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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? The psychology of motivation deals with the motives to and the degree of intensity with which we pursue our goals. The term motivation derives from the Latin word motivus ("triggering movement"). In this article, we discuss the topic motivation that closely follows the study guide for the preliminary examination.

Last updated: Aug 13, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

The Neurobiologic Basis of Motivation

Motivation is closely linked to the neurotransmitter dopamine and 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, the primary neural circuit mediating motivation, reinforcement, and reward-related behavior. Selected peptides and hormones Hormones Hormones are messenger molecules that are synthesized in one part of the body and move through the bloodstream to exert specific regulatory effects on another part of the body. Hormones play critical roles in coordinating cellular activities throughout the body in response to the constant changes in both the internal and external environments. Hormones: Overview and Types act within the ventral tegmental area and 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 to influence behavior related to food and eating, drug use, and social reward. Activation of 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 leads to further 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 behavior reinforcement.

  • Hunger: The hypothalamus and parts of the amygdala form the center of eating and satiety.
  • 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) promotes 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 of incentive salience or “wanting” the reward, including visceral involvement, in addition to a cognitive desire.

The Theory of Motivation: Subjective Orientation

Motives are divided into primary and secondary groups.

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, 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: 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 biologic significance) Power, performance, prestige, and connection

Theories of Motivation

Several theories try to explain motivation. One application of these motivation theories is to increase productivity in the workplace

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

The Ethologic Model: the Instinct Theory

Ethology is the study of how animals Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, animalia was one of the kingdoms. Under the modern three domain model, animalia represents one of the many groups in the domain eukaryota. Cell Types: Eukaryotic versus Prokaryotic or humans behave in their natural environment. This model supports the position that most animal and human behaviors are based on phylogenetic factors. The question central to the study of instinct is determining which behaviors are inherent and which are learned individually.

The motive here is to eliminate a state of deficiency. The renowned ethologist and zoologist Konrad Lorenz (1973 Nobel Prize winner in Physiology or Medicine) observed various species and concluded that specific instinctive acts take place in a way that is maximally standardized.

  • The impetus elicits appetitive behavior.
  • A key stimulus or a dummy appears.
  • 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.
  • An orienting response occurs.
  • The final act of completion is fulfilled and the lack or need is satisfied.

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 is the learning of a behavioral pattern that occurs soon after birth in animals Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, animalia was one of the kingdoms. Under the modern three domain model, animalia represents one of the many groups in the domain eukaryota. Cell Types: Eukaryotic versus Prokaryotic and humans. In this process, a long-lasting response to a person or object is rapidly acquired. Phase-sensitive learning that occurs at a particular age or life stage that is rapid and irreversible is also 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. Which parts of the behavior are inherent and which are learned individually?

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. 

Final act The final act of consummation leads to a loss of motivation to act according to a defined behavioral program Example: blackbirds open their beak and swallow the food; the need is satisfied
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 Examples: head-scratching, nail-biting, knuckle-cracking
Vacuum activity The motive is so strong that it is triggered without a key stimulus. Example: 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

Maslow assumed that primary needs must be satisfied before secondary needs become relevant. He supported a humanistic image in which extended motivations represent humankind and every human being potentially strives for self-actualization.

Only a small fraction of people are able to satisfy the need for self-actualization (transcendence). 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

According to this theory, people must have their basic physical and psychological needs met MET Preoperative Care, have meaningful relationships, and feel respected before they can achieve self-actualization.

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 expectancy-value theory of motivation consists of answers to 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

Evolutionary psychology is a more modern theoretical approach that examines adaptations using evolutionary terms. Behavior is thought to be adaptive and is the basis for voluntary actions. The volitional process here is stronger than the motivational process.

The Rubicon model of action phases

The Rubicon model of action phases makes a clear distinction between motivational and volitional processes. This model separates the motivational process of the pre-decision phase and the volitional processes of the post-decision phase. The model also distinguishes between the initiation and the conclusion of an action. According to the Rubicon model, an individual reaches a “point of no return” and moves from setting goals to striving for goals.

