substance-Related and Addictive Disorders (World Health Organization (WHO)):  Addiction Addiction Substance use disorders are a significant cause of morbidity and mortality, especially among adolescents and young adults. A substance-related and addictive disorder is the continued use of a substance despite harmful consequences; these include significant impairment to one’s health or relationships or failure to fulfill major responsibilities at work, school, or home because of substance use. Substance-Related and Addictive Disorders is a psychological and physical state, which is characterized by the fact that an individual feels an insurmountable desire for a certain substance or a certain behavior despite physical, mental or social disadvantages. He can no longer control this desire and is dominated by it.

The topic of addiction Addiction Substance use disorders are a significant cause of morbidity and mortality, especially among adolescents and young adults. A substance-related and addictive disorder is the continued use of a substance despite harmful consequences; these include significant impairment to one’s health or relationships or failure to fulfill major responsibilities at work, school, or home because of substance use. Substance-Related and Addictive Disorders belongs in the article about motivation because addicts act very purposefully: to get the ‘pleasure’ of the addictive substance is usually the only motive for addicts, and consequently they pursue this goal. One differentiates between substance dependencies and substance independent addictions (food addiction Addiction Substance use disorders are a significant cause of morbidity and mortality, especially among adolescents and young adults. A substance-related and addictive disorder is the continued use of a substance despite harmful consequences; these include significant impairment to one’s health or relationships or failure to fulfill major responsibilities at work, school, or home because of substance use. Substance-Related and Addictive Disorders, gambling addiction Addiction Substance use disorders are a significant cause of morbidity and mortality, especially among adolescents and young adults. A substance-related and addictive disorder is the continued use of a substance despite harmful consequences; these include significant impairment to one’s health or relationships or failure to fulfill major responsibilities at work, school, or home because of substance use. Substance-Related and Addictive Disorders).

Hallucinogens (lysergic acid diethylamide (LSD), mescaline), opiates Opiates Opiates are drugs that are derived from the sap of the opium poppy. Opiates have been used since antiquity for the relief of acute severe pain. Opioids are synthetic opiates with properties that are substantially similar to those of opiates. Opioid Analgesics ( morphine Morphine The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. Opioid Analgesics, heroin Heroin A narcotic analgesic that may be habit-forming. It is a controlled substance (opium derivative) listed in the U.S. Code of federal regulations, title 21 parts 329. 1, 1308. 11 (1987). Sale is forbidden in the United States by federal statute. Nephrotic Syndrome), cannabis, alcohol, nicotine Nicotine Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. Stimulants, and analgesics are counted among psychoactive substances.

According to DSM-4, dependency exists if 3 of the following criteria are present:

  • Development of tolerance Tolerance Pharmacokinetics and Pharmacodynamics
  • Physical withdrawal symptoms
  • The substance is consumed in larger amounts and longer than intended
  • The substance intake can no longer be controlled
  • A lot of time is spent on procurement and consumption of the substance and other factors (work, family, leisure activities, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).) are neglected
  • The substance is consumed despite physical and psychological damages

How does dependence arise?

Several factors play a role in developing dependency. The WHO speaks of a multifactorial model of explanation.

Personal factors Negative self-image; tendency to reward oneself quickly; impulsive, antisocial behavior
Environmental factors Family: disinterested and unstable environment, little to no emotional attention Attention Focusing on certain aspects of current experience to the exclusion of others. It is the act of heeding or taking notice or concentrating. Psychiatric Assessment, little scholastic achievements, status gain in peer groups (testing courage, power Power The probability that a test will correctly reject a false null hypothesis. Statistical Tests and Data Representation games, ‘coolness’), easy availability of substances (especially alcohol, nicotine Nicotine Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. Stimulants)
Effect of the drug Enhancing effect for consumers, the effect on the mesolimbic dopamine Dopamine One of the catecholamine neurotransmitters in the brain. It is derived from tyrosine and is the precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. Receptors and Neurotransmitters of the CNS system (reward system) with tolerance Tolerance Pharmacokinetics and Pharmacodynamics development, withdrawal symptoms associated with abstinence

Psychosocial effects of the drug

Theoretical learning processes are important to explain the origin of dependence. On the 1 hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy operant conditioning Operant conditioning Learning situations in which the sequence responses of the subject are instrumental in producing reinforcement. When the correct response occurs, which involves the selection from among a repertoire of responses, the subject is immediately reinforced. Psychotherapy takes place: the drug leads to relaxation ( positive reinforcement Positive reinforcement Psychotherapy), and the drug prevents negative emotions/situations or withdrawal symptoms disappear ( negative reinforcement Negative reinforcement Psychotherapy). Classical conditioning includes situational and social triggers Triggers Hereditary Angioedema (C1 Esterase Inhibitor Deficiency) such as getting together at a bar, parties, and conflict situations (partnership, supervisors, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).).

References

  1. Alder, B., Millar, K., Britton, R., &Penwill, R. (2009). Psychology and sociology applied to medicine: An illustrated colour text.
  2. Brown, E. L. (2014). The use of the physical and social environment of the general hospital for therapeutic purposes. New York: Russell Sage Foundation.
  3. Fox, K. R. (1997). The physical self: From motivation to well-being. Champaign, IL: Human Kinetics.
  4. Publications received. (1980). Social Science & Medicine. Medical Psychology and Medical Sociology14(2), 181-182. doi:10.1016/0160-7979(80)90041-7

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