Why do we all get so frightened?

Why do we all get so frightened?
Have you ever thought of why we get so frightened? What part of the brain has this function to make us feel frightened?
Flight or fight is the natural instinct that we human beings possess so that our brain can quickly notify our body to make biological changes to save our life. Usually we only notice some physiological changes when we are fearful or running away such heart bounding, breathing rate increases, clammy hands, and butterflies in our stomach, difficult to breathe, tight chest, etc. Usually we only focus on our behaviour rather than knowing how it works in the brain and why it happens like this. Where does this fear message come from? Let’s look at which particular part of the brain does the alarm job to heighten our awareness to “fight or flight”.

The emotional part of the brain comprises of the limbic system, the amygdala, the hippocampus, and the basal ganglia.

The limbic system is the main areas for the experience and control of feelings. It sets the emotional tone of the mind, which filters external events through creating emotional coloring. It tags events as internally important, and stores highly charged emotional memories.

Although we know that generation of emotion is located in multiple areas and interconnected, we only focus on the amygdala, the limbic system, the hippocampus and the basal ganglia in here.
This critical task is processed by the structure called amygdala, which is regarded as the “fear centre” of the brain. It belongs to a small region of the brain called temporal lobe and is located at a point a line goes through your eye and your ear that intercepts with each other. It plays a key role in activating emotion. When it receives information form other parts of the brain, it will assign a level of emotional significance to whatever is going on and rings the alarm bell. For example, when a dog is fiercely barking at us, and is running towards our direction and appears to attack us, the fear centre will send sensory information to the other part of the brain and notify us to “escape or fight back”. At this time other body system will activate the release of the stress hormones cortisol for us to respond to this threat.

In addition, the amygdala also helps us remember a traumatic experience. Take the dog attack as an example. Next time when we see a barking dog coming to our direction even not showing any intention to attack us, we will flee to avoid the threat.

How does the connection work? The amygdala is connected to the hippocampus and runs like a circuit. The hippocampus is involved in storing highly charged emotional memories, both positive and negative. The amygdala is involved in negative emotions and the hippocampus is involved in aspects of memory. When we experience a threat, the memory is being registered in the hippocampus. Next time when a similar event happens, the hippocampus will send the sensory information to the amygdala to alert us that a threat is imminent. This process is going to promote survival in instinctual ways.

Sometimes a situation occurs when the circuit connecting between the amygdala and the hippocampus is dysfunctional. It may produce interference in stopping the amygdala or hippocampus within the limbic area, and as a result it cannot differentiate real from unreal information (Bradley 2000, pp259-260).
The basal ganglia are a set of large structures surrounding the limbic system. It is involved in integrating feelings, thoughts, and movement, as well as helping shift and smooth behaviour. It is also believed that the basal ganglia are involved in forming habits.

Research suggests that the basal ganglia are involved with setting the body’s anxiety as well as forming habits. When we are excited the basal ganglia will cause us to jump; when we are nervous it causes us to tremble; and when we are scared we will freeze.
When the basal ganglia are overactive, we are more likely to be overwhelmed by stressful situations and have a tendency to freeze or become immobile (in thoughts and in actions). To soothe the basal ganglia, research demonstrates that practising mindfulness skills would be able to slow down the activity of the basal ganglia and hence it calms the basal ganglia down, and thus our anxiety reduces.

Tips to calm our amygdala and other parts of our brain include:
1. Start using diaphragmatic breathing. This is the link from the youtube teaching diaphragmatic breathing: https://www.youtube.com/watch?v=kgTL5G1ibIo
2. Meditation – research has shown meditation can calm stress and enhance brain function
3. Remove caffeine and cut down sugar will help reduce a high lactate/pyruvate ratio’s connection with anxiety.
4. Vitamins B1, B3, and B6 help decrease anxiety by increasing the body’s ratio of pyruvate to lactate.
Gabriel Wong
Clinical Psychologist
References:
Amen, D. (2016). Change your brain change your life. New York: Crown Publishing Group.
Lazarus, P. (1995). Healing the mind the natural way. New York: G.P.Putnam’s Sons.

How to achieve an optimal healthy Brain?

How to achieve an optimal healthy Brain?

The engine is the most vital part of a car. When we refuel, many cars require a high-performance petrol to run the engine. It appears the intake is going to affect the outcome, i.e. enhancing the performance or functions of the car.
By the same token, the brain is the commander of the mind and the body. It consists of the cognition, long term and short memory, decision making, controlling emotions, and also coordination of the whole body system through the spinal cord, all the nerves and muscles in the body. There are many self-help books, fitness centres, and programmes to advocate for physical health. On the contrary, there are not many books or advocates talking about how to achieve an optimal, healthy brain both short term and long term.
Every organ or devise has a lifespan. We occasionally hear that someone needs a lung transplant, a heart transplant or a kidney transplant. Have you heard of any brain transplant? How do we protect our brain life or even maintain the various functions of the brain to enable it to be run effectively? In other words, how do we reduce the chance of clinical dementia when we are going to age? Younger people may say it will not happen now as dementia only happens in older people. One thing worth mentioning is the brain starts ageing from the age of around 24. We need to think about how to match our brainspan with our lifespan now. According to the neuroclinical psychologist Dr Nichola Gates (2016), there are four steps to achieve optimal brain function and reduce clinical dementia.

Boosting our healthy brain

Most people already know what to eat to reduce heart disease, diabetes, lowering our cholesterol, etc. But is there any food out there that is particularly beneficial for our brain?
First of all, we need to include elements of the Mediterranean diet in our meals. Food that is low in saturated facts, and high in anti-oxidants are preferable, and also include wholegrains, high amounts of omega 3 food such as oily fish, eggs, avocado, etc., vegetables and fruits. Processed meat such as ham and salami might have to be avoided as it might be carcinogenic. Food that can promote good mental health should include food containing calcium, protein, vitamins D3, B3, B5, B6, and B12, folic acid, Vitamin C, zinc, copper, and amino acids including Tryptophan. All vitamins Bs are good for mental health especially B6 and B12.

Research indicates that there is a link between the brain and the gut. Most of our serotonin neurotransmitters are manufactured in our gut rather than in our brain. Chronic stress can affect our immune system as well as changing the barrier function in the gut making it more prone to infection. Most of the Irritable Bowel Syndrome is caused by anxiety, and it demonstrates the gut-brain-stress link existence within our system.

