Pride: A turbo-charge for motivation or a social nemesis?

by Mary Lamia, Ph.D.

(Originally published at PsychologyToday.com)

You may not consider emotions as a source of motivation or a fuel that helps you to attain a goal. Yet a primary purpose of emotions is to activate, direct, and motivate your efforts toward achieving objectives. Thus, emotions drive action and they are a major ally in goal directedness and accomplishment. Certainly, this is the case for the emotion of pride.

Pride ignites a positive appraisal of the self that can create feelings of optimism and worthiness. The expression of pride informs others of your value, and you can likely imagine the difference in facial expression and posture when pride is felt in contrast to an emotion such as shame. In social situations, pride alerts others to your confidence and importance, and perhaps even more so when a prideful expression is coupled with captivating humility.

Unlike self-esteem, which has more to do with a general attitude about one’s own worth, pride is triggered in response to a specific accomplishment, an achievement, an event, or a measure of performance. Such temporary bursts of positive emotion can powerfully influence us, as David Brooks (2011) has pointed out in a recent New York Times opinion piece. As a result, experiencing pride because of a success can lead you to imagine further and even larger achievements (Fredrickson & Branigan, 2001). Motivation to persevere in your attempts to achieve a long-term goal, or to sustain effort in a negative situation, can be aided by experiences that trigger the emotion of pride (Williams & DeSteno, 2008).

Given its involvement in self-evaluation and in the relationships you have with others, pride is considered a self-conscious and social emotion along with embarrassment, guilt, and shame. But where pride has a positive valence, embarrassment, guilt, and shame are associated with the evocation of painful feelings (see previous PT blogs on “Shame: A Concealed, Contagious, and Dangerous Emotion” and “Whatever Happened to Guilt?“).

Yet these self-conscious emotions can interact, such as when you experience embarrassment, shame, or guilt in response to pride. For example, although you may gear your efforts toward accomplishments that will trigger pride, experiencing the emotion may subsequently trigger shame about your desire for recognition, guilt about leaving others behind, or embarrassment when others acknowledge your achievement. On the other hand, the emotion of pride can be triggered simply from refraining from an activity that will otherwise trigger shame or guilt.

While pride in an achievement can instill you with confidence, it can potentially create an attitude that is overly confident. But is such overconfidence necessarily maladaptive? Actually, being overconfident can be highly adaptive or, perhaps, even profitable.  Although overconfidence can, at times, lead to flawed assessments, idealistic expectations, and risky decisions, it can encourage you to compete, rather than retreat, in situations where you are capable of winning; and it has positive effects on ambition, credibility, and morale (Johnson & Fowler, 2011).  Being confident, or even overly confident, allows you to be in the game.  Situations that potentially may lead to failure or defeat are sometimes perceived as far too risky. Yet not playing the game unless you’re going to win may be overprotecting your general sense of pride.

Overconfidence is considered to be the best strategy when there is uncertainty about the strength of an opponent and the outcome, and where the costs incurred are less than the value of competing or fighting for the resource (Johnson and Fowler, 2011). In evolutionary terms, fighting for and subsequently winning a desirable mate may be worth the risk of sustaining a serious injury. But this also can apply more broadly to the use of deception in business, such as when the potential consequences that may result from false marketing or advertising are seen as worth the value of securing consumers. Such overconfidence that weighs the costs incurred in competing as less than the value of the resource often disregards risk to others.  In this case, even though such risk can result in consumer disappointment, anger, or lawsuits, these are likely seen as less expensive then losing the competitive venture.

Pride doesn’t make you self-centered, but it can characterize narcissism. Hubristic pride, which represents a more global and overly self-confident attitude, can be a result of the narcissistic cognition that who you are translates to being precious or highly valued. Since the evolutionary purpose of self-conscious and social emotions has to do with functioning within a group, pride indicates status to others and its expression can raise social standing. However, where pride can motivate behaviors that are geared toward the attainment of status, hubris falsely promotes it and may have evolved as an attempt to convince others of success even when it is unwarranted (Tracy & Robbins, 2007). Likely you are aware of people who have falsely acquired social standing with self-confidence that lacks a portfolio. Nevertheless, spurious pride is convincing and alluring whether it’s an attribute of an adolescent who uses it to extort popularity or a trait of a narcissistic leader.

For more information about Understanding Myself: A Kid’s Guide to Intense Emotions and Strong Feelings: http://www.marylamia.com

References

Brooks, D. (2011, September 30). The Limits of Empathy. The New York Times, p. A25.

