Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for the ‘Motivation’ Category

Stress and HPA Axis

Posted by Dr. Vollmer on May 24, 2016


The stress response releases glucose to energize us to “fight or flight” from a perceived danger. Too much stress can shut down our systems and cause Chronic Fatigue Syndrome. Early stress can impair the HPA axis and cause us to feel charged up even though we cannot identify a trigger. These are the concepts that I want to convey to my students. The problem is that we know so little. There is a developing system which is programmed to help us cope with perceived danger, however, when this system is injured in early childhood, our sense of perceived danger and/or our reaction to it may be seriously impaired, resulting in either an unnecessary hypervigilence or an overwhelming sense of collapse. Perhaps medication can press the re-set button, but we are a long way from knowing that, except to say certain patients have that experience. The below cited New York Times article speaks to the complexity of this circuit. We know a little, allowing us to once again have more questions than answers.


Posted in Motivation, Neurobiology of Behavior, Stress | Leave a Comment »

Dorsolateral Prefrontal Cortex (DLPFC): Heart Of Life’s Success

Posted by Dr. Vollmer on May 23, 2013

According to Wikipedia…..

“DL-PFC serves as the highest cortical area responsible for motor planning, organization, and regulation. It plays an important role in the integration of sensory and mnemonic information and the regulation of intellectual function and action. It is also involved in working memory. However, DL-PFC is not exclusively responsible for the executive functions. All complex mental activity requires the additional cortical and subcortical circuits with which the DL-PFC is connected.[2][3]

Damage to the DL-PFC can result in the dysexecutive syndrome,[4] which leads to problems with affectsocial judgementexecutive memoryabstract thinking and intentionality.[5]

Academic Child Psychiatry, and Laura Tully PhD, in particular,  is trying to understand how social skills work on a neuroanatomical level, and in light of that, all roads point to the importance of a well-functioning dorsolateral prefrontal cortex (DLPFC). When this part of the brain works well, people can plan, anticipate, organize, empathize and thereby make good judgments, socially and otherwise. These findings deepen my appreciation for genetics, and how much of behavior, and positive outcomes, are based on DNA. Unempathic parents can disorganize a good brain, a good child, but empathic parents cannot replace a defective DLPFC. In other words, I think of the nature/nurture argument, as often supported by Steven Pinker PhD at Harvard, that growth is pre-determined, but malnutrition can change the outcome. A good diet cannot make someone taller, but a bad diet can make them shorter. So too with behavior. Good parenting does not always create “good” kids, but “bad” parenting can hurt “good” kids. The basic ingredient, a good DLPFC, is essential for life success. It is almost impossible to compensate for a defect in the DLPFC, as seen by people with head trauma resulting in damage to this area. Understanding the need for good brain functioning, helps parents of children with mental handicaps understand their limitations, as parents. Likewise, parents of children who do have good  brain functioning, need to understand that  their main job is “not to screw it up,” as I like to say. Nature and nurture go together, but understanding how this dynamic plays out, is essential to promoting the best development possible.

Posted in ADHD, Genetics of Human Behavior, Motivation, Neurobiology of Behavior, Parenting | 6 Comments »

Space Sharing: Herd Animals-Confirmed!

Posted by Dr. Vollmer on February 26, 2013

So, now we have technology which places an office in a pocket. The calendar, the phone, the email and the fax are all being filtered through a hand-held device. Now, I know I am late in the game, but I am coming to understand portability. I could be anywhere in the world and return phone calls, have a phone session, renew prescriptions and stay in touch with the day to day struggles in my local news. So, I think to myself, this brings a new-found freedom of not being tethered to an office. Duh, my readers are saying. Yes, I am slowly coming to understand that, but at the same time, I also understand that young creative types are searching out work spaces which they can share, and yet work independently. The water cooler returns. How do I understand the need for freedom, while there also seems to be a need to gather and work with the energy of other working folks. As with most things that I right about, this is another push/pull experience. There is both a need to break out of the mold and lie on a beach while getting work done, and at the same time, there seems to be a need to be around others, in order to work in parallel. I attribute the latter to the social nature of the human condition. We are the people we surround ourselves with. We compete, we strive, we grow, based on the bar that our friends set for themselves. We are comparative beings. We measure success against others whom we care about. Positive growth stems from surrounding yourself with others who are striving for what you want for yourself. Intuitively, those seeking out a shared work space know that. They will be more creative if they can find the right energy, the right environment, the right people to work alongside. New technology does not change human nature, although it might change some aspects of the human brain. The part of human nature that needs others for growth and development does not change with the smart phone. We are herd animals, after all.

