Individuals not infrequently use terms to describe themselves such as, “I am worthless…I am useless…etc.” These individuals apparently believe that they have no value. The whole concept of value is tied in with dopamine secretion and motivation in the literature. In addition, dopamine is apparently insufficient in certain regions of the brain of those with negative symptoms( while also increased in the striatal.
It is possible to put together the experimental findings regarding dopamine with the clinical expressions of thoughts of self-worth. Consider the following formula: I expect that nothing will work out for me and that any individual act I perform will be a failure –> diminished dopamine secretion —-> loss of motivation →negative symptoms. This then creates a cycle back to a sense of failure.
Aside from the clinical understanding, the above cycle gives some clues as to the treatment plan. In short, it is important to a) build up an individual’s expectations regarding an activity or long-range goal b) start an activity that is intrinsically rewarding to the individual or fits in the long-range goal or both c) to modify the expectations, conduct a restructuring after a successful activity (“What does this indicate to you?” “Does it mean that you do have enough energy to perform things that you felt were too demanding?”).
It should be noted that individuals build up a positive expectancy after a series of positive experiences and then feel devalued and regress totally when the positive expectancy is not met. However, even a slight shift from a positive attitude to a neutral one on the part of the staff may be misinterpreted as devaluation and lead to a regression. An example is an individual who is totally involved in a project during the day and then felt let down and devalued upon returning to the usual routine on the unit. Also in view of the dopamine hypothesis, these individuals may respond to positive expectancies and positive feedback but may go in the opposite direction when punished resulting in a decreased dopamine secretion. The rules here are:
2.Do not use punishment such as a withdrawal of privileges as a way of controlling the individuals incentives and behavior.