S1 Episode 52: Dread Making Decisions?

What happens in our brains when we’re confronted with decisions? And why do some people dread making decisions more than others? Dr. Gregory Berns, neuroscientist and Professor of Neuroeconomics at Emory University, explains that there are different brain systems involved in the decisions we make. When faced with choices, we want to pursue pleasure and happiness as much as we want to avoid pain and negative outcomes. Decision making is also about projecting ourselves into the future and how much uncertainty we can handle.

Dr. Phil Stieg: Have you ever had trouble making decisions? That’s probably a rhetorical question we all have. In fact, making decisions often makes us dread making the wrong choices. Our expert guest today will explain what’s going on in our brains, why we feel this way and how we can become better decision makers. I’m happy to welcome back. Dr. Greg Berns, Distinguished Professor of Neuroeconomics and Director of the Center for Neuropolicy and Neuroscience at Emory University. He’s the author of several popular books, including Iconoclast and the New York Times Bestseller, How Dogs Love Us” Greg, welcome back.

Dr. Greg Berns: Thanks Phil. Great to be here.

Dr. Stieg: Neuroeconomics, neuropolicy, and neuroscience. I mean, these are individual, but really diverse topics. How do you tie them together professionally?

Dr. Berns: Sometimes I don’t do so very well doing that. And I kind of compartmentalize my professional spheres of life. When students ask me kind of to explain my career, the common thread through all of it is using neuroscience and technology to understand how the brain works and with people, how we make decisions. And so that’s what really ties kind of the neuroscience, the economics and the policy altogether.

Dr. Stieg: Since we’re talking today about decision making, do you approach that from the perspective of neuroeconomics, neuropolicy, neuroscience, or again, do you combine them into the decision process?

Dr. Berns: It’s really a combination of all of it. And so my training is really more of a biomedical scientist as a neuroscientist and a physician. My first stance comes at it from looking at the brain. So I always want to know for a given circumstance, whether it’s a decision making problem or simply how one reacts to things that are kind of passively falling into your lap. I first want to know what is the brain doing? How is the brain reacting to new types of information? And then is there something in the brain that we can learn that then may either predict how someone makes a decision or how maybe we can even intervene and help them make better decisions? Now, the economics in particular came in, I would say later in my career, because I’m not classically trained as an economist. What happened was, this is probably back in kind of the early 2000’s, a group of neuroscientists, like myself, who were primarily interested in reward and decision making got together with a group of economists who were mostly experimental economists, meaning that they studied how people make decisions, kind of from the outside, just looking at the person and began talking to each other, to see if in fact we were actually studying the same problem. And it turned out that we were, and we had very different approaches to it, one with the brain and one studying kind of mathematical models. And then neuroeconomics was born out of that, which attempts to combine both of them. So that’s kind of how I view myself now,.

Dr. Stieg: What got you interested in decision making?

Dr. Berns: It was an evolution. And so my interests have kind of originated in how the reward system works. And so, through most of my career, I’ve been trying to understand what drives the human reward system. And, you know, we can get into how you define that, but it’s basically talking a lot about the dopamine system. So the neurotransmitter dopamine, under what circumstances that’s released, how does it affect other synopsis? And then ultimately, how is that related to the choices that we make? And so my interest in that system eventually led me to economists because most of the mathematical models that economists use are fundamentally about decision making. And what economists do that I think is quite different than what psychologists do, is that economists tend to look at what people do, not what people say. So there’s kind of an expression, you know, you can either walk the walk or talk the talk but to an economist the only thing that matters is what you actually do. So it’s the walk. It’s not what you say, it’s what you do versus a psychologist who might ask you, Oh, how do you feel about this? Or what do you think about that? That doesn’t matter so much as opposed to the actual choices that you make. When neuro economics started, this was all kind of a rather novel idea because what economists brought to the table was this idea that there’s—think of it as a meter inside your head and economists call it utility. That’s just a word for essentially, what’s an imaginary concept that says no matter what you do for a moment to moment, you’re always trying to maximize the utility that you expect to get out of that world, whatever you do, you feel like that’s in your best interest at that moment. We can make that assumption and then say, Hmm, well, if that’s true, then maybe your reward system is constantly trying to predict how much utility you’re going to get out of the world, whether it’s a purchase that you make, or whether it’s an interaction with another person, your reward system is constantly monitoring that.

