Psychiatry & Psychotherapy Podcast - The Big Five: Conscientiousness Part 2

Episode Date: October 22, 2020

In Conscientiousness Part 1 we explored the sub-facets of conscientiousness, summarizing the advantages and disadvantages of each. For completeness, we will provide sources for that material as well as brief summaries of those sources. Today, in Part 2, we will focus largely on conscientiousness in daily life, psychopathology, and therapy. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast? Go to Psychiatrypodcast.com. Sign up, sign in, take the test, and the certification is email to you in seconds.

All right, welcome back to the podcast. this is a facet of the Big Five personality types, just as review, the Big Five extroversion, which is gregariousness, enthusiasm, assertiveness. Another one is neuroticism, which is anxiety, impulsivity, anger, those types of issues. Agreeableness, people high in agreeableness are more compassionate, polite, maternal, and orientation. Then there's openness to experience. They like abstract ideas. They're moved by art and music. And then conscientiousness, which is orderliness, industriousness. And remember from part one that there are different components, one is competence, good judgment, keeps informed and makes intelligent decisions. The second one is order,

likes things in place, picky about how jobs should be done. The next component is dutyfulness, attends work and school even when feeling under the weather, pays debts quickly, does jobs carefully, performs tasks. Conscientiously, the next one is achievement striving, which is clear about goals,

works towards goals in an orderly way, strives to achieve and be excellent in what they do. The next one is self-discipline. which is paces oneself well to meet deadlines, possesses self-discipline, and finally, deliberation, rarely makes decisions and hastes always considers consequences, plans trips carefully, thinks twice before answering. So Alexis, welcome to the podcast again. Thanks for having me.

So we left off kind of talking about the mix of environment and genetics and, you know, how much does someone have a choice maybe in being conscientious? I was just listening to a podcast or YouTube this morning. And this guy was talking about how he adopted Dave Ramsey's financial principles and how he got out of debt and how he lived really weird. Like he sold things. This was someone who's not making a lot of money, who was in a lot of debt. And they just completely, as a couple, changed their lifestyle.

I would say they became conscientious. And so sometimes ideas and beliefs and the way that we decide to live can change maybe how we might reply to some of these questions and conscientiousness. So let's start talking about goal-oriented behavior. So tell me a little bit about what you found here. Okay. So when we look at how people with high conscientiousness, our high conscientious nature act, they're really, their behavior is really driven by personal goals. So some people, you know, like

the Ramsey, might want to really start working on their finances and they do a lot of research and get going on that. And there's some people that really want to strive in academics and they go all the way with a PhD in physiology or there's some people that, you know, or medicine. Yeah. They get through medicine. Yep. And there's, there's even people that, you know, really want to end up in Hollywood one day and start acting when they're five years old. And maybe they make huge sacrifices, right? They work at a Starbucks during the day and they go to every audition they can. You know, if you listen to pretty much anyone who's made it, they had so many failures.

Yeah. You know, yeah. So goal-oriented. Yep. So kind of how this relates to people that are in the workforce. right? There's actually a study done by Barrick, and the study is called conscientiousness and performance of sales representatives. So they actually did personality testing of people in an office, and they looked at how these people function and how their endpoint for their goals

were written regarding to the workplace. So they found that can-do performance components are primarily related to measures of ability, declarative knowledge, procedural knowledge, and skills. On the other hand, will-do performance components are best predicted by measures of personality, particularly components of conscientiousness, interests, and reward preferences. So basically, this study found that cognitive ability is associated with supervisory ratings of performance, primarily through the mediating effect of job knowledge rather than motivational variables.

Okay, say that again. Like, what does that really mean? So the people who are higher conscientious, what, did they perform better? Yeah, so basically what this is getting around to is that conscientious individuals can be expected to perform better because they set goals, which directs their effort. They exert more effort to achieve difficult, challenging goals,

and they're more committed to exert effort to pursue those goals for a longer time period. Yeah, so the, they look at, looked at the intercorrelation matrix of conscientiousness specifically in terms of goal setting, it was 0.39, goal commitment, 0.35, sales volume, 0.21, supervisory rating of job performance, 0.29, all of those statistically significant. Whereas if you look at other things like extroversion, you know, which is gregariousness and outgoingness and stuff, they did. did not have a better sales volume or supervisor rating.