Fredrickson, B. L., & Branigan, C. (2001). Positive emotions. In T. J. Mayne & G. A. Bonanno (Eds.), Emotions: Current issues and future directions (pp. 123–151), New York: Guilford Press.

Johnson D.  & Fowler, J. (2011). The evolution of overconfidence. Nature, 477, 317–320.

Tracy, J. and Robbins, R. (2007). Emerging insights into the nature and function of pride. Current Directions in Psychological Science, 16(3), 147-150.

Williams, L. and DeSteno, D. Pride and Perseverance: The Motivational Role of Pride. Journal of Personality and Social Psychology, 94(6), 1007–1017

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Please visit http://www.marincountypsych.org for more information about our association and membership benefits or to locate a licensed clinical psychologist in Marin County.

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Blog Disclaimer:

The opinions expressed by the authors are their own and do not reflect the opinions of the Marin County Psychological Association. The information posted on this blog is not intended as, and is not, a substitute for professional mental health services.

 

 

 

 


 

You (or your spouse) Call It Quits:  Now What?

By Ann Buscho, Ph.D.

Divorce statistics widely published on the web suggest that approximately 41% of first marriages end in divorce.  The divorce rate for second marriages is 60% and for third marriages it is 73%.

The statistics don’t reflect that on every measure of stressful life events, the events that cause us to get sick, depressed, anxious, and to feel like our worlds have collapsed, divorce is at or near the top of the list.

Most people have no idea where to turn when their marriages fall apart.  Many turn to a therapist (like me) in an eleventh-hour attempt to salvage the marriage.  John Gottman’s research tells us that many of those attempts fail, because couples are getting to therapy “six years too late.”  Well-meaning friends and family often counsel people to hire the most aggressive attorney they can find.  The children (whom I often describe as “canaries in the mine”) begin to show signs of distress, regression, anxiety, acting out, or other mental health or behavioral symptoms.

Most people have no idea what their choices are when it comes to the divorce process.  In fact, most don’t realize that they have choices about how to divorce, and therefore no sense of what process would work best for them and their families.  Unfortunately, people often find themselves in an ill-suited process that either provides too little support, or generates too much adversarial conflict.  Either way, it often costs more than they can afford, and doesn’t meet their real needs.

Some need decision-makers, like a judge or custody evaluator.  Most prefer having a hand in their decisions, but need education about finances or parenting.  Many need emotional support and to be empowered to express their needs and interests in a respectful negotiation.

During the divorce, people must make life-altering decisions at a time when even small decisions feel overwhelming.  Flooded with feelings of grief, guilt, anger, shame, or fear, they struggle with big decisions about money, property, children and parenting.  With so many people facing divorce with so little information about the process options available to them, it became apparent that a large gap exists between the availability and the need for information about divorce process options.

A volunteer group of attorneys, financial specialists and mental health professionals now offer a monthly community service program for individuals who want to learn more about the process of divorce.  These “Divorce Options” workshops help individuals learn their divorce process options and explain the legal, financial, psychological and emotional issues of divorce.

An attorney discusses the different types of divorce processes: self-representation, mediation, collaborative divorce and litigated divorce. The attorney also addresses the filing process, costs, child custody, child/spousal support and property issues.  A divorce financial specialist addresses dividing property, cash flow, real estate issues and the tax consequences of divorce.  A mental health professional addresses the emotional process of divorce, how to break the news and the impact on children.

The educational program is sponsored by Collaborative Practice California, and is offered in many locations around the state of California.  The four-hour workshop costs $45.  No one is turned away because of inability to pay.  Pre-registration is NOT required.

Workshops are repeated on the last Saturday of every month, at Family Service Agency, 555 Northgate Drive, in San Rafael.

The next workshop will be November 26th 9 am to 1 pm.

For more information, please contact us at divorceoptionsmarin@gmail.com or visit: www.collaborativepracticemarin.com

For more information about Dr. Buscho: www.DrAnnBuscho.com

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Please visit http://www.marincountypsych.org for more information about our association and membership benefits or to locate a licensed clinical psychologist in Marin County.

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Blog Disclaimer:

The opinions expressed by the authors are their own and do not reflect the opinions of the Marin County Psychological Association. The information posted on this blog is not intended as, and is not, a substitute for professional mental health services.