Dr. Stieg: When I’m working with my residents or my children, and we’re in the process of making decisions, I ask them to make lists of pros and cons and then sort of kick it around. But then there’s also the aspect of time and timing that play a role in our decision making. Can you distinguish those factors for us?

Dr. Berns: Time, time is a bitch, really, because I just said that decision making is about the future. You have to project yourself into the future. And of course, there’s great uncertainty about the future. We don’t have crystal balls and the further into the future, you have to project yourself, the greater, the uncertainty. Now economists kind of have brought a very neat way of dealing with the future into their equations. And the idea is that essentially the further into the future, you go, the less valuable anything is. If I make a decision and the outcome is going to be immediate, that’s a very powerful reinforcer, if you will, that will give me a very strong reward system response because I know the outcome is going to happen right now. If I make a decision and I’m not going to get the results of that, say, for a year, well, that’s not going to carry nearly as much weight as something with an immediate payoff. And, the standard way economists deal with that is what we call exponential discounting, which means that a day from now is the same as a day a year from now. A day is a day as a day, or a minute is a minute is a minute. But what’s interesting about that is that humans actually don’t treat time that way. In fact, no animal treats time that way. We all suffer for what’s something, the different names for it, but we all suffer from myopia, meaning that we’re kind of near sighted when it comes to time. Anything that’s going to happen in kind of the immediate future, something that’s imminent, carries an outsize weight to us. And, and we can’t help it. It’s the fundamental reason why that chocolate cake is so appealing, even when you know that you shouldn’t take it. It’s, it’s the reason why New Year’s resolutions always fall by the wayside by February.

Dr. Stieg: When we think about decision processes, as you said, it’s future-oriented and is that orientation then based on pleasure, money, pain, or power? And if that’s the basis upon which we make decisions, so be it. But then I ask where does integrity and compassion and the moral things in life play in our decision process?

Dr. Berns: Oh, that’s a great question. The economists would say, yes, all of these decisions are, are ultimately based on what they call utility, which kind of simplistically is the amount of pleasure you expect to get out of that decision or conversely, the amount of harm and pain you hope to avoid. Those are typically treated on the same scale as opposites. Although I think it’s an interesting conversation to have, whether in fact pain and pleasure are actually opposites of one another. They may be independent, but the question you raise about things that don’t fit in those categories, I think is very interesting. And it’s something that I’ve studied a fair bit of and is quite unique to humans. And that is this idea that abstract ideas, philosophies, politics, religions, just things that we hold in our mind acquire value in and of themselves. And I think that’s absolutely true, but because of their nature, you can’t really put a monetary value on them. You can’t put kind of a materialistic value on it. And, uh, some of the studies that we’ve done with, with MRI have suggested that in fact, those types of decisions are governed by different systems in the brain altogether.

Dr. Stieg: But do you think it’s possible that the concept of integrity or compassion is intriguing to me and it’s a value of mine. And so I would then turn that around and say, if I make the decision the right way, it provides me pleasure because I’ve done it in my mind, the correct way. It’s not either or, but it’s a circle.

Dr. Berns: It is. And, and there’s, I, there is no doubt that, that the systems are linked and, and kind of one of the ways to tell the difference in terms of how you’re making a decision. And this is, this is an old philosophical debate. Is your decision based on expected outcomes? Is something gonna be good or bad? Is it going to go this way or that way? Or is it completely independent of that? So one way to tell whether a system is value-based or what philosophers call deontological is if it’s completely independent of the outcomes, it’s just something that, you know internally is right. It’s what the right thing to do is.

Dr. Stieg: Are there certain generic qualities of what a good decision is?

Dr. Berns: That is a tricky question because of course.