And if you look at emotional stability, which is like the neuroticism, they actually did not have any improvement in sales volume or supervisory rating. If you look at agreeableness, they too also did not have any increase in sales volume and no statistically significant improvement in job performance. So conscientiousness for the win. Right. And they kind of boiled it down to really important aspects of this study, right? So at the end of the day, they were able to see that conscientious individuals were 15% more likely to have set prior goals, 12% more likely to commit set goals, 4% higher increase in sales volume compared to those not high in conscientiousness, and about 8% higher likelihood of receiving higher supervisory ratings of job performance versus those who didn't score high in conscientiousness.

Okay. Yeah, let's talk about industriousness and orderliness. So what do we know about people who are high conscientious in terms of those things? Okay, so when we talk about industrious, we talk about people that are hardworking, attentive, and focus. They really like things in their places. They don't want things out of place. And they're concerned with preserving the integrity of the borders between things. So maybe this could mean even, you know, during meals, you don't really want your mashed potatoes and green beans to be touching. It kind of like does something to your brain. Are you like that? Sometimes. Yeah. Okay. So interestingly, orderliness appears to be associated with disgust sensitivity. It's not a huge correlation, but it's there. Yeah, what do you think about that?

This is super interesting. So I was weirded out by this honestly because it seems so carnal of a characteristic to have disgust around you know different aspects of your life and I actually listened to a lot of podcasts and YouTube's by Jordan Peterson who is controversial but he has some good stuff around this this is his this is his area of research expertise personality theory yeah yeah so go ahead So this kind of dates back to a really long time ago where we can first start noticing this disgust. Orderliness is associated with what's called the behavioral immune system. And this probably is elevated in geographical areas where infectious disease is prevalent.

What is a behavioral immune system? What does that mean? Yeah. So pretty much there's actions and behaviors around us in our community, in our life, that put off red flags. in people with high conscientiousness as something they don't want to go towards. So this is actually really seen in people with politics. Conscientistness is actually correlated with very high conservatism. So people that are very, very conservative want things to stay in a certain way and in a way that's always been. So that might correlate, you know, I don't believe in abortion because it's always been dated that human life is valuable. and human life begins at X date.

So that's what I believe because that's a moral construct of behavior that's been... Right, and also just the disgust of a child dying. Right. And if, you know, people who tend to be pro-life see, you know, the fetus as the child. And that is...

There's a primary revulsion of disgust towards several things. Bodily fluids is one of them. Blood. and that's, you know, that's why sometimes people get a little faint when they're starting surgery. Yeah. You know, the harm of children. So, okay, yeah, what else did you find out about this?

This specific study we're looking at is Zoo, 2019, which actually Jordan Peterson was a co-author on, but not the first author. It's called an orderly personality partially explains the last. link between trade disgust and political conservatism. Yeah. So the primary hypothesis of this paper was that disgust-sensitive individuals would be higher in orderliness in order to reduce said disgust. And this predisposes people to endorse belief systems that promote an orderly society. So kind of like we were talking before for people that tend to lean more conservative.

And across six samples, participants were measured in traits of disgust. trait personality and political orientation. And they can measure this with the revised discuss scale. And this measures 25 items and three trait discuss subscales of core, animal reminder, and contamination discussed. So when we look at the trait personality, we're measuring the big five personality, as we mentioned in podcast one. And then for political orientation, this study used the IPIP liberalism scale.

Realism scale, yeah, okay. And the right-wing authoritarianism scale. Yep. So when we correlate all three of these aspects, we find that evidence shows that orderliness most consistently mediated the relationship between contamination, pathogen, and sexual disgust and conservatism. So this suggests that conservatism may serve as a disease avoidance strategy, and then orderliness provides a clean environment with fewer hiding places for these pathogens. You know, I think it's worthy to note that some of these correlations are around like 0.22.