Reducing our brain burden

All drugs have a different pharmacological effect on the brain as they have different effects on the perception and cognitive function. Too much or over stimulation of dopamine due to substance abuse can increase the dopamine level by five to ten times the normal levels thus overwhelming the brain, leading to the consequences of reducing the capacity for critical thinking, decision making, learning, and memory, as well as poor brain function.

Research shows that there is a 16% chance of getting dementia for smokers. Some life style factors that can also lead to dementia such as lack of exercise, chronic stress, cardiovascular disease, smoking, poor sleep, illicit drug, alcohol, diabetes, and obesity are unhealthy brain burdens.

Excessive consumption and chronic alcohol abuse will damage the brain. When alcohol reaches the brain, it damages the connective tissue at the end of the neurons which results in disrupting neural communication. Fortunately, it is a temporary damage, and the brain will repair it once the ethanol remits. Chronic alcohol abuse and excessive consumption of alcohol over a period of time will affect the cerebellum and the frontal lobes. Frontal lobe dysfunction leads to difficulties to make decision and judgement, regulate emotions and affect the executive functioning. Cerebellar atrophy will lead to the classic symptom of ataxic gait which affects muscle coordination in balancing and walking. Wernicke syndrome can also happen due to extreme loss of Vitamin B1 as it is being depleted by alcohol. People with Wernicke syndrome shows ataxic wide gait, and involuntary changes to eye gaze with rapid side-to-side movements. Moderation of alcohol consumption is crucial in order to extend our brainspan.

The nicotine in cigarettes will disrupt the neurotransmitter systems that associated with dopamine and reward, as well as causing oxidative stress. In addition, research suggests that a new compound in tobacco called NNK has been found to provoke white blood cells in the central nervous system to attack healthy cells. As a result gray matter is decreasing in the brain that leads to the thinning of the cerebral cortex which involves thinking and memory.

Building brain reserve

The last ten years of neuroscience research suggests that our brain can change and grow due to neuroplasticity. Reserve here means resilience. We have to build up this capacity for the brain to function well and develop functional resilience against pathology and trauma. The research found out that by engaging the brain in more stimulating and mental activities, physical exercise, and social connection will benefit our brain by increasing the performance, stimulating brain growth and decreasing the chance of developing dementia.
A study (2017) revealed that adults who participate in high levels of physical activity tend to have significantly longer telomeres than their counterparts. Telomeres are nucleoprotein structures positioned at the end of chromosomes. As a consequence of mitosis, telomeres naturally shorten and as telomeres shorten, cell senescence increases, and eventually cell apoptosis occurs. In other words, high level of physical activities can enable us to live longer as telomeres will be lengthened instead of shortened. Another research revealed meditation also has some effects on telomere length by reducing cognitive stress and stress arousal, and thus it increases positive states of mind and hormonal factors that promote telomere maintenance. In short, both physical activities and meditation can lead to longer telomeres which mean cell division can still be continuing when we are ageing.

Cultivating wise mind

Marshal Linehan (1995) explained that the wise mind is the balanced part of us that comprises our inner knowledge and intuition. It is that place where reasonable mind and emotion mind overlap. Emotion mind is driven by our emotion whilst reason mind is mainly based on our logic and analytical mind. It can be cultivated through practising of mindfulness skills. The practice of mindfulness skills over time will help us develop our self-awareness and insight. It enables us to look inside and the environment around us without judging, as well as accepting the whole situation. This will foster an internal calmness which empowers us the capacity to regulate our emotions and alleviate our stress. As we know that chronic and long-term stress will develop into depression as stress hormones damage the hippocampus.

References:
Epel, E. Daubenmier, J.; Moskowitz, J.; Folkmna, S.; and Blackburn, E. (2015). Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres. Journal of American New York Academy Science, 1172:34-53.
Gates, N. (2016). A brain for life: How to optimize your brain’s health by making simple lifestyle changes now. Australia: HarperCollinsPublishers.
Linehan, M. (2015). DBT Skills Training Manual, second edition. NY: Guilford Publications.
Tucker, LA. (2017). Physical activity and telomere length in U.S. men and women: An NHANES investigation. Journal of Preventive Medicine. July, 100:145 -151.

Gabriel Wong
Clinical Psychologist

Understanding Chronic Pain

Whether minor or severe, chronic pain affects 29 percent of Australians and about 15 to 20 percent of Americans each year. In Australia, the total cost of chronic pain is estimated to be around $34.3 billion including lost productivity, attribution to other illnesses such as depression, heart disease, and cost of the health system.

According to the International Association for the Study of Pain, pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (Merskey & Bogduk, 1994). The Australian definition for chronic pain is defined as pain that extends beyond the expected healing time of an injury or can accompany chronic illnesses such as arthritis or lupus” (Pfizer Health Report, 2011; Stollznow Research for Pfizer Australia, 2010).

All pain experiences are normal experiences to what your brain thinks is a threat. The amount of pain you experience is not commensurate with the amount of tissue damage. Acute pain is thought to be an important and adaptive signal. It tells us a message or warning that something is damage in our body. Sometimes pain can misinform us. It reminds us that we are in danger and we needs to avoid that.

Pain receptors are called nociceptors, and are scattered all over our body. It transduces noxious stimuli into nociceptive impulses. Electrical impulses are being transmitted to the spinal cord via afferent nerves and then along sensory tracts to the brain. The neural signal will modulate the pain by amplifying it. Consequently, we will experience the pain through this process. During this process psychological and social factors are involved, and as a result it may aggregate the pain.

When we receive our pain signals, some chemicals are produced to calm down the system to inhibit the pain reaction while the other chemicals excite the system to stimulate the pain response. The pain experience is related to ascending, and descending messages and this process happens in the spinal cord itself (Wales, 2012a). If there are more inhibitory chemicals, the person may feel more pain, and if there are less of the inhibitory chemicals, the pain may be less. Messages ascend to the brain through the spinal cord to inform a threat in tissue damage and is called neuropathic pain.

Pain centralized in the nervous system can become very sensitive, and after a while, it adapts to it. In the end, even low-key events are perceived as painful. Fibers with messages descending from the brain involve the sympathetic and parasympathetic nervous systems. Those nerve fibers that associate with the sympathetic and parasympathetic systems make a contribution to the pain experience. The role of the sympathetic system is to protect us during dangerous time by the stress hormone adrenalin and the good hormone endorphin into our body. If it lasts too long, the chemical cortisol will damage our body and brain and will make us feel sick. Chronic pain can lead to depression, mood changes, anger, anxiety insomnia, and it will make the patients feel stressed all the time.

