Pleasure Maximisation and Distress Avoidance

Over the past three blogs in this series on Neuropsychotherapy Basics, we have looked at the basic psychological needs of attachment, control, and self-esteem enhancement. Now we turn our attention to the forth basic need in the consistency model, that of pleasure maximisation and distress avoidance.

This need, to avoid pain and maximise pleasure, is intuitive and obvious, for the most part, when observing human behaviour. We do try to avoid painful situations, be they physical or emotional, and we are generally orientated to seek comfort and pleasure when it is in line with our other needs. There are complexities, however, when we will suffer pain or discomfort to achieve a goal that satisfies a bigger need than just the need to be comfortable. As we discussed in the previous blog, the net satisfaction of all the needs may require compromise on some level to achieve an overall outcome. For example the athlete who suffers pain in training and competing to satisfy a more demanding need for self-esteem enhancement by winning a gold medal, is an example of compromising the need to avoid pain for a better overall outcome of need satisfaction.
[private]
The good-bad evaluation

But what is pleasure and what is pain? These things can be very different from individual to individual. So if there is a basic need to avoid pain (physically, psychologically, socially), we need to understand how the individual evaluates what is pain and what is pleasure.

There is an automatic evaluation of experience as either ‘good’ or ‘bad’, and this evaluative function of our minds is always monitoring our experiences. The evaluative reaction to a stimulus has a specific neural foundation that is automatic and is not a conscious process. Just how a person will size up the world around him is dependent on his prior experience and his momentary state. For example a hot drink on a very hot day may be evaluated more negatively than an ice-cold drink, and reciprocally so on a cold day—this is a state dependent evaluation. An evaluation that may not change much with the state of the individual could be something like going on a roller-coaster—to one individual this may be evaluated as ‘bad’ and to another it may be evaluated as ‘good’ based on prior experiences with roller-coasters. The relearning of taste preferences is a complex process influenced by motives such as social compliance and positive self-evaluations, yet is the same automatic evaluative process in play. For example the development of taste for wine may be motivated by a need for social acceptance (attachment and self-esteem), but ultimately becomes an automatic preference for wine as part of the neural evaluative process.

We can consciously, and deliberately train our senses to experience something as beautiful, pleasurable, or tasty, not because the sensory input of the object is intrinsically pleasurable, but because of the qualities we bring to the situation or thing. For example, on first listening to a certain style of jazz, the listener may evaluate the sound as too complex, dissonant and unpleasant. However, the person may have a new set of friends who ‘love’ this style of music, and to ‘fit in’ the person takes time to listen, and learn more about the music, the players, maybe even go to some live shows. After some time the listener finds the music not only tolerable, but even enjoyable. The listener has changed the evaluation of the music so much so that now the listener is even seeking out new music of the same kind, quite separately from the social motivation that initiated the exploration into the style of jazz in the first place.

When a situation is evaluated either positively or negatively (good or bad), it triggers an approach or avoidance tendency (our motivational schemas). When we evaluate a situation our mental activity is primed or orientated in a certain direction. For someone who evaluates New York cab drivers as ‘bad’, based on past negative experiences, they may be primed to ‘jump’ at the sudden lane changes made by the driver. Another person, however, who has a positive evaluation of New York cabs would not be startled or fearful at the sudden lane change of the driver (within reason). Another example could be the person who has just seen an intense action movie and steps out into the street where he hears a loud bang, he is more “primed” to have a startle response than if he had just watched a comedy. This motivational priming is the orientation of the motivational system to be either more approach or more avoidant toward certain cues in our environment.

Mental processes transpire more easily and quickly when the good-bad evaluation is compatible or syncronised with the behavioural approach-avoidance orientation. For example we have a negative evaluation of the loud bang in the street (it sounds like danger) and we engage an avoidance behaviour to run into the nearest storefront for safety. When such evaluations and behavioural orientations are consistent the mental system works more efficiently. If we evaluated the bang in the street negatively and engaged an approach behaviour to step further out into the street in the direction of the sound to investigate, then the efficiency of our mental system is taxed. This is not to say that it is not possible, we can do this sort of thing, but the opposing evaluation and behaviour (‘bad’ evaluation – ‘approach’ behaviour) do cause more stress than if they were in agreement (‘bad’ evaluation – ‘avoidance’ behaviour).