The link between orderliness and the composite PO score or the political orientation score is 0.13. Discussed is linked to the political orientation point 2.1. So these aren't incredibly strong links, but they're there. What I thought was super interesting, just even taking it back to the pathogen-oriented, I was listening to Jordan Peterson, and he was basically saying, you know, they did hand washing techniques at liberal versus, you know, Republican conventions. And they found that people that attend Republican conventions wash their hands like five times more with the hand sanitizer stations than do Democrats. That's interesting. That's very interesting. Okay, so let's keep going.

Tell me a little bit about the behavioral immune system. Do you have anything more that you want to add to that? Yeah, so the behavioral immune system is made up of adaptive psychological response mechanisms that are sensitive to cues that might predict presence of infectious pathogens. And then you respond with appropriate cognitive processing and effective reactions. So in social terms, an important component of the parasite stress hypothesis is that high levels of infection may lead to ethnocentrism, xenophobia, distress of different others, and conformity, because adapting such behaviors will reduce the likelihood

of exposure to unfamiliar infections to which immunity hasn't been developed yet. Okay, so what you're saying is that it's possible that this sort of person with heightened conscientiousness would be more afraid of the other. Right. Because the other might contain some disease that would literally eradicate your society, right? Yeah. And it's not like this hasn't happened in history.

You know, when Spanish settlers came over to South America, when people came over, you know, people came over from Europe to North America, huge groups of people died of viruses that they had not adapted to yet. So there is a cost of, you know, integrating different cultures. And so what you're saying is that maybe there's this sort of behavioral immune system, behavioral meaning your behaviors protect your immune system, which are not completely conscious, conscious. Like we're not, it's not like people are thinking consciously,

okay, I'm going to have xenophobia to protect myself from a viral infection that may eradicate my family. Yeah. Okay. Super interesting. Interesting. Well, and I think that's helpful actually in the time that we're in, right? Because a lot of us have questions like why do some people have implicit bias or implicit racism?

And potentially this is one explanation for like why tribes, why there's in groups and out groups, right? And why there's the other and why there's some natural sort of base, maybe unconscious drivers there. Not that I would argue that, I don't know if I would say globally that's there, but I would say maybe there's a bell curve, right? And that some people are further along on the bell curve of disgust. And maybe that sort of revs up that behavioral immune system in different ways. Okay, let's move on to this article on the facet scales for agreeableness and conscientiousness, which kind of proved that orderliness and industrialism is actually

a construct of conscientiousness. Right. So conscientiousness is described as having both proactive and inhibitive aspects. So when we talk about the proactive, we're talking about traits as need for achievement and committed to work. And then when we talk about inhibitive, these are the traits as moral scrupulousness and cautiousness. So this study used the NEO PIR, which we talked about in podcast one, that huge 240 question assessment, and the abridged big five. circumplex scales from the international personality item pool. So they used questions from both of these scales, and then they correlated them together, which suggested two primary subdomains, and this was the industriousness and the orderliness.

So they came up with ten items for each of the ten scales, and the study reported that there was a demonstration in the level of organization and personality between these two facets and the broader conscientious domains. So factor analysis indicated that each big five domain is divisible into two correlated aspects, which are the orderliness and the industriousness. Yeah, so they're both sort of in the big umbrella of consciousness. You know, if you have a ton of fish and they're all swimming in different directions, the orderliness, the conscientiousness or the orderliness and industrialism, right,

are relatively swimming the same direction in the sort of umbrella of conscientiousness. So let's talk about the advantages and the disadvantages of being high conscientiousness. So let's talk first about the advantages. Okay, so conscientiousness is important in a relevant term, right? Because it kind of drives us to get things done. It helps us achieve our goals. It helps us be less distracted. So accumulation of all these positive outcomes.