In the early 1960s by Ronald Melzack and Patrick Wall, they proposed a Gate Control Theory. They suggested that pain signals encounter what are called nerve gates in the spinal cord that open or close dependent on a number of factors and may be involved instructions coming down from the brain. When the gates are open, pain messages can get through, and pain can be intense. When the gates are close, pain messages are being prevented from reaching the brain and may not even be experienced at all. It is believed that something must be happening to modulate the experience of pain.

Depressed mood and stress can affect the intensity of the pain the person feels. Dr Irene Tracey at Oxford University demonstrated that subjects even thinking of the pain can add an increase activation in their pain-circuits. She also found out that distraction can also cause some reduction in tension as it obviously disrupts the continuation of the cognitive thinking process that has been focusing on the pain sensation.

On the other hand, people experiencing trauma may have their pain experience shut down at that point in trauma, and the body may also release the beta-endorphins, our internal pain killers, to shut down the pain. However, it is only for short-term. Chronic stress on the other hand does not produce analgesia. Instead, it produces hyperalgesia or increased sensitivity to pain. It is believed that it is triggered by high levels of glucocorticoids that involve some structural rewiring of the central nervous system.

Treatment of chronic pain can be managed by pharmacotherapy such as the opioid drug family. It resembles our own bodies’ pain relievers, the endogenous opiates. Sometimes physiotherapy may require helping patients strength their muscles or ligaments to prevent them from further injury in the future.

There are some treatments and techniques that could help manage the pain. If you are suffering from chronic pain, most of the time you are causing pain with your thoughts and emotions. If this is the case, you could benefit from have a psychologically validating intervention. This could help you work out with some accuracy how your thoughts, feelings, and movements all impact on the nervous system affect your chronic pain. Cognitive behavior therapy treatment is quite effective in helping patients with chronic pain challenge their maladaptive cognitions including catastrophising, all-or-none thinking, and maximizing/minimizing, etc. Somatic quieting is preferable for patients to relax rather than tensing their body muscles thus reducing stress and alleviating pain. Graded or gradual physical activity is involved in the CBT to help patients slowly build up their muscles strengths.

Magnet therapy is believed to relieve Headaches, arthritis, menstrual cramps, carpal tunnel syndrome, and sports injuries (Whitaker & Adderly, 1998). Hypnotherapy is a viable alternative to psychopharmacological interventions for controlling acute, chronic, and postoperative pain, as well as pain from nonsurgical procedures (Patterson, 2010).

References:

Butler, D., & Moseley, L. (Second Ed) (2014). Explain pain. Neuro Orthopaedic Institute. Noigroup Publications.
GoodTherapy.org (2013). Chronic pain. GoodTherapy.org. Retrieved on 2 April, 2017, from: http://www.goodtherapy.org/learn-about-therapy/issues/chronic-pain.

Medtronic (2013). Improving life by easing chronic pain. Medtronic, Inc. Retrieved on 2 April, 2017 from: http://www.medtronicneuro.com.au/chronic_pain_causes.html.

Patterson, D.R. (2010). Clinical hypnosis for pain control. Washington: American Psychological Association.

Pfizer Health Report (2011). Australians living with chronic pain. Pfizer Health Report, 46, p 4.

Satterfield, J.M. (2015). Lecture 19 Mastering chronic pain. In Jason.M.Satterfield. Cognitive behavioural therapy: Techniques for retraining your brain. The Great Courses. Chantilly, VA.

Stollznow Research for Pfizer Australia (2010). Chronic pain. Stollznow Research for Pfizer Australia. Australia: Pfizer Australia Pty Ltd.

Wales, C. (2012a). The nervous system. Chronic Pain Australia. Retrieved on 22 May, 2013, from: http://www.chronicpainaustralia.org.au/index.php?option=com_content&view=article&id=31&Itemid=233.

Whitaker, J., & Adderly, B. (1998). The pain relief break through: The power of magnets. Boston: Little, brown and Company.

Gabriel Wong
Clinical Psychologist

What mindset do you have?

Carol Dweck from Stanford University has been researching on achievement and success and came out with two kinds of mindsets, namely, the fixed mindset and the growth mindset.
Fixed mindsets tend to make people think in terms of absolutes, and their traits and abilities are innate and cannot be changed or developed regardless of opportunities for learning and growth. It can affect someone’s self-esteem and self-development particularly in the face of mistakes and failures.

With the growth mindset change and development are constant. People place an emphasis on learning from mistakes and failures instead of placing permanent labels on themselves like the fixed mindset. The growth mindset can be applied to many areas of life. Intelligence, creativity, physical ability, and artistic ability can be developed over time with practice, hard work, endurance and the willingness to learn and adapt.

People with fixed mindset believe their personality traits and abilities as well as those of other people are concrete and innate and cannot be changed over time. For example, the Olympic athletes showed their “talents” and abilities when they were young. But if they did not have any opportunities to further develop their “talents” and abilities through training, coaching, competition, they would not have developed their “talents” and innate abilities overtime and consequently they could represent their own country to participate in the International Olympics. During this development and training process, they have experienced numerous failures, injuries and refinement of their skills before they see their achievement and success. Even at the end they could not win the medal, they still feel proud of their effort they had put in.

People with a growth mindset believe that everything about a person can be changed or developed in some way. By valuing personal and professional development people with the growth mindset are better capable or responding about the world around them. For some they might not even to be conscious in their decision to work harder to achieve the peak of their abilities as the mindset simply comes naturally. But others shifting from the fixed to the growth mindset and they must learn to push away their fears and inadequacy to embrace the evolution of their abilities that is possible if they commit to the growth mindset.

People with a growth mindset see mistakes and failures as opportunity to learn and improve themselves. Mistakes and failures are poisonous to the fixed mindset. Someone with the fixed mindset will ignore the presence of a mistake rather a need to remedy the situation which will ultimately personal or professionally harmful.

As a result missed opportunities are common symptom of a fixed mindset. They have an unhealthy relationship with mistakes and failures that distort reality. In this distorted reality a person may see success is already pre-determined and even not to think about putting the effort in as they think it does not make any difference. This mindset will prevent people from risking the situation that could mean a greater success. On the other hand someone with a growth mindset believes that mistakes and failures are a natural part of the learning and growth process. They would see these as opportunities rather than trying to avoid.