Posted in Motivation, Musings, Neurobiology of Behavior | 6 Comments »

Breaking Habits: Medicine, Psychology and Business Converge

Posted by Dr. Vollmer on January 24, 2010

This blog is part of my series on motivation.

Many academicians from various fields want to study why people have habits which are self-injurious. However, motivations are often mysterious. Understanding these motivations is important to a number of disciplines.  Physicians want to improve health, psychologists want to understand the brain, and a new field in business, behavioral economics, is interested in understanding how people make good and bad decisions for themselves when it comes to their financial lives.  All three of these fields are counting on one basic principle: when you know what makes people tick, it is a lot easier to help them change.

Primary care physicians want to do primary prevention by changing bad habits.  Primary prevention is the field of medicine which aims to stop a disease before it takes hold. Cigarette smoking and overeating are the two most common preventable causes of death in the United States.

Mokdad AH, Marks JS, Stroup DF, Gerberding JL (March 2004). “Actual causes of death in the United States, 2000“. JAMA 291 (10): 1238–45. doi:10.1001/jama.291.10.1238. PMID 15010446.

Kevin Volpp MD and his colleagues published a study in the New England Journal of Medicine in February 2009 in which they demonstrated that with financial incentives over a twelve month period, 15% of employees stopped smoking as compared to 5% in the placebo group. Clearly, in a large company, when a great number of people stop smoking, there is a huge savings in health care dollars, so a financial incentive could be cost-effective. (N Engl J Med. 2009 Feb 12;360(7):699-709)

Social psychologists are interested in habits in order to try to figure out how the brain works. Recently, I went to a lecture at the UCLA Anderson School of Management and I heard a presentation by Wendy Wood PhD. Dr. Wood talked about behaviors are context dependent, meaning that certain environments cue us to behave in a particular way. For example, most people eat popcorn when they go to the cinema. She demonstrated that even if the popcorn is old and stale, most people will still eat it as they watch a movie. As she puts it, “with repetition, people form cognitive associations between the response and context cues (eg locations, presence of others). Then, perception of the context activates the associated response in memory. This activation process does not require a supporting goal, and people thus repeat good and bad habits.”

Behavioral economics understands that habits are hard to break because change is difficult, particularly when the outcome is uncertain and because people tend to discount delayed costs and benefits. The prevalence of these biases suggest that there is room for improvement. Similarly, the knowledge of these biases should help advisers develop problem-solving skills. Further, one of the key findings in the field of behavioral economics is that people’s preferences for actions are not absolute, but rather relative to some anchor point, and can therefore be influenced by changing the anchor. Anchor points can be social norms, habits acquired in childhood, or a cultural frame (eg whether physical activity is presented as fun or as drudgery). Accordingly, behavioral economics suggests that some habits will change if there is a cultural shift.

I am interested in merging these three fields. Primary care physicians are limited because they are seeing one patient at a time, and hence they are not focused on changing culture. Psychologists are limited because they are looking at habits as an automatic response in the brain, and hence they are not thinking broadly in terms of the societal influence on habits. Behavioral economics is looking at changing behavior on a population level by changing the values in the society, but they are not looking at the individual differences in the brain which leads certain people to be more susceptible to bad habits than others. These three areas of scientific study need to get together. I feel the need to repeat: when you know what makes people tick, it is a lot easier to help them change.

Posted in Motivation, Musings | 4 Comments »

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