Dr. Stieg: Didn’t want to make it easy for ya…. *laughs*

Dr. Berns: I know, well, my first thought, or my question to the question is that I’m good for whom? Good for the individual or good for someone else? And then if it’s good for someone else that kind of reflects back on you and you get kind of an internal benefit from it. So I think one has to be more precise in saying good for whom?, But that actually brings up an important point and kind of the situation that we find ourselves in presently with COVID right? This whole crazy issue of wearing masks. Is it good for me or is it good for you? Well, when you get down to it, it’s good for everyone, right? Why wouldn’t you do it? I mean, that’s been, it protects you, but mostly it protects other people. Uh, and that’s what we call a public good.

Dr. Stieg: So when we’re making a decision, the psychological factors that are going on are what? And are there other associated biological factors? You know, your heart rate goes up, your respiration goes up, you start to perspire and are those linked ?

Dr. Berns: Well, there’re of course they’re going to be many processes involved. There are a kind, a simple way that I like to think about it is, you can divide it into cognitive processes and emotional processes. And that’s just a very simplistic way of dividing this up. So anytime you’re faced with a decision, you can kind of think of it kind of dispassionately and pros and cons, as you mentioned, that’s kind of an effective strategy, I think it was Benjamin Franklin who liked to use that strategy. And that’s one way to separate out the emotions from it. You just kind of write down, okay, well, these are the good points. These are the bad points and you try to weigh them. Then of course, there’s the emotional responses, which are frankly more difficult to control and you might properly call these gut feelings, whatever those are. And I think these are very different systems and it kind of comes back to the interconnectedness of the brain. And you might have one system, the cognitive system, maybe prefrontal only based telling you to do one thing. And then your gut is telling you to do another thing. And it’s not clear to me where the actual decision maker is. There’s not the kind of the modern view of the brain. There’s not like a little, a little person inside your head that’s pulling the levers, it doesn’t work like that. We frankly don’t know.

Dr. Stieg:  You’re an expert on the concept of dread and that state of mind in terms of making decisions. Can you explain what you mean by dread and how it plays a role in our decision making processes?

Dr. Berns: Many years ago, when we were in the midst of studying the reward systems, my colleagues and I, we, we recognized that reward is only one half of the equation, really. Yes, we pursue pleasure. We want, you know, we want to be happy, but we also want to avoid pain and unhappiness. And that is, we think a rather different system in the brain. And so we wanted to study what role that had and the choices that we make. Now, there’s a logistical and ethical, difficultly to hear when we, when we want to study this, because I think we can all acknowledge that pain is a big part of life. You can’t avoid it, although we try to. Nobody likes it, but it is a fact of life. But how can you study that in the laboratory? You can’t, you can’t bring people in and, and subject them to suffering. And so we were kind of faced with this conundrum. We knew the pain was important, but we didn’t really know how it affected decision-making because you can’t ethically do stuff like that to people. We actually devised a paradigm where we inflicted a, let’s say, minor amounts of pain to people, and they did this willingly. So I want, I want to be clear about this, that when people signed up for these experiments, we were, and what we did is we, we put little electrodes on the top of their feet and, you know, we gave them a little electric shocks. To be completely ethical about it, we first titrated the amount of voltage that the person found uncomfortable. We gave them control of that and said, you know, okay, this is the maximum amount of shock we’ll give you. And we won’t give you any more than that. And people were fine with that. As long as they knew what they were in for. And what we did was we asked people to make decisions. And these were these brought in the element of time. And the interesting choices were, would you prefer a large voltage shock now, or would you prefer a less voltage shock, say in a minute? But you’ll have to sit there and wait for it for a minute.

Dr. Stieg: And the answer was?