For parents It would be a better way to complement the child and teach them how to live with a growth mindset by praising a child for hard work rather than ability. While praising children is nothing new to parents, what could be new from Carol Dweck’s argument is that there are multiple ways in which to praise a child and each has its own merits. These differences are based in the difference between praising ability and praising effort and the method a parent chooses can encourage a child either to develop a fixed or growth mindset without the parent realising it. While it may seem nothing wrong for praising a child for its high intellect or specific talents, parents may not realise the effect this type of praise could have an impact on the child’s mindset.

What type of mindset a child may develop would probably associate with how the parent praises a child. This could be a beginning of a fixed mindset when a parent praises a child with intelligence when the child presents with good grades. However, a growth mindset could grow from an association between hard work and intellect such as a parent praises the child for the hard work that resulted in high grades. Overtime an association is formed – good grades equates to intelligence and poor grades equates to stupidity.

It would be preferable for parents need to demonstrate the type of associations that lead to a growth mindset rather than a fixed mindset. Praise for effort regardless of the test grade will reinforce hard work rather than a number or a letter grade. This can help prevent the feeling of failure that may come from a poor grade received by someone with a fixed mindset. As the hard work put into the studying for the test is more important than the grade itself. Creating an environment that encourages hard work, effort and growth is crucial for children to learn how to continually develop their intellect and talents rather than always taking the easy way out.

References:
Dweck, C. (2012) Mindset: changing the way you think to fulfil your potential. London: Little, Brown Book Group.
Dweck, C. (2015) Mindset: how can you fulfil your potential. London: Little, Brown Book Group.

Gabriel Wong
Clinical Psychologist

Gaming problem or problematic internet use – what can I do as a parent?

Gaming problem or problematic internet use – what can I do as a parent?

If we are going to do a survey on how many children and adolescents are over-using their smartphones, ipads, computers, etc. I am sure this would be adding up to over 90% of the school population. If you walk down the street, we can see many people are still looking at their phones while crossing the street. What is happening in our society? Are we closer or a bit distant from each other?

Even here are some good books like Mental health in the Digital Age, Internet Addition, etc., to provide us enormous information based on research on gaming, and problematic use of internet, none of them mentioned some workable strategies to help these children, adolescents, and parents to manage these problems

I went to a few workshops from renowned speakers talking about these topics but to my surprise none of them provide some concrete strategies on how to help parents and their children and adolescents in the family overcome gaming and problematic internet use.

It appears that not only problematic internet usage and gaming happen on children and adolescents, but it also occurs in adults too. Why is that? Are adults setting a role model for their children and adolescents?

I have been observing that parents have been given iphones, smart phones or tablets to their young children to baby-sit them while they are engaging with their friends. These parents are encouraging them to go down that pathway at an early stage. Just look around and observe next time when you are sitting in a café or in a shopping centre, you will be amazed how many parents and children are hooking on their iphones or smartphones individually without interacting with each other.

One student in Year 8 told me that he likes gaming because he wants to shut himself down when his parents are having a fight. Although this is a maladaptive way of coping with the home situation, it does help the him stay away from his parents’ fight and totally enjoying in playing games on his computer. Overtime this avoidance strategy has become an addiction on gaming. He is only the tip of the iceberg.

I have been noticing that most of the children and adolescents who are “addicted” to computer games and problematic internet use would be coming from a dysfunctional family. There is not much interaction between family members. Or there is either disconnection or enmeshment between family members. It is very common in families with these kinds of problems.

Resolving gaming or problematic internet use is better to look from a systematic family perspective. If parents do not want their children or adolescents sitting in front of the computer, this behaviour has to be replaced by another one. Imagine if the child or adolescent spends 5 hours sitting in front of the computer playing games or hooking on the internet, to stop them from spending five hours requires replacing with other activities that are beneficial and of interest to the child or adolescent. Doing something together with the children at an early stage is crucial from preventing similar problem happening in the future.

Setting up some house rules and boundaries are important especially when the children are still young. It stills work even before they go to high school.
Some of the House Rules may be considered by respectable parents:
1. Make Sunday the family day unless one or both of the parents have to go to work. Do things together on Sunday whether going to church, having outdoor activities, playing chess together, mowing the lawn, doing gardening etc.
2. No internet access after certain time, e.g. nine o’clock. Everyone’s electrical devises including iphone, smart phone, ipad, tablet, etc. are putting in a bucket to recharge for the next day.
3. Move the computer or laptop to a public area in the house like the lounge or rumpus if possible. Allowing the child or adolescent to use these devises in their own room shutting the door will be disaster at the end. Parents can monitor what they are doing every now and then. This is different from being a helicopter parent as parent does not have to sit next to the child watching what he/she does.
4. All phones are recommended to switch to pre-paid to discourage large amount of data download for gaming.
5. Encourage the child or adolescent to participate more activities both indoor or outdoor. This will help them develop interpersonal skills when they interact with people rather than just sitting in front of the computer talking to people in the virtual world.
6. Make sure parents be the role model, i.e. preach what they want their children or adolescents to do.

Some tips worth considering are:

1. The children or adolescents may start whining or fighting with you initially. You need to be calm with them and just repeat what you expect them to do. Let them know you are following the same rules too. Remember do not argue with them because you are the boss of the house. Your bosses don’t argue with you. They just ask you to do the tasks.
2. After one month or so you will start noticing the change. It will take 30 days to develop a habit.
3. Reward them using a token system when they can achieve what you want them to do. Look at your credit card or Wolli card, they are all based on a fly buy point system to allow you to trade in certain items such as a flight ticket to go overseas.
4. Spend more time with your children and adolescents. By doing so, you will develop a rapport and a relationship with them overtime.
5. In case the problem is quite serious and the above-mentioned strategies do not really help at all, speak to the School Counsellor and arrange a meeting with the school to work out some strategies to improve the student’s situation. Seeing the GP and refering to a child psychiatrist may be required at times if strategies are running out.

It would be better for parents to start spending more time with their own children and adolescents in order to develop a trusting and lovable relationship. Think of this analogy: if you don’t have enough money, you can borrow money from the bank. But if you run out of relationship with your children, where can you go to get some? Also remember: Something easy was difficult first!