Clinical Diagnosis: How Would You Make Sense of These Symptoms?

by Nancy Hoffman PsyD, Geriatric Neuropsychologist

Clinical Presentation

The 75-year-old patient came to my office for a neuropsychological evaluation only after much pleading by his daughter, Caroline. John Smith was a tall, striking man who still embodied the successful stockbroker he once was. He was good looking and had an air of authority about him. However, he also seemed to be lost during much of the conversation, staring out the window while Caroline and I discussed a puzzling array of symptoms.  When he would speak, he was quite tangential and required frequent redirecting.

He was fond of tennis and told Caroline he had been watching Wimbledon with his new girlfriend. She was confused by this admission. They lived side by side in a duplex in Southern Marin and she hadn’t noticed anybody coming or going from her father’s side of the house. Her husband often kept different hours than she did, but he hadn’t noticed anyone coming or going either.

After several weeks of speculation, Mr. Smith finally admitted to Caroline that his new girlfriend didn’t use the front door. Instead, she would step into his side of the house through the television once she had finished her duties as a news anchor. They would sit side by side, holding hands and watching Serena Williams humiliate her opponents on the courts of Wimbledon. They were falling in love and he hoped they would soon marry.

Mr. Smith also told Caroline that he had been playing poker with a couple of professional clowns, who also accessed his apartment through the television. However, they were not quite as charming as his lover and he wanted help from his son-in-law to get them out of the house.  The night before, he had called 911 to report intruders. However, when the police arrived they could find no sign that anyone had been in or near Mr. Smith’s apartment.

Caroline called my office in a panic. Her father had a history of alcoholism but had been sober for 20 years. Could he have resumed drinking? Was he abusing prescription pain killers or was he picking up some other type of drug during his morning walks into town? The symptoms seemed to have come on suddenly and she was at a loss as to how to understand what was happening to her father. His primary care doctor had had him psychiatrically hospitalized and he was now in the intensive outpatient program (IOP) at Marin General Hospital with a diagnosis of delusional disorder. However, the antipsychotic medications they were giving him for his visual hallucinations only seemed to be making matters worse. Caroline was wondering if a neuropsychological evaluation might shed more light on her father’s condition.

During the course of our clinical interview, Caroline told me her father’s symptoms appeared to get worse as evening came. However, by morning, he was always much better.  He also had some extrapyramidal signs and would sometimes appear to have a slight tremor in his head, shaking it back and forth as if saying repeatedly, “No. No. No.” Some days were better than others, but she never knew what to expect. Calls to the police were becoming more frequent.

Testing

Medical: Mr. Smith’s labs were all normal and a CT scan had come back “unremarkable.” Caroline did reveal her father had been diagnosed with sleep apnea, but did not use the CPAP as prescribed. Could chronic hypoxia have been the cause of hist odd constellation of symptoms?  He had also moved the mattress from the bed frame to the floor because he was so restless at night, he would sometimes fall out of bed. Other than that, his health was good, although he was beginning to show signs of Parkinson’s such as rigidity and a shuffling gait.  His physician suspected the hallucinations were due to an undiagnosed psychiatric disorder and had him hospitalized for being “gravely disabled.”

Cognitive: Mr. Smith was mildly to profoundly impaired on every neuropsychological measure  administered. He could not provided a detailed sequential personal history and he did not always respond appropriately to questions. He had difficulty following instructions and would often apply his own criteria to the task at hand. For instance, on Trail Making Test Part B, which requires a person to connect letters and numbers alternately, he decided it would make more sense to connect the numbers first in order and then connect the letters in alphabetical order separately. No amount of coaching could convince him to try to follow the standardized instructions. Most of his work was slow and on verbal recall tasks, cueing was found to elicit confabulation.

Psychological:  Testing was limited due to Mr. Smith’s inability to follow instructions or sustain attention long enough to respond appropriately to questions.  He could not understand the Personality Assessment Inventory, even though had had an advanced degree. The Geriatric Depression Scale did not indicate a mood disorder, but he appeared apathetic throughout the clinical interview.  Apathy, which is easily misdiagnosed as depression, is often an early sign of many forms of dementia.  There was no history of any psychiatric disturbance in his early life and no family history of psychosis, depression, or bipolar disorder. Mr. Smith did have a history of alcohol dependence but was active in AA and had been sober for 20 years.

How would you diagnose this patient?

Mr. Smith’s primary symptoms included significant and global cognitive decline, disturbances in REM sleep (i.e. “acting out” his dreams), fluctuations in awareness (staring into space for long periods of time vs being able to hold a conversation), extrapyramidal signs (, and visual hallucinations. The use of antipsychotics only exacerbated his symptoms but the hallucinations did not cause him any great distress.