So what does this mean in therapy? We want to prime our clients to be more approach than avoidance orientated, and so it would be beneficial to focus on positive therapeutic goals as much as possible.

Approach and avoidance – two independent systems

The approach and avoidance motivational systems operate independently of one another and have independent neural substrates and mechanisms. They can be activated in a parallel fashion, although they tend to mutually inhibit each other.

On a neural level the left dorsolateral prefrontal cortex (Left dlPFC) is associated with approach goals, and avoidance is more closely aligned with the right (Right dlPFC). For the processing of emotions the left ventromedial PFC is associated with positive emotions and the right for negative emotions. So we can see that these motivations and evaluations of approach/positive and avoidance/negative are biologically aligned. There are more correlations in the deeper limbic system as well and it gives credence to the theory that these approach and avoidance systems are indeed neurally independent systems. There is also a genetic tendency to bias positive or negative emotional evaluations, but this will be a topic for another blog.

Basic needs have a neural foundation from birth that initiate behaviour like crying, sucking, and wiggling the body, to meet those needs. These genetically governed behaviours are the beginning of what will develop into much more personal and sophisticated motivational goals. The first need that develops into an approach goal is the need for proximity of the primary attachment figure. This is, as we have discussed, also the need for control. As the infant experiences encounters with her mother, she starts to develop a repertoire of behaviours to influence the mother to meet her needs. Neural activation patterns emerge that represent this and other goals, and are strengthened with the help of oxytocin and dopamine. Actually both baby and mother are rewarded by oxytocin and dopamine release when in loving, mutually satisfying connectedness. The increasing strength and complexity of thee neural patterns continue to form circuits that become more easily activated and eventually become spontaneously activated and sophisticated schemas are developed. The specific groups of motivational schemas that develop to satisfy the basic needs are infinitely richer and more multifaceted than what might be suggested by the classification of just a few attachment styles. We are not simply secure, avoidant, or ambivalent, but are a complex mix of these sorts of styles. As we grow our motivational goals are shaped by our wider environment as well. For example a middle-class European child will develop different goals to achieve social standing and success, than will a poverty stricken child in a war-torn African nation. The environment, along with the social expectations, limitations, and so on, will shape our motivational schemas.

Let us continue to talk about approach and avoidance as these schemas relate to pleasure maximisation (approach) and pain minimisation (avoidance). Although it may seem like these two schemas are opposites, like a positive and negative charge, they are just different goals with different modes of operation. The approach schema is all about closing the gap between a desired goal and perceived reality to attain that goal which satisfies a need. There is often a progress toward a goal, with rewards along the way, and then attainment or not of that goal. Whereas the avoidance schema is about increasing the distance between something undesirable and perceived reality, often to preserve or protect a basic need, and is often never achieved, but is more a mode of continual surveillance. When pursuing a positive goal, like completing a university course, it is relatively easy to determine whether one has come closer to the goal—there are subgoals and markers along the way (like completing semesters) to the final destination of the goal. However, avoidance goals require constant control, as well as distributed (instead of focused) attention. For example, say a husband is anxious to avoid an argument with his wife; he has to keep vigilant, watch what he says, be careful to read the signs of a possible argument, and he can never reach the goal of avoidance because there is always the possibility that it could happen in the future. This sort of avoidance is more a matter of continual attention, and often anxious tension, than simply apprehending a concrete goal. People with strongly formed avoidance goals (or with a dominance of avoidance over approach goals) experience fewer positive emotions and less need satisfaction because so much energy and focus is put into avoidance. As a consequence of this effort and lack of need satisfaction, these people can be expected to have lower well being and mental health.