Gabriel Wong – Clinical Psychologist

Using actions to change behaviour

Using actions to change behaviour

Today I am going to share this idea with you of how we can use action to change behaviour. Many people are quite familiar with the interrelationships between thoughts, feelings and actions, especially if you are a therapist. We tend to ask our clients to change their thinking, as we understand that if their beliefs are not going to change, their feelings and behaviour will remain the same.

There is a story about Abert Ellis when he was 19. He had a shyness towards women. He was inspired by the work of John Watson, a behavioural psychologist. He went to talk to 100 women and ask them on a date in the Bronx Botanical Gardens. At the end he approached 130 women and talked to around 100 of them. However, he was not successful at all. But it helped him overcome his fear and shyness of women and that led him to talk to another 100. That was to demonstrate how his actions, talking to 100 women helped him change his attitudes about his fear of talking to women.

When our thoughts, feelings and actions are not aligned with each other, we do not feel comfortable and will generate some form of resistance to defend ourselves. The concept behind this can be attributed to the theory of cognitive dissonance (Festinger, 1975). One of my personal experiences was when I was a late adolescent, I did not like to eat durian. I had been influenced by other people that its smell was just like the cat poo. One day I decided to try a little bit and was amazed with it’s taste and nothing smelled like cat poo. Initially my belief and behaviour contradicted each other. Something had to be done in order to eliminate or reduce the dissonance. Even though I still had trouble resisting it, but when I decided to eat a little bit, it was proved that there was not anything that tasted or smelled like cat poo and at the end my attitude was changed.

Like watching a TV show initially you don’t like, after a while you tell yourself it is not that bad – you change your thoughts and feelings to make sense of the action to avoid cognitive dissonance.

In one occasion when I worked with a student who was caught shoplifting, she rationalized that they made such a big profit and when she took a few items from their shop it did not affect their financial stability. Obviously she was trying to justify her shoplifting behaviour  and was correct by aligning her belief and behaviour to reduce any cognitive dissonance, and as a result she did not feel bad about doing shoplifting. I was surprised the justification she came up with to make sense of her behaviour.
Like watching a TV show initially you don’t like, after a while you tell yourself it is not that bad – you change your thoughts and feelings to make sense of the action to avoid cognitive dissonance.

The theory of cognitive dissonance has been applied to what we called the Forced Compliance Behavior. When someone is forced to do (publicly) something they (privately) do not want to, dissonance in their cognition happens – I don’t want to do it and their behaviour is, I did it. The individual who performs the action is inconsistent with their beliefs. As the behaviour had already happened so dissonance will need to be reduced by changing their attitude.

Festinger (1957) did an experiemnt to demonstate the theory of dissonance. The study was called Measures of Performance. They asked the first group of participants to perform a series of monotonous tasks to put cotton spools onto a tray,empty the tray and refill the tray,and the other group to turn pegs in a peg board one after the other for 30 minutes non-stop. When they finished they were told they had to tell the waiting participants their tasks were all about mental preparedness and were very interesting. They were paid either $1 or $20 for telling a participant this message.

Can you guess :
Who reported the task as more fun and interesting?
A. those paid $1
B. those paid $20

Actually the tasks were very boring. It was the act of lying to others from each individual participant to create cognitive dissonance. Festinger predicted the $20 group would have less justification to change their opinions because they were paid a larger sum and felt less internal conflict. Those who would pay $1 feel more dissonance and justify their lie by changing their opinion of the boring task to match the lie they told others.

In the book “The As If Principle” (2013) written by psychologist Richard Wiseman, he mentioned how to use the theory of cognitive dissonance to apply it to our daily life. A few examples such as “if you ask older people to act younger, their memories and cognitions improve”, “If you ask someone to sequence their fist, their willpower improves”, “If you ask a procrastinator to spend three minutes pretending they find a task more interesting, they are more likely to complete the task”.

Have you heard about the Benjamin Franklin effect? One of Benjamin’s opponents, whom he had never even met or spoken to before, attacked him in a speech. Instead of delivering a speech accusing him back, Franklin asked him if he could borrow one of his rare books. He agreed and sent the rare book to Benjamin. A week later Benjamin returned the book to him with a thank you note. Afterwards they became lifelong friends. How and why did this happen? Benjamin Franklin explained that once your opponent has done you a kindness he will be more likely to do you another one. It was because the positive action of lending Franklin a book was converted into positive thinking and feelings towards Franklin. Once again, action changes attitude faster than attitude changes action. By the same token you can also use this technique to ask a girl on the street to do you a favour, and if she agrees there is a higher chance you will be able to make friends with her later on.

In order to change our thought, it would be preferable to minimise our cognitive dissonance and resistance so that if we act first, then it will align our thoughts and feelings to the action. Remember that action changes attitude faster than attitude changes action.

References:
Cherry, K. (2006). What is cognitive dissonance? About.com Psychology. Accessed at http://psychology.about.com/od/cognitivepsychology/f/dissonance.html.
Festinger, L. (1975). A theory of cognitive dissonance. Stanford: Stanford University Press.
Ferrier, A.; Fleming, J. (2014). The advertising effect: how to change behaviour. South Melbourne: Oxford University Press.
Wiseman, R. (2013). The as if principle: the radically new approach to changing your life. New York: Free Press.

Gabriel Wong
Clinical Psychologist at the Resilience Centre

Understanding the importance of sleep

Gabriel Wong
Clinical Psychologist

Understanding the importance of Sleep

According to the Maslow’s Hierarchy of needs, sleep is one of our biological and physiological needs apart from food, drink, shelter, warmth, sex, as well as WIFi. Sleep is also one of the three pillars of health in addition to fitness and food. Research says human beings can be deprived of food for as long as 36 days whilst we can only be deprived of sleep for 11 days.

About 50 to 70 percent of people do not get enough sleep, and about 40 percent of adults are chronically sleep deprived. Australian Research says students are getting about 7.5 hours a night’s sleep on school nights, and 25% of the students are getting 6.5 hours or less sleep on school nights.
The Australasian Sleep Association reports that each year 500 fatalities out of 10,000 accidents are related to falling asleep at the wheel and that three million Australians suffer from chronic sleep disorders. Lack of sleep has a big impact on the judgement, concentration and decision making. In the past both the France crash in 2009, the Chernobyl nuclear plant disaster, Exxon Vladez oil spill and the Space Shuttle Challenger explosion have be found to be a direct result of operator fatigue. Lack of sleep will affect our ability to learn and think. When we do not get enough sleep, it will affect our mood; it makes us feel grumpy, intolerance, lack of motivation, and short-fused. In addition, it deregulates our appetite hormone and makes us feel hungry.

