Caring for People in Pain Pain Rehabilitation Parenting

What Works For You? Rewards Today or Avoiding Harm Six Months Down the Road?

1step2life is built on cutting edge developmental and rehabilitation science.

Research shows that when people live with chronic pain, continued bed rest and withdrawal from activities leads to a downward spiral. Inactivity leads to muscle breakdown, weakness, and increased pain. Withdrawal from daily activities leads to isolation, depression, and anxiety. Depressed mood increases pain leads to further withdrawal.

Moving, activity, maintaining relationships, and engaging in activities that feed your joy help maintain and support mental and physical health and well being.

Download Benore, Fahrenkamp, Zhakunets, & Banez (2020):

School re-entry following chronic pain and disability: A pathway to success

Developmental Science

The developmental science underlying the app may be less obvious. Developmental psychology looks at age-related changes in how we think, feel, and behave. When we started developing 1step2life, I brought my training as a developmental psychologist and my experience as the mother a teen living with chronic pain.

Most apps designed for people in chronic pain – in fact most rehab programs – improve health and reduce pain by asking you to do things that are difficult now so that things will be better in the future.

For example:

  • Follow a strict diet
  • Do these exercises
  • Go to work, even though you’re in pain.

These guidelines are based on good rehabilitation science – we know that diet, exercise, and activity all reduce pain over the long haul.

But they’re not based on good psychological science – particularly not good developmental science.

Why? Because they focus on harm avoidance rather than reward and because they ask you to do things that are hard NOW for a better tomorrow. In other words, short term pain for long term gain.

1step2life uses short term rewards to facilitate long term change.

Using the science of risk to motivate behavior

1step2life focuses on short term reward rather than reducing harm over the long haul.

It’s based on the dual-systems model of risk taking developed by Laurence Steinberg, first winner of the Jacobs award for “groundbreaking contributions to the improvement of the living condition”.

Steinberg has spent his career studying adolescents. His early work focused on the family— —how teens renegotiate family relations during the pubertal transition (kids win, moms lose) and then on to parents’ continuing role in adolescents’ lives. His textbook, Adolescence, was the first in the field. It continues to influence generations of students who will go on to become healthcare workers, lawyers, and educators and whose ideas about teenagers will be based on facts, not stereotypes. I highly recommend his book, You & Your Adolescent.

More recently, Steinberg has focused his attention on adolescent risk-taking, integrating his background in human development and family studies with neuroscience and brain imagining techniques.

Teenagers are risk takers

Although teens are typically healthier than either children or adults, they wind up in the hospital a lot. Why? Risk. They crash cars because they’re drunk or drive too fast. They shoot each other. They take foolish risks texting and riding bicycles.

Teens do dumb things.

But they’re not stupid. Study after study has shown that adolescents are AWARE of risks. If anything they are more aware of risk than adults are (probably because we keep warning them about danger) and overestimate the negative consequences of their actions.

Why then, do teens make so many bad decisions?  

It’s all in their brains.

In Age Differences in Sensation Seeking and Impulsivity as Indexed by Behavior and Self-Report: Evidence for a Dual Systems Model, Steinberg and colleagues argue that the different growth speed of two areas of the brain creates a perfect storm for risky behavior.

Their argument is straightforward. Sensation seeking—taking pleasure in strong positive experiences —is situated in two brain areas: the ventral striatum and the orbitofrontal cortex, both of which process incentives. Impulse control—what keeps us from acting prematurely—is situated in the lateral prefrontal cortex. Although both are involved in risk-taking, they aren’t the same. Steinberg’s analogy: people waiting in a long line at Disney World to take a roller coaster are high in sensation seeking (leading them to seek out risk) but also high in impulse control (which should help them avoid risk).

Although both areas of the brain change from childhood to adulthood, they don’t change at the same speed. 

  • The incentive processing centers become sensitized right after puberty, making adolescents take much more pleasure out of rewards.  This leads them to experience risk as relatively more pleasurable. 
  • The impulse control centers of the brain develop more slowly over time and are still developing in early adulthood.  This is the part of the brain that keeps you from doing risky things before you think through the consequences.

Too much accelerator, not enough brake

During most of the teen years, this creates a problem. Risky behaviors feel great and are experienced as more rewarding.  Impulse control hasn’t yet caught up—nor have knowledge and judgment. Thus emotion says go, but wisdom hasn’t yet said stop.

How science changed my parenting – and was inherent to the development of 1step2life

There are important take-home messages here for risktaking, social policy, and our understanding of teens.

But the first thing I took home from this reading had to do with my parenting. TEENS ARE MOTIVATED BY PLEASURE, NOT BY PAIN.

Thus telling a 13 year old that he will fail a test tomorrow if he doesn’t study isn’t that effective in inducing willing compliance. He knows that. But risk avoidance is not emotionally motivating. And that video game sure is.

Reminding a 13 year old how good it feels to accomplish something, how happy he’ll be when it’s done, and how much more time he will have to play if he studies efficiently works a lot better. Those activate their incentive processing center. And teens are VERY sensitive to pleasure.

So I tried it.

I stopped reminding my son of all the negative consequences of not doing what he was supposed to.

I consistently pointed out how good it felt to do the right thing. Every positive I could think of.

Science worked. He became less anxious. His work improved. We’ve gotten along better. And he’s taking more making good choices.

And you know what? I feel better too. I can be motivated by reward as well.

What does this have to do with 1step2life?

1step2life focuses on logging positive steps you take. Why? Because doing them feels good. Taking a shower. Texting a friend. Even a little bit of cleaning is a short term reward that maybe – just maybe – it might be worth getting motivated for.

Not a teenager? It doesn’t matter. Research has shown that almost all people find working for a short term reward is more attractive than long term harm avoidance. It’s one of the reasons it’s so hard to save for vacation or stick to a diet.

By keeping your long term goals in mind with the Weekly Check In, then rewarding yourself by logging your success with the Daily Check In, you take many short steps that make you happy today.

Just as my son would often drag himself out the door to school. Not because of a long term fear of not graduating. Not because he was hoping that getting up and out would reduce his pain long term. But because he wanted to see his friends at lunch and because he really liked his social studies teacher.

Caregiver Mode

You’ll also see this reward centered approach in the Caregiver checklists. Complimenting, sharing, having fun together – all of these are positive rewarding experiences. And the sense of accomplishment that comes when people gain autonomy within the context of a positive, rewarding relationship is as well.


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(c) 2020