results in conscientious people being happier. So it's important to understand that conscientious individuals oftentimes can live healthy, wealthy, and happy lives just because they're able to self-regulate to meet their goals. So people that are high in conscientiousness have a tendency to invest in their future, similar to how somebody would invest money instead of letting it burn a hole in your pocket, you know, so they can kind of say, okay, what do I need to do now in preparation? for a happy, healthy future later? And what can I spend time on now just because of, you know, temporary happiness? So that might be somebody that's going to med school and being in college and

saying, oh, shoot, all my friends are going out. But I really have a chemistry test I need to do well in tomorrow. All right. I'll sacrifice going out with my friends to get that A or B in chemistry so that I can be ready to apply competitively to medical school so I can be a doctor. So it's kind of just that really very forward-thinking. Willing to suffer and willing to give up things temporarily. Right. I mean, it's the same thing as having a budget, right? Yeah.

And saving for retirement and, you know, thinking about, like, I'll give the example of saving for retirement. If you understand how compounding interest works, you know, know, like, you will want to put away money every month into your 401K. You'll want to max it out. You want to max out maybe your IRA. And you'll know that in 30 or 40 years, if you invest those in index funds and things like the, you know, the 500 biggest companies out there, like the SP 500 index funds, you'll know that those things in general increase over, you know, decades.

And so you'll invest in those and you'll get the reward. But if you're super low in conscientious, you may be looking for the sort of the pleasure in the moment, right? So you may spend that money on more meals, more time out, more adventures. And then, you know, there's advantages of both, right? But I was saying in general, my personality is much more conscientious. Like I've always been thinking about, you know, what's five, ten years from now. You know, when I was in undergrad, I used to read the textbooks on the way to the rowing boathouse, which was like 30 minutes.

So I'd always study 30 minutes there, 30 minutes back. I'd study on the weekends. Like, I've just always been very conscientious. You know, I missed out on maybe some normal college experiences because of that. But that was just how my brain works, you know. And, you know, maybe that was informed by different jobs. situations I had early on in life too, where I was like, you know, I don't want to change light bulbs the rest of my life. Eight hours a day, there's nothing wrong with people who do that, but that wasn't something that I wanted to do.

And that kind of motivated me to keep sort of investing instead eight hours a day into studying, right? So there's that sort of cumulative, you know, engagement across decades. It's a different mindset. It's a different way of thinking about things. What about there's this one study that looked at, are they more empathic towards other people? Yeah, so this is actually a recent city in 2016. And the way that the study was constructed, they had individuals undergo the Big Five personality test. And then they correlated that with the empathy quotient or EQ and the interpersonal reactivity index or IRA.

And this study really wanted to address whether the Big Five personality model is associated with empathy. empathy, and then they wanted to invest the effect on culture on the association between personality and empathy by using the set of questionnaires across lots of different samples. So they did patients in, or people in Germany, China, Spain, and the USA. So they used the ANOVA, the analysis of variance, to check for associations of empathies to age and gender in all samples. And then they found that for EQU or emotional quotes, that conscientiousness is really important. It accounts for 8% explanation of variance. So next to agreeableness, which we'll talk about, you know, in a future podcast, conscientiousness is the second

personality dimension with a bigger predictive value for empathy. So here, the association may be explained by the negative relation of conscientiousness to psychoticism, which is defined by a lack of empathy. And then this relationship between psychoticism and empathy in turn can be explained by the lack of concern for others as well as egocentricity, which are both among the significant features of psychoticism, which is opposite of conscientiousness. Psychopathy. Psychopathy, yeah. That's interesting.

Because usually it's those that people are antisocial, you know, people who are like the psychopathic, they have that lower affective empathy. And they also tend to be lower in conscientiousness because conscientious people are planning, they're orchestrating, orderly. They're very scrupulous morally, right? Whereas if you're super low conscientiousness, you may have less of a sort of a guilt complex in there, right, that drives your,

you acting in a way that helps society. So interesting. Yeah, and the correlation is actually pretty strong between the empathy quotient and conscientiousness. It's 0.4. So 0.4. And with, the other things like perspective taking, it's 0.24. Whereas if you look at, and it's also high in agreeableness, empathy quotient is high with agreeableness, 0.46, so even a little bit stronger than conscientiousness. With openness, 0.24, so not as strong. Neuroticism, negative.