How much sleep do you need? Children and adolescents require 8.5 to 9.2 hours whilst adults aged 22-55 need eight hours. Normally people usually take not more than twenty minutes to go to sleep. If you are really tired you may only take five minutes to go to sleep. Remember when we go to sleep we think of nothing.

Our circadian rhythms are our 24-hour biological cycles, and it controls our bodily functions like going to toilet, feeling hungry, controlling our body temperature and our high and low blood pressure. Our body has an alternating cycle of sleep and alert periods throughout the 24-hour sleep – the sleep drive and our cycle of alertness. A well-slept person is supposed to achieve a harmony between the sleep cycle and the cycle of alertness.

The daily rhythm of alertness shows that we have two periods of alertness, 8-10a.m. and again at around 8-10p.m. and two periods of minimal alertness at around 2-4p.m. and 1-5 a.m. The minimal 2-4p.m. alertness is also called the post afternoon dip.

Sleep consists of two basic states: the rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. The period of NREM sleep comprises Stage 1-4 and lasts from 90 to 120 mins, with each stage lasting anywhere from five to fifteen minutes. Surprisingly, however, Stages 2 & 3 repeat backwards before REM sleep is attained. So, a normal sleep cycle has this pattern: waking, stage 1,2,3,4,3,2,REM. Usually REM sleep occurs about 90 mins after sleep onset.

Scientists believe that we dream to fix experiences in long-term memory – that is, we dream about things worth remembering. The first period of REM typically lasts for ten minutes, with each recurring REM stage lengthening, and the final one lasting an hour.
What are the secrets of a good night’s sleep?
• Implement a routine: our body loves consistency, i.e. going to bed at about the same time each night and waking at the same time in the morning.
• Avoid having a nap in the afternoon: only have not more than twenty minutes of nap if you really feel tired. As twenty minutes will take you to go to the Stage 1 and 2 of the NREM sleep.
• Relax before bed: listen to some relaxing music such as the Pachabel’s Canon in D Major or some Mozart music.
• Don’t sleep in too warm a bed: we need to cool off our body temperature in order for the brain to go to sleep.
• Turn the clock away especially digital clock: the tiny luminous rays will disrupt the sleep cycle. Make sure you do not look at your iphone, ipad or computer in the middle of the ight as the blue light from our computer will disrupt the secretion of melatonin from our body making us feel awake.
• Don’t not use alcohol to help you go to sleep. Alcohol may help you go to sleep short-term, but after a few hours you will be waken up after the alcohol effect is gone.
• Write the list of “problems” down instead of thinking of these problems in your mind before your sleep. Look at the lists of problems the next day and see if you can resolve it. Two main rules are: solve it if you can or survive it you cannot.

If you have tried all these tips and still cannot sleep for a period of time, you probably may suffer from chronic insomnia. You feel tired, exhausted, irritable, and cannot concentrate. Primary insomnia refers to your sleep problem is related to the sleep process itself. It may already have started in childhood years or your early days. Secondary insomnia means the sleeplessness is caused by another problem like you are worrying about the work, exam or a relationship, etc. You may visit your GP to look at the root of your problem. Sometimes the melatonin hormone may help you go to sleep if this is only related to the sleep process. Many long-haul flight pilots require to use melatonin to help them sleep the next day when they arrive in another country. If your sleep is caused by a psychological problem, it would be better to go to see a psychologist so that the psychologist can help you work out the root problem and resolve it. Once the root problem is being resolved, the person can gradually go back to the sleeping pattern using the sleeping tips mentioned above. Sleeping pills or tranquilisers are the last resort but it cannot be used long-term.
Have a good night sleep everyday!

References:
Harrington, C. (2014). The complete guide to a good night’s sleep. Australia:Macmillan.
APS Institute. (2016) APS practice certificate in sleep psychology. Retrieved from http://elearning.psychology.org.au/pluginfile.php/9422/mod_resource/content/7/Sleep01_LearnerGuide.pdf. (Accessed: 4 March)
Australians Sleep Association. Retrieved 2016 http://www.sleep.org.au/information/consumer-information/tips-and-facts-about-sleep.
Carr-gregg, M. (2004). Surviving year 12. Second Edition. Austrlia: Finch Publishing
Carskadon), M. (2016) Available at : http://www.brown.edu/Divisions/Medical_School/biomed/Faculty/C/Carskadon.html (Accessed: 4 March).
Rickard, N & Rickard-Knight, W.E.J. (2001). Relaxing music prevents stress-induced increases in subjectivity anxiety, systolic blood pressure and heart rate in healthy males and females. Journal of Music therapy, 38(4).

The YES factor

The YES factor
By Gabriel Wong (Clinical Psychologist)

Do you still remember those days your friend came to knock on your door and persuaded you to buy the World Book which cost over $800? At the end you bought one set of the World Book plus other children books too that amounted to $800! Have you worked it out about how this had happened in just fifteen minutes’ time?

If you did not have that experience, think of when was the last time you bought a new car or an used car, or even a piece of furniture you did not intend to buy it. I am sure there were numerous occasions that you were persuaded by the salesman in this manner.

One interesting thing is my high school principal like to use the “Yes Factor” when she runs a post-suspension meeting with a student and his/her family. How does she do this? She always starts with “Today we are here to resolve the matter so that you can come back to school. In the last few days you probably have thought about what you have done. We would like to talk about this now so that we can move on and not to dwell on this matter any more.

“Today we are here”, “to resolve the matter”, “so that you can come back to school”, “In the last few days”, “you probably have thought about what you have done”, “We would like to talk about this now”, “”we can move on”, “not to dwell on this matter any more” are all the “Yes Factors” and undeniably true as everyone in the post-suspension meeting tends to agree with that. When people agree with what you say with the first few statements at the beginning, it is more likely that they will also agree with some suggestions you are going to bring up.

You may be amazed if I tell you that pacing is originated from conversational, covert hypnosis or Neural Linguistic Programming (NLP). You were not being hypnotised at all and how come you accept what someone asked you to do. This is because people are using the “Yes” factor or pacing technique.

HOW DOES PACING OR “YES FACTOR” WORKS?

