For Older Folk — on the Mental Health Wisdom of Avoiding or Suppressing Regret — a Small Study Published in Science

20 April 2012

Introduction

The naturally optimistic will not benefit from this short essay.

It is intended, instead, for realists and pessimists. People who clearly recognize the losses they have had, especially those they brought on themselves, and those they will soon be faced with.

What follows is about maintaining hope in the realistically assessed absence of hope. It is about detouring the anger and depression that age sometimes tempts us into.

What follows might even be about voluntarily deluding oneself, so as to continue to step forward along a terminally rock-strewn trail.

Memorable wisdom from a World War II friend

I met my friend, Marlin J. Asmussen, last year, while selling him a used garden cart for his nephew.

Fortuitously, Oklahoma culture (like most of Texas) is characterized by its willingness to engage in friendly talk that often goes somewhere meaningful.

After speaking about Marlin’s World War II Navy service, I diverted him into talking about the less dramatically bloody, but inevitable losses that accompany aging. For him, one of the atrocities that time inflicts on us included the inconsolable loss of his beloved wife and life companion.

Marlin said, in essence, “I focus on the future, to keep going.”

And he went on to imply that looking backward brings too much sorrow to serve as a successful coping mechanism.

I very frequently remind myself of his advice — as I, too, confront irretrievable absences that a short-timer’s limited days no longer have the power to heal.

And, now, science legitimates the value of Marlin Asmussen’s advice.

Citation — to a small research study that supports the merit of avoiding feelings of regret

Stefanie Brassen, Matthias Gamer, Jan Peters, Sebastian Gluth, and Christian Büchel, Don't Look Back in Anger! Responsiveness to Missed Chances in Successful and Nonsuccessful Aging, Science, doi: 10.1126/science.1217516 (19 April 2012)

Why I mention this study

Stefanie Brassen and colleagues’ work appears to provide a neuroscience confirmation of what many elderly people know from experience. Her clever experiment implies that at least some people may be able to cognitively control regret-avoidance by act of will.

If true, this supports psychology’s cost effective emphasis on cognitive and behavioral therapies. This, in turn, should encourage the open-minded among us to adopt Marlin Asmussen’s “no regrets” perspective.

Background — about non-depressed (“successful”) aging

According to Brassen’s team, older people recognize that their time is running out. The non-depressed elderly concentrate on regulating their emotions, so as to “optimize well-being.”

For the elderly, regret is a negative emotion. We cannot realistically do anything to change past results — whether they were, for example:

(a) failing to win a gold medal at the Olympics,

(b) not having tried in the first place.

In either event, divorcing ourselves from feeling completely responsible for what is irretrievably past is an essential coping skill.

So, is there a way to use neuroscience to see who does this well and who does not? And mechanistically why?

The neuroscience underlying Brassen’s experiment

Past research indicates that the brain’s ventral striatum is involved in processing feelings of reward and regret, including feeling badly about missed opportunities. It is connected to the anterior cingulate cortex, which we think plays important roles in decision-making and the reaction to emotions, including our bodies’ automatic responses to those, such as heart rate and blood pressure.

How the experiment was designed to indirectly monitor these brain connections — and to compare the results between three experimental groups

When you have a reasonably good idea of how something works, you can look at it working and come to some conclusions about conditions that you cannot see.

For example, Brassen’s team wanted to find out:

(i) whether young people are different than old people in how they feel and respond to regret

and

(ii) whether well-adjusted old people are different than depressed old people on the same measure.

They decided to use two different experiments to research these questions, each effectively taking advantage of our brains’ way of working.

In the first experiment, the team subjected 61 people to functional magnetic resonance imaging. The fMRI procedure monitored the brain’s regionalized blood flow — while these 61 subjects played a game that the researchers had designed to induce feelings of regret for:

(a) mistakes made

and

(b) opportunities lost.

Note

Brain blood flow presumably corresponds with localized amounts of neural processing. By knowing (in real time) where in the brain metabolic activity is highest, one can infer what the neural processing being observed is controlling or responding to.

These 61 people were divided up into:

(i) a 21-person group of (median age) twenty-five-year-olds,

(ii) a 20-person sample of normally adjusted sixty-five-year-olds,

and

(iii) a 20-person packet of depressed sixty-five-year-olds.

In the second experiment, the team monitored emotion-tracking autonomic (bodily automatic) responses (using skin conductance and heart rate) in a split group of 30 sixty-five-year-olds. Half of these people were psychologically normal. The other 15 were depressed.

The idea here was to see if there might be emotional components to what the MRI had traced in the brain’s blood flow during the same game.

Here is the “regret” game that the researchers designed to parallel real life during their two experiments

This is the part that is cleverly simple:

On each trial, an array of eight boxes was presented, where seven boxes contained a gain (“gold”) and one contained a loss (“devil”). Boxes could be opened from left to right.

At any stage, volunteers could either open the next box or stop and collect the gains acquired so far in this round.

Exposing the randomly distributed “devil” ended the trial and all gains from this round were lost.

If volunteers decided to stop and collect their gains, the position of the “devil” was revealed, indicating how far they could have safely continued (“missed chance”).

© 2012 Stefanie Brassen, Matthias Gamer, Jan Peters, Sebastian Gluth, and Christian Büchel, Don't Look Back in Anger! Responsiveness to Missed Chances in Successful and Nonsuccessful Aging, Science, doi: 10.1126/science.1217516 (19 April 2012) (at paragraph immediately above “Figure 1”) (paragraph split)

During the MRI, the 61-person group played 80 rounds of this game.

Test hypotheses

You will remember from school that you cannot do a scientifically legitimate experiment, without designing it to test one or more hypotheses.