His clinical team, which included his primary care doctor, a psychiatrist, and an LCSW from the hospital’s IOP, had several hypotheses, but no one seemed to agree on a single diagnosis. Given the constellation of symptoms and his presentation, they hypotheses generated included:

   a)  Bipolar disorder

   b)  Psychotic disorder

   c)  Delusional disorder

   d)  Lewy Body Dementia

Lewy Body Dementia

There are two common problems clinicians frequently encounter when trying to differentiate Lewy Body Dementia (LBD) from other forms of cognitive decline. One problem is the overlap between LBD and other forms of dementia. The other is that some of the characteristic features of LBD don’t appear until the later stages of the disease.

Lewy Body Dementia is now considered to be the second most common type of dementia after Alzheimer’s and may account for up to 25% of all dementia cases (Hansen et al). However, because the symptoms are so confusing, it is often misdiagnosed as a psychiatric disorder. Although the diagnostic accuracy of Lewy Body Dementia is poor, visual hallucinations are an important early sign (Hohl, et al). Fluctuations in consciousness are sometimes problematic because there is no agreed upon definition and the symptom report relies heavily on the observations and opinions of family members and friends.

According to the Lewy Body Dementia Association (www.lbda.org), the clinical criteria for a diagnosis of LBD include progressive dementia as a central feature.  Memory problems may not occur until the later stages of the disease while impairments in executive function and attention are more evident early in the disease process.  The diagnostic criteria also requires one of more core features, including fluctuations in awareness, visual hallucinations, and parkinsonism.  Suggestive features include REM sleep disturbances and neuroleptic sensitivity.  Supportive features include frequent falls and/or syncope, unexplained losses of consciousness, and autonomic dysfunction.

Lewy Body Dementia and Parkinson’s disease are difficult to differentiate. A general rule of thumb to follow is Parkinson’s can progress to dementia, thereby generating a diagnosis of Parkinson’s Disease Dementia (PDD), while Lewy Body Dementia begins with signs of cognitive decline approximately one year before any signs of Parkinson’s appear.

There are also personality changes that accompany LBD. The patient may become less emotionally responsive and may tend to give up favorite hobbies.  They may also appear to be apathetic and engage in purposeless hyperactivity (Galvin et al).  Fluctuations in cognition may also be accompanied by unexplained irritability.

LBD is more common in men than in woman (2:1) with a mean age of onset of 68 (Khotianov et al). The prognosis following diagnosis is poor and most patients die within 6.4 years. The most common cause of death is aspiration pneumonia.

If you suspect LBD in a long term care patient, a thorough evaluation by a geriatric neuropsychologist or a neurologist can help to clarify the diagnosis. At this time, a definitive diagnosis can only be made at autopsy (Khotianov et al.).  Early diagnosis is important as treatment with donepezil (Aricept) can often help to increase alertness and cooperation with caregivers, while treatment with L-dopa and most neuroleptics can cause symptom exacerbation.

Mr. Smith was given a diagnosis of probably LBD, which allowed the family to make appropriate plans for his future care.  All neuroleptics were discontinued and he was started on Aricept, which he was able to tolerate. He showed improvements in awareness and some of his behavioral disturbances were relieved. By knowing the expected progression of the disease, the family was able to make appropriate plans for his future care.

For more information about Dr. Hoffman: www.collaborativeassessment.com

References:

Galvin, James E. MD, MPH; Malcolm, Heather; Johnson, David, PhD; and Morris, John C. MD. Personality Traits Distinguishing Dementia With Lewy Bodies From Alzheimer’s Disease. Neurology 2007; 68:1895-1901.

Hansen L, Salmon D, Galasko D, et al. The Lewy body variant of Alzheimer’s disease: a clinical and pathological entity. Neurology 1990; 40:1-8.

Hohl, Ursula MD; Tiraboschi, Pietro MD; Hansen, Lawrence A. MD; Thal, Leon J. MD; Corey-Bloom, Jody, MD, PhD. Diagnositc Accuracy of Dementia With Lewy Bodies. Archives of Neurology 2000; 57:347-351.

Khotianov, N., MD; Singh, R. MBBChir, MA; Singh, S., MBBChir, MA. Lewy Body Dementia: Case Report and Discussion. Journal of the American Board of Family Practice 2002;15:50-54,

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Please visit http://www.marincountypsych.org for more information about our association and membership benefits or to locate a licensed clinical psychologist in Marin County.

# # #

Blog Disclaimer:

The opinions expressed by the authors are their own and do not reflect the opinions of the Marin County Psychological Association. The information posted on this blog is not intended as, and is not, a substitute for professional mental health services.