Another term for the yes factor is called pacing. It is used to bypass the critical factor – the cognitive functions that would normally critically analyse and scrutinise information. It is just like going through a filter. That is the part of the mind that screening out what you feel is untrue or believe is unethical. If the statement was “The sky is green,” you would not even bother to look up as you already know the colour of the sky. However, deciding which information to accept and which to reject is not always that easy.

It is used to trick the person’s subconscious mind into accepting external information from the persuader into the subconscious mind as absolutely free. It is a powerful implant of information than even the person can usually communicate to themselves with his or her own thoughts. Normally only what you consciously know to be true is allowed to pass.

Dr Milton Erickson used pacing to neutralise the filter of a person’s critical factor so he can slip suggestion past the critical factor into the subconscious. The “Yes Factor” or pacing can be almost any technique by which a persuader gets your critical factor to lower its critical analysis and scrutiny of the information you are receiving. When the critical faculty of the human mind is bypassed, selective thinking established.

For instance, if many people entering the night club are searched by the security guard and nothing questionable is found, the security guard’s defense efforts become tired, lazy and lowered. Normally, though, everything in our world is questionable keeping the critical factor sharp and alert. The persuader paces the subject by providing the mind with information that is undeniably true, something the subject strongly believes, or is absolutely and immediately verifiable, in successive patterns until the subject’s guard is lowered.

This pacing can take any form of information that serves as an accurate representation of the subject’s current ongoing experience, including what they see, what the hear, what they truly believe, and describing or imitating the subject’s conscious experience or even subconscious experience, such as their breathing.

Pacing can be such obvious statements the subject truly believes or knows are true, or subconscious act/messages that the persuader does which the subject is not even aware of, e.g. mimicking or describing breathing. We can observe the pacing technique in many of the counselling therapy sessions.
Pacing can be nonverbal as well. Dr Erickson would match the persons rhythm and emotional state. He would copy and model the patient. He would breathe at the same rate as the person, blink at the same rate, if the person was pacing. Erickson might tap at that pace or speak at the same rate and use the same pitch of voice that the patient was using.

As an example Erickson once sat beside a man with schizophrenia in a hospital who was speaking in a word salad. Erickson then spoke in his own word salad for many hours. Eventually the patient became frustrated and told Dr Erickson to speak sensibly. These were the first words of any sense that the patient had himself spoken for many years.

Dr Erickson liked to give suggestions as statements which could not be refuted. He used a series of comments which were accepted by the person as true, the patient would develop a “yes set”, a momentum of acknowledgement which was usually accompanied by the patient nodding their head in agreement. This is similar to the purpose of the “fly wheel” in a car which gathers momentum to continue the motion of the engine. This mental set prepares the persons mind for them to accept the therapeutic suggestions which are to be given to the person to help them. A series of accepted suggestions makes it more likely that the next suggestion will be accepted also. Hence we often ask a series of rhetorical questions followed then by a rhetorical question for therapy.

Obama in his Denver 200 Convention Speech had used 14 separate “Yes Factors”or pacing statements. Obvious examples include, “now is the time”, and “as I stand here before you”. These statements are undeniably true in the simplest terms, and as a result it can be used to lower our critical factor defences to allow implantation of subconscious messages. Three of Obama’s favourite hypnotic paces were “that’s why I stand here tonight”, “now is the time” and “this moment”. He used “as I stand before you tonight” three separate times, around the beginning, middle, and end of the speech to continue pacing the audience throughout his whole speech.

After pacing you repeatedly in multiple ways and on multiple levels, your cognitive critical factor defences would be lowered. Then the persuader will implant a lead – the command or absolute unquestionable truth the persuader places in your subconscious mind. Essentially the pace or truth is connected to the new message or lead using connecting or linking language. In Obama’s speech, for example: “We need change… and… that is why I will be your next President.” Is a basic pace and lead.
After the person has been exposed to a few of the “Yes” statements, the persuader can use the lead in the direction of altering someone’s state at that point in time. One form of pacing or yes set is to comment on what the realities are for the person. When the pacing is under the control, the persuader can start to lead by giving out some suggestions which need to be congruent with the emotional state of the person. Politicians, salesmen, teachers, leaders, counsellors, and even CEOs apply these techniques in their work place. By applying the pace and lead technique, the person would be able to accept what the persuader was intended to ask for, and consequently the person is more likely to accept the suggestions given by the persuader.

References:

Bandler, R., & Grinder, J. (1975). Patterns of the hypnotic techniques of Milton H. Eickson, M.D. Volume 1. CA: Meta Publications Inc

Barack Obama Acceptance Speech (2008). Barack Obama delivers his acceptance speech at the 2008 Democratic National Convention in Denver. Retrieved from https://www.youtube.com/watch?v=tQGsP8mnHsg

Grinder, J; Bandler, R. (1981). Trance-formations neuro-linguistic Programming and the structure of hypnosis. California: Real People Press

Reiman T. (2010). The yes factor. New York:

Metaphors

Metaphors

By Gabriel Wong (Clinical Psychologist)

I recently went to a Family Therapy workshop run by a renowned Master Family Therapist, Professor Maurizio Andolfi. During the workshop I noticed Professor Andolfi used metaphors to help family members understand the predicament and hence changes occurred during the session. I am amazed he used metaphors in family therapy and it works so effectively.

What is a metaphor? Metaphors are not just stories. They are used to teach us valuable moral principles and life lessons. These stories are designed to have a specific effect on the listener. The reason why a metaphor works is because it can relate the action in the metaphor and the listeners’ own life. Metaphors or stories can relax people and people tend to pay attention to listen to the story. There is also an entertainment value in it. Metaphors connect the linear, sequential mind, i.e. the conscious mind and the emotional, symbolic mind, i.e. the subconscious mind. It helps to engage people whenever we want to, not just their conscious mind. In addition, a metaphor is a way of talking about something without talking about it.

In the Bible Jesus used many metaphors and parables to help his disciples and his followers to understand or visualise Jesus’ missions, and how the kingdom of God was like. It has been suggested that if a picture is worth a thousand words, then perhaps we can regard a metaphor as being worth 1000 pictures.