Dr. Berns: Nobody likes to wait for painful things. And that is, that is what we call dread. That state that you’re in, you know, like where you’re waiting for the shot, or, you know, you’re waiting for the dentist to come in where nothing has happened to you yet, but you’re imagining it. And so nobody likes that. Now what’s interesting about it is that people vary a fair bit and how much they don’t like it. So some people we called “extreme dreaders.” And these were folks who hated waiting so much that they absolutely said, “Yes, I’ll take the bigger shock now I can’t stand to wait for a smaller shock. I know, it’s less painful, but I don’t want to wait for it. So just give me the big one now.: And then there were kind of more mild people who said like, “Yeah, I don’t really like to wait, but no, I’m not going to take a bigger shock just to get it over with.” And what’s interesting is we looked at what was happening in their brains between these two types of people. And pain, unlike reward, is represented in a much more diffuse way. Pain is a very complicated phenomenon, as you know. It’s in part it’s due to what we called nociception, which is the physical transduction of, of a painful stimulus into a nerve impulse, you know, in, in your finger, your hand, your foot. And then that has to get translated into something in the brain and all sorts of things get mixed in with that. And the one that’s probably the most important for this circumstance is attention. If you’re about to get a shot and you’re focused on your arm, and you’re just kind of looking at it, waiting for that needle to go in, yeah, that’s going to hurt a lot more than if you’re distracted. And so what we saw in these folks’ brains was that there was activity ramping up in their cortex in areas associated with the foot and other sensory areas in advance of the actual shock. It’s like people were simulating what was going to happen even before it happened. And in some cases that simulation was greater than the shock itself.

Dr. Stieg: How do you differentiate or do you not the concept of dread versus anxiety? You know, I mean, I’m just sitting there where, “Oh God, how bad is it going to be with, how long is it going to be?” The component of anxiety I presume plays some role in dread or others, do you equate them?

Dr. Berns: For sure. They’re, they’re definitely related. And I think kind of in this specific context, they probably are the same thing. Although I would, I would use anxiety kind of in a more free floating way. You know, usually we talk about anxiety as, as a diffuse emotion. Whereas in this case it was quite targeted, you know, where, okay, I’m anxious or I’m dreading that shock.

Dr. Stieg: So let’s take a Navy SEAL, you know, they’re put in ice cold water, they’re suffocated. I mean, all of these extreme things that they go through and they learn how to deal with that. I’m presuming that they are by nature, mild dreaders. That’s one question. And the second question is, can I be, if I’m an extreme dreader, can I be trained to be a mild dreader.

Dr. Berns: That’s a great question. We haven’t done those studies, but I would think that you can train people. I believe in the ability to learn. So I don’t see why you couldn’t. For dread and specifically the dread or anxiety of pain, the technique is, is pretty simple. It’s distraction. What we observed in that study, it was the more attention you focus on that body part, that’s gonna get jabbed or shocked or whatever, then yeah, the more you’re going to dread it, the more it’s going to hurt. Techniques like distraction are highly effective.

Dr. Stieg: And when you talked about, you know, the big shock quickly, or the lesser shock and in a period of time, can individuals be categorized on the basis of time versus whether they’re a mild or extreme dreader?

Dr. Berns: Yeah. Great question. Yes. You can. If you give people enough choices and kind of different tradeoffs of voltage and time, yes. You can calculate what we call the discount rate. And it’s, it’s exactly the same as if it was for rewards, except now it’s for, for painful outcomes. So you can classify people as steep discounters or gradual discounters, or as we did, it was based on their brain activity and how much they ramped up their sensory systems in anticipation of it. It turns out that they were correlated over the times that we looked at.

Dr. Stieg: I know there’s people sitting out there saying, “Oh my God, I’m a, I’m an extreme dreader.” Or somebody thinks I’m a mild dreader. Is there any help that you can give people to guide them in their decision making to make it easier? Are there exercises or steps that they can take?

Dr. Berns: Yeah. I mean, I’m probably in the extreme dreader category.

Dr. Stieg: *laughs* You don’t sound like it.

Dr. Berns: I’m neurotic enough to call myself that. You know, I kind of lump people. You’re either dreading the future or you’re regretting the past. So pick your poison. No, but seriously, the extreme dreaders, I think have to kind of fall back on things like distraction because it becomes a self-perpetuating cycle. The more you dread the future of what might happen, the more you focus on it. And then that just amplifies the process. And the only things that, that really help with that is to distract yourself and do something else to take your mind off of that. You know, these are basic things, you know, exercise helps a lot, hobbies, especially things that if you can use your hands and you get kind of just absorbed in… these all help.

Dr. Stieg: Greg Berns, it’s been fascinating. You’ve been helpful to me, both personally, and also I think in how I can deal with patients in battling through the process of making difficult decisions. Thank you so much for being with us.

Dr. Berns: Thank you. It’s really been my pleasure.