Trip to the Clinic: the Transtheoretical Model

The transtheoretical model (TTM) attempts to explain how a clinician Clinician A physician, nurse practitioner, physician assistant, or another health professional who is directly involved in patient care and has a professional relationship with patients. Clinician–Patient Relationship can 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 skill is especially important for patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with dependency, as it helps in making therapeutic decisions. An example of where this model is used in clinical medicine is in helping patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship stop smoking Smoking Willful or deliberate act of inhaling and exhaling smoke from burning substances or agents held by hand. Interstitial Lung Diseases. The TTM consists of 6 stages:

  1. Purposelessness (pre-contemplation stage): creating awareness of the problem
  2. Realization (contemplation stage): resolving ambivalent thoughts
  3. Preparation stage: preparing the environment (e.g., set a smoking Smoking Willful or deliberate act of inhaling and exhaling smoke from burning substances or agents held by hand. Interstitial Lung Diseases quit date)
  4. Action stage: address new, more healthful habits and consider prescription support
  5. Maintenance (preventing relapse Relapse Relapsing Fever): providing follow-up and ongoing support
  6. Termination (maintenance): the new behavior has become the new “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 and a decision needs to be made on which one to follow, resulting in conflict.

The 3 conflict typologies: Lewin (1931)

Appetence refers to a tendency, craving, or instinctive inclination. Aversion is the avoidance of a thing, situation, or behavior because it is associated with displeasure or pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways.

  • 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 which to follow.
  • Aversion–aversion conflict: the avoidance conflict:
    • In an aversion–aversion conflict, the affected individual has the choice between 2 negative alternatives; in other words, the individual must choose the “lesser of 2 evils.”
    • 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”). They are 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 potential side effect of weight gain.

Double appetence–aversion conflict: Miller (1944)

  • This 4th type of conflict extends Lewin’s simple typology by adding the double appetence–aversion conflict. 
    • Here, an individual must decide between 2 alternatives, each with positive and negative aspects.
    • Example: Do you choose the low-paying residency in your favorite city or the high-paying job at a rural hospital far away?

The Achievement Motivation

The desire to surpass one’s own or another’s achievements is called achievement motivation. People with high achievement motivation choose tasks that are a degree more challenging. Only if failure or success can be the result of a task is it possible to assess a quality standard. Aside from positive responses like joy and pride, individuals are motivated by the desire for increasing efficiency: The road to success is optimized in more ways.

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

A student wants to get a B grade on their preliminary examination, while a fellow student is satisfied with a D. The fundamental question of the Atkinson model is why different people set goals at different levels.

Choosing a goal = 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 × appeal of success, OR

Choosing the difficulty of the task = expectation × value

  • Moderately complex 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.
  • Complex 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, but the positive effects are more significant if success occurs.
  • Success-motivated individuals choose moderately difficult tasks.
  • Failure-motivated individuals choose overly challenging tasks.

The Attribution Theory

People justify their successes and failures according to their explanatory styles. These causal attributions are divided into different attributional dimensions:

  • Internal/external
  • Stable/unstable
  • 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

In a 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, an “observer” relates a behavior (e.g., aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder) primarily back to human behavioral traits while putting situational factors aside. An “actor” explains their behavior exactly the opposite way—by blaming the situation for their actions.

Addiction: Looking for More

The World Health Organization (WHO) defines addiction as a psychological and physical state characterized by an insurmountable desire for a particular substance or behavior despite the physical, mental, or social disadvantages it brings. The individual 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 this article about motivation because addicts act very purposefully—getting pleasure from the addictive substance is usually the only motive for addicts, and consequently, they pursue this goal. There are both substance dependencies (e.g., food) and substance-independent addictions (e.g., gambling).

Hallucinogens (e.g., lysergic acid diethylamide (LSD), mescaline), opiates (e.g., 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 all considered psychoactive substances.

According to DSM-5, 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 for longer than intended.
  • The substance intake can no longer be controlled.
  • Much time is spent on procurement and consumption of the substance, and other things (work, family, leisure activities) are neglected.
  • The substance is consumed despite physical and psychological damages.

How does dependence arise?

The WHO describes a multifactorial model in which several factors play a role in developing dependency.

Personal factors Negative self-image; tendency to reward oneself quickly; impulsive, antisocial behavior
Environmental factors Disinterested family 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, few scholastic achievements, status gain in peer groups (testing courage, power games, “coolness”), easy availability of substances (especially alcohol and 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, 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 attempt to explain the origin of dependence. 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, in which the drug leads to relaxation ( positive reinforcement Positive reinforcement Psychotherapy) and prevents negative emotions or ameliorates withdrawal symptoms ( negative reinforcement Negative reinforcement Psychotherapy). Classical conditioning includes situational and social triggers Triggers Hereditary Angioedema (C1 Esterase Inhibitor Deficiency) such as meeting with friends, attending parties, and situations involving conflict (e.g., with a partner or supervisor).

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