There was a famous story about Dr Milton Erickson who just used a few metaphors to treat a 12-old boy who had been suffering from bedwetting for several years. His parents had tried many ways to stop the bedwetting including bribing him, punishing him, and talking to him, but none of the ways worked. When the boy came he sent the parents away. Then he started to ask the boy about his life. He has a younger brother but his younger brother was bigger than he was. Erickson asked what things he likes to play. He said baseball and his brother likes football. Erickson said football is a dumb sport. Suddenly the boy was interested in what he said. Erickson said you know football is just a bunch of big groups running into each other. Now baseball you like to play needs coordination. You need to open the glove at the right time and close the glove at the right time. When you throw the ball, have you noticed it takes a lot of skills. If you let go too soon it doesn’t go where you want it to; if you let go too late it doesn’t go where you want it to go. You have to let go at the right time. Erickson says if you don’t let the ball go at just the right time, it can lead to frustration. Letting go at just the right time gets it where you want it to go, and that’s what leads to success.

And then Erickson talked to him about archery. And he says you know when you aim at something the pupil of our eye automatically contracts. You don’t have to think about. And he talks about the digestive system and how after you eat something you don’t have to think about how to digest it. The valve and the processes happen in there. They open up and close down as the nutrients move through the system in just the right order at just the right time. And then he sent the boy away and the boy never wet the bed again. Erickson talks about baseball, archery and the digestive system and the boy never wet the bed again.

Let us look at what type of problem is bedwetting? It all includes the timing problem, the muscle control problem, the sensory problem, and the awareness of the sensation to wake the boy up. Erickson provided solutions in the story for those types of problems. We noticed that Erickson did not mention bedwetting during the conversation with the boy. But after telling the boy these three stories/metaphors, his bedwetting has stopped. What a remarkable lesson we learn from Erickson.

Now I am telling you a Chinese Cracked Pot story:-
A water bearer in China had two large pots, each hung on the ends of a pole which he carried across his neck. One of the pots had a crack in it, while the other pot was perfect and always delivered a full portion of water. At the end of the long walk from the stream to the house, the cracked pot arrived only half full. For a full two years this went on daily, with the bearer delivering only one and a half pots full of water to his house. Of course, the perfect pot was proud of its accomplishments, perfect for which it was made. But the poor cracked pot was ashamed of its own imperfection, and miserable that it was able to accomplish only half of what it had been made to do. After 2 years of what it perceived to be a bitter failure, it spoke to the water bearer one day by the stream. “I am ashamed of myself because this crack in my side causes water to leak all the way back to your house.” The bearer said to the pot, “Did you notice that there were flowers only on your side of the path, but not on the other pot’s side? That’s because I have always known about your flaw, and I planted flower seeds on your side of the path, and every day while we walk back, you’ve watered them. For two years I have been able to pick these beautiful flowers to decorate the table. Without you being just the way you are, there would not be this beauty to grace the house.”

What message have you got after reading the Chinese Cracked Pot? Ask you friend or your family member if they have noticed any change in you in a few weeks’ time.

References:
Berman, M; Brown, D. (2000). The power of metaphor. Story telling & guided journeys for teachers, trainers & therapists. UK: Crown House Publishing Company
Moine, D; Lloyd, K. (1990). Unlimited selling power. How to master hypnotic selling skills. New York: Prentice Hall
Personal .psy.edu. Chinese cracked pot. Retrieved from http://www.personal.psu.edu/staff/k/a/kah19/parable.html.

The Fun Theory

The Fun Theory

By Gabriel Wong (Clinical Psychologist)

Have you been issued a speeding ticket in the past?  Yes, I have.  Now whenever I drive past that particular street my mind reminds me that I have to slow down and warns me not to speed again, as I don’t want to have another 3 points off my licence.  I was still thinking from a punitive perspective at that point in time.

How about the majority of the drivers who never speed and always obey the speed limit? They have not been rewarded so far.  Have they been rewarded for doing the right thing rather than being punished for doing the wrong thing?  In educational psychology we advocate for a positive reinforcement approach in school.

What do you think if were to reward those drivers who comply with the driving speed on the road?  Is it possible to do that?  Do you have any ideas before you watch this video?

Kevin Richardson (USA) was the award winner of the Fun Theory Award, an initiative of the Volkswagen, who designed the Rewarding Speed Limit Signs.  His idea was to take a portion of the revenue from the speeding fine and use to fund a lottery.  Everyone who complied with the law was automatically entered and in effect, given a free lottery ticket.  This simple idea rewarding good drivers to do the right things, has resulted in 22% decrease in the average speed. When it is fun to do something, it motivates us to do it and we will actually do more.

How can we get people to put on their safety belts in the car, of their own accord, and enjoy it?  Andrés López Rivera in 2009 designed this car seat belt giving people fun and enjoyment while travelling in the car when the seat belt is put on.

Would you like to design a similar set in your car?

We still see children or adults who do not throw their rubbish in the bin or recycle their plastic bottles and glass.  How can we encourage them to change their  behavior and help people change their habit?  How can we make this fun in order to motivate people to develop this habit?  Let us look at the Bottle Bank Arcade Machine and the World’s Deepest bin video from the Fun Theory.com.  Just look at people’s faces and notice how much fun and joy they have exhibited.

When they transformed the bins into something that gave people some fun, they transformed the experience.  As a result, people deposited 230% more trash in the “World’s Deepest Bin” than in a bin nearby.  The Bottle Bank Arcade machine received 50 times more than the traditional machine.

Nowadays people are more dependent on using escalators when they go to work or in shopping centres.  Even when there are stairs available, few choose to use the stairs and prefer using escalators.  How can we motivate people to use the stairs more often?  Look at some ideas from the Fun Theory.com about how they transformed a subway staircase into “Piano Stairs”.

We have noticed that more people are using the “piano stairs” than the escalator after they discovered that walking up or down the staircase is fun to them.  And 60% more people than usual, chose the stairs over the escalators at the end.

Have you even been feeling frustrated that your kids and teenagers are having trouble tidying up their room, leaving their clothes all over the place in their bedroom? Sounds familiar?  Well, this guy, Naoki Yamada helped you solve this problem by simply making it fun for your children to clean their rooms.  Let’s watch this video together and you will be amazed how creative Naoki Yamada was by transforming some tedious tasks into fun.

The Fun Theory initiated by Volkswagen suggested that pleasure is motivating.  If we are more creative, we can transform some unpleasant, boreding, repetitive, mechanical tasks into fun thus reinforcing people to continue to have fun and enjoy it when they do it next time.  The most important point is how can we create the conditions within which people will motivate themselves?

Reference:

Volkswagen (2009).  The Fun theory.  Retrieved from http://www.thefuntheory.com.