Grawe (2007) developed the Inventory of Approach and Avoidance Motivation (IAAM) to measure the tendency to operate in either approach or avoidance modes, and found that psychotherapy patients attained significantly higher scores on all IAAM avoidance scales. These findings suggest that strongly developed avoidance tendencies have a multitude of unfavorable effects on mental health. Grawe found that both implicit and explicit avoidance has a negative influence on mental health, associated with low self-esteem and general low wellbeing.

It would seem prudent then that therapy should aim to reduce the use of avoidance goals and promote more positive approach goals to satisfy basic needs. In the example of a depressed person, their behaviour can be attributed to a hyperactivation of avoidance schemas, inhibiting approach schemas, and the resulting negative effects of stress hormones that damage the hippocampus and deactivate the anterior cingulate cortex, among other detrimental effects. If therapy can weaken the established avoidance tendencies and gradually reactivate the approach system, there will be a revitalisation of the ACC and stronger PFC connections and other neural changes that will elicit a positive change for the client.

Neural mechanisms of Approach and Avoidance Learning

When we talk about approach and avoidance schemas, what we are really trying to understand is the very nature of motivation and learning. We have a long way to go in our understanding but current neuroscience is helping us understand the underpinnings of motivation. We have encountered the amygdala in regards to the fear response, but it is also involved in emotional evaluation of more pleasant perceptions in collaboration with the nucleus accumbens. The nucleus accumbens is integral in learning of behaviour as we shall see below.

In a typical neural learning scenario the hypothalamus informs the PFC of physiological states (like the system is getting low on blood sugar) & the decisions made in the PFC (like making a move to get something to eat) are transmitted to the nucleus accumbens that in turn triggers a process eliciting and strengthening behaviour (behaviour reinforcement mediated by dopamine). The nucleus accumbens integrates information coming from the amygdala (emotional), and hippocampus (location/context), and makes a decision to activate or terminate a behaviour (like going to get something to eat). Let’s say the nucleus accumbens has given the ‘go’ signal to get something to eat. The act of eating and satisfying hunger releases dopamine, and the dopamine binds with receptors involved with motor actions and perceptions of eating. Through second messenger cascades there is elevated synaptic transmissions and the whole network that has been activated is strengthened—making it easier for the same network to light up in the future. Dopamine is the reinforcing agent here and represents neural motivation, or motivational salience in establishing behaviour. Any behaviour that is reinforced involved the release of dopamine. In fact, if you think “motivation”, think “dopamine”. Because dopamine is key to motivation and learning (establishing and reinforcing synaptic connections), then in therapy, learning must have high motivational salience for effective learning. Without the activation of the dopamine system there will not be good, long-term learning taking place. Dopamine is the intrinsic motivator and energiser of approach/avoidance schemas, and so motivation (dopamine reward) is very important to the therapeutic process.

Closing

Our motivational goals are based on a number of basic needs and these simultaneously transpiring processes will have a certain amount of inconsistency as we try to gain a net satisfaction of our overall needs—inconsistency during this process can not be avoided. We strive to satisfy all our needs to a maximum extent, but this is rarely, if ever, achievable. As we discussed with self-esteem, sometimes different motivational schemas compete to satisfy or protect needs that result in compromise for the overall good of the system. Sometimes pain must be approached to achieve a higher goal of self-esteem satisfaction as happens when preparing for an athletics tournament. Or an avoidance goal of not getting up in public to speak may have to give way to the more pressing avoidance goal of not appearing afraid before peers, and so the motivations compete and incongruence and inconsistency is experienced for the sake of the best compromise for need satisfaction. I could go on with even more complicated and convoluted examples, but suffice it to say that there are very complex and competing motivations that are being managed to satisfy, as best one can, the basic psychological needs.

This series on Neuropsychotherapy Basics is primarily sourced from Grawe, K. (2007). Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy. New York: Psychology Press. For a more detailed description of what has been discussed in this blog, and for associated references, I encourage you to read this book.

[/private]