So, here, the team wondered:

(1) whether emotionally healthy old adults would show a reduced physiological response to missed opportunities,

(2) whether these healthy older folk would differ from younger and depressed older folk in how they processed good and bad outcomes,

(3) and, if the happy older folk did differ from both the other groups, was it because they controlled the parts of their brain that regulate emotional responses?

Results of the MRI study

This is the first key finding:

Consistent with our previous findings in an independent young sample, the degree of missed chances predicted subsequent risk-taking behavior in healthy young and depressed old volunteers.

Specifically, the greater the amount of missed chances in the current trial, the more risk these subjects took in the next trial, despite the fact that consecutive rounds were explicitly independent.

This behavioral response to missed chances was not observed in healthy elderly . . . .

© 2012 Stefanie Brassen, Matthias Gamer, Jan Peters, Sebastian Gluth, and Christian Büchel, Don't Look Back in Anger! Responsiveness to Missed Chances in Successful and Nonsuccessful Aging, Science, doi: 10.1126/science.1217516 (19 April 2012) (at third paragraph below “Figure 1”) ) (paragraph split)

In other words, well-adjusted old people do not take the risks that younger people do, even when know the emotional price that regret might conceivably have on them later.

Presumably, emotionally healthy older people know that their comparative decrepitude and their now-short life span will not allow them to make up for costly errors.

On the other hand, depressed older people, however, seem not to have learned, or emotionally adjusted to, this lesson. Is it because they wish to make up for earlier mistakes made or opportunities lost? The study does not provide an answer this question, but I can certainly see that impulse occasionally acting in me.

The physiological underpinnings of these behavioral responses are interesting. All the groups exhibited reduced activity in the bilateral ventral striatum, when they lost their “gold” gains during the game. However, the young and depressed samples exhibited the same reduced activity, when they learned that they had abandoned a winning opportunity too soon. The healthy older group did not display this reduced signal for missed opportunities.

Consequently, the difference between healthy aging and non-healthy aging may lie in people’s recognition that concrete losses are different than hypothetical missed opportunities at the late stage of life. In contrast, it makes sense that we would have evolved to favor youth, who are willing to take chances to correct previously missed opportunities.

In short, the sense of missed opportunities has different emotional meanings and behavioral consequences for young versus old well-adjusted older people.

Here’s another important finding. The apparent cause of this difference between the groups’ treatment of real versus fictional losses lies in how their anterior cingulate cortex processed the game’s “missed opportunities.” Healthy older people showed increased ACC activity, whereas the other two groups did not.

Given what we know about the anterior cingulate cortex, we can surmise that older adults are actively recruiting conscious control over their emotional reaction to opportunity losses and to the regret that these prompt in us.

Results of the heart rate and skin response experiment

In this second experiment, not only did the team measure autonomic physiological responses (heart rate and electrical skin response), but they asked the subjects how they felt about their “bad” game decisions.

The two groups exhibited the same risk-taking differences that the MRI had revealed — despite the fact that both expressed increased regret, when the lost opportunity proved to be large, rather than small.

In other words, the healthy older group (unlike the depressed group) did not let its “pissed-off-ness” encourage it to take more risks.

The groups’ comparative automatic responses trended the way the experimenters thought they would. Skin conduction went down and heart rate up in the depressed group. This indicated that the depressed group was exhibiting more emotional reactivity to sub-optimal decisions. The research team confirmed this characteristic afterward, during a standardized interview.

The real eye-opener is — that there may be no price to pay for being emotionally grounded, while playing Life’s games of chance

What follows is obviously not completely applicable to the slings and arrows of Life’s misfortunes, but it is nevertheless reassuring:

Using a multimodal approach our data show that emotionally healthy aging is associated with a reduced responsiveness to regretful events.

Humans tend to avoid the negative feeling of regret by changing future decision behavior. In the current study these effects were restricted to healthy young and depressed older subjects.

Importantly, the lack of such behavioral responses to fictive losses in healthy older adults had no negative effect on overall performance.

Similar to other sequentially independent guessing tasks, the consideration of missed opportunities was irrelevant for performance in the independent rounds.

© 2012 Stefanie Brassen, Matthias Gamer, Jan Peters, Sebastian Gluth, and Christian Büchel, Don't Look Back in Anger! Responsiveness to Missed Chances in Successful and Nonsuccessful Aging, Science, doi: 10.1126/science.1217516 (19 April 2012) (at article’s last paragraph) (paragraph split, emphasis added)

The research team’s conclusion

Brassen’s group concluded that aging theory is correct, when it assumes that well-adjusted elderly people use cognitive techniques to disengage from negative experiences.

Activation of the anterior cingulate cortex in the healthy older test group appears to provide a physical basis for this process. The ACC has previously been shown to control emotions and positive attention. So, when it kicked in here, the team assumed that emotional control-taking is part of what the well-adjusted elderly are doing.

More significant for the rest of us is the psychological technique that this successful group seems to be using. Causationally, the healthy group appears to substitute uncontrollable external factors in place of pure personal responsibility for things gone wrong. The depressed elderly appear to do the reverse.

Brassen et al. suspect that re-training maladaptive aging responses via cognitive-behavioral programs might be a promising avenue for redressing the sorrow and anger that accompany some people’s aging process.

Re-enter Marlin Asmussen’s simple observation to me. “Look forward.”

Caveats

The experiments' sample sizes were excruciatingly small and unavoidably not randomized.

It is unlikely that experimental blinding between experimenters and subjects was sufficient.

The moral? — Believable mostly because we already suspected that these results were the reality

Lying to ourselves is occasionally useful.

Especially, if we do not want to croak carrying the emotional burden of our life’s often long list of irremediable stupidities.

Equanimity is a useful tool.

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For Older Folk — on the Mental Health Wisdom of Avoiding or Suppressing Regret — a Small Study Published in Science