0.1.9. Extroversion, 0.3.0.3. so it's it's a little bit correlated with extraversion, but the most with conscientiousness and agreeableness. Agreeableness, I would have suspected. I would not have suspected conscientiousness until I saw this paper. Yeah.

So good find. Okay. Let's keep going. What about some of the disadvantages to conscientiousness? Okay. So it's pretty easy to kind of pan out how both of these things, you know, way too much empathy in others, way to, you know, spending a lot of time on work, spending a lot of time on future-oriented behavior. This can get out of hand pretty

quickly if you don't set boundaries for yourself. So I would say the top two most important disadvantages are perfectionism and workaholism. And then what's super interesting is that there's also greater drops in life satisfaction following unemployment. And that's something we can pretty much expect, right? Because you work your whole life to get to this attainable goal of reaching, you know, CEO of your company or a doctor. And all of a sudden, you don't have that and you're sitting at home. I had this doctor patient years ago. And he got let go of his job. He got let go. And it was devastating for him. He was high conscientious. You know, someone who was doing research, working hard, you know, these people at this level,

80 hours a week is pretty normal. Okay. And so him getting let go was just this huge blow. And this makes kind of, it gives it a nice perspective for me when I read this. There is a huge drop, especially when employment, your aspiration, your goal, Right. The thing that you've been working towards is blown apart. I see that in medical students as well when they fail a test, when they fail step one. It's like they've been working so hard to get to this point.

And then they have test anxiety. So I did a whole episode on the US Emily, Step 1 recently. It's because it's such a weighty thing. Right. If, you know, and if you're high conscientious, it's like you can't control to some degree how weighty you're going to feel that. You know? Yeah. So I guess like the follow-up question would be, where does this come from?

Where does this pit of despair come from, right? And maybe it's that unemployment or failure might represent a chronic blocking of an important goal, which can lead to decrease well-being. It could be that, you know, being unemployed or going through a failure can remove opportunities to gain emotional benefits. Maybe you get a hit of dopamine every single time you hit a checkmark on your to-do list. Or you feel really awesome when you get an appraisal from your boss saying, hey, you're doing an amazing job. And that's not something that you benefit from anymore. Or it could even be, you know, people high in conscientiousness attribute their failure to their own lack of ability. I can almost guarantee the listeners who are actually listening at this point, you're probably high in conscientious.

First of all, to listen to something that's very detailed, right? Like, if you're in psychiatry, if you're in psychotherapy, you can, and you're not high in consciousness, you're probably not pursuing further education to the degree that you, my listener, are pursuing. And so, yeah, I just want to add that in there. But oh, I was thinking about myself here because I think I get totally motivated when I, you know, people sign up for the resource library. They leave the nicest notes, you know, and this one person recently left this note that, you know, she had really enjoyed listening for the small moments like the bell chime with Dr. Cummings, like these little, what do you call them when you see them in the movie? They're like these, hold on, I got to pull this. I got to pull this up. This was classic.

Okay. this was Kimberly Vilt, a psychiatric RN and an N.P. student graduating soon. This letter was probably one of the nice ones. It said, first of all, I love your podcast, listen enthusiastically for the small Easter eggs, like the clock chimes and episodes featuring Dr. Cummings. And she goes on. She says, I've downloaded the Emotion Connection app and improved my skills in reading microexpression. I found it incredibly helpful to begin to understand my patients.

Anyways, it was a very nice note. It went on like paragraphs. But that kind of like, I think for me as a conscientious person, I'm like, okay, I'm helping one person. Yeah. Someone appreciates it out there, you know? Okay. Yeah, so going back to this unemployment study, I found the statistic to be crazy. Okay.

So in a four-year longitudinal study of almost 