One of the most common frustrations I hear from my clients and families is a struggle to understand and “fix” a lack of motivation. For example, “Why can’t I take action to actually achieve my goals?” or “Why doesn’t my child change an obviously unhelpful behavior?” These conflicts can feel obvious, paradoxical, and insurmountable, which often leaves clients and families feeling mystified at the behavior. Discussions about motivation typically end with some version of “Yes, I know it’s difficult, but you have to do it anyway.” While this sentiment is often true, it misses the struggle involved in translating desire into action.
Our use of the word “motivation” has become vague and ill-defined; is it the desire for a specific action or is it only truly present when we implement some new behavior that supports a desire? Where does willpower fit in? My goal here is to bring some clarity to the concept of motivation and an understanding of the neurological influences affecting motivation.
A more apt description for lack of motivation (in therapeutic terms) is “behavioral apathy;” a lack of desire to initiate behavioral change or respond to stimuli. The vast majority of my clients have some desire to have a different outcome: better relationships, improved performance, elevated mood, etc. What they often lack is the ability to turn that desire into new behaviors that support their end goals. For example, my desire for clean laundry is not sufficient by itself to make it so. Similarly, a desire to not be depressed is rarely enough to overcome depression. At some point, there must be a translation into cognitive or behavioral change.
While this topic can be dense, my hope is that by understanding what is happening physically, we can challenge the unhelpful internalized narratives of “I’m broken/lazy/worthless” which tend to arise when we struggle with behavioral apathy.
The neural mechanisms behind motivation and behavior change are vast, complex, and our understanding is still being refined. For the purposes of this discussion, we can distill the process down to a few major elements:
Brace yourselves! We are going to dive into some of the neurological details behind motivation, and I will do my best to make it digestible. Generally, there are multiple parts of the brain working in concert during these stages: the supplementary motor area (SMA), primary motor cortex, caudal cingulate, posterior and anterior rostral cingulate, and ventral tegmental area (VTA). Individual differences play a large role in how we perform in this process. Studies have shown that otherwise healthy people who score high on apathy have significantly increased SMA and cingulate motor zone activity during the evaluation stages of behavioral initiation tasks. In other words, the brains of apathetic people work much harder and experience more difficulty in making decisions than people who are less apathetic, making them less likely to follow through on the decision.
Studies have shown that decreased structural and functional integrity in these regions directly increases behavioral apathy. Accounting for the neurological difficulties and changes that occur with comorbid mental health and addiction struggles provides strong evidence for why many clients may struggle with motivation and change. There is a catch-22 here in that people with mental or physical struggles are more likely to need to implement significant behavioral and lifestyle change, yet also more likely to have genuine impediments to doing so. Loved ones without these issues would benefit from understanding this paradox and infusing some compassion into the “bootstrapping” messages that are often conveyed with the best intentions.
Additionally, our neurotransmitters play a role in overcoming behavioral apathy by chemically transferring impulses between nerves. If all the correct brain regions are appropriately involved and we have all the desire in the world, we still need adequate amounts of serotonin to actually start and maintain a behavior, dopamine to notice and appreciate our efforts (increasing the likelihood of repeating the behavior), and a neurotransmitter called GABA to stop ourselves from doing things we would rather not. GABA, dopamine, and serotonin can affect mental health when out of balance, so it follows that people with mental health struggles would also struggle with the full process of motivation and behavior initiation.
Now that you have had a “crash course” in neurology, let’s take a look at the big picture. My goal in understanding how neurological differences affect motivation is not to excuse or enable apathy. Rather, I believe if we can understand and explain to clients that struggles with motivation and behavior change are legitimate, significant, and unique, we can better personalize treatment.
If you suffer from behavioral apathy you should first ask yourself, at which point do you typically falter? If we paint motivation or behavioral apathy with too broad a brush we risk intervening at the wrong stage or misunderstanding the specific stumbling block getting in the way of our desired behaviors.
In treatment, we can support our clients in making these changes by setting reasonable goals and titrating them as appropriate. One of the most powerful elements of my work at Open Sky is that the very structure of the program and incredible essence of the wilderness provide the basic scaffolding to heal physiologically and reward incremental efforts to break old patterns. Clients can ride this cascade of experiential success while their brains create new pathways, causing the scaffolding to recede and allowing them to increasingly rely on themselves for positive change. Finally, our understanding of this process, we cannot wait until we “feel like” changing, we must change and see how it feels.
Tune in to Dr. Aaron’s SKYlights Podcast episode on motivation here.
MacInnes, Jeff J. et al. Cognitive Neurostimulation: Learning to Volitionally Sustain Ventral Tegmental Area Activation. Neuron, Volume 89, Issue 6, 1331 – 1342
Valerie Bonnelle, Sanjay Manohar, Tim Behrens, Masud Husain; Individual Differences in Premotor Brain Systems Underlie Behavioral Apathy, Cerebral Cortex, Volume 26, Issue 2, 1 February 2016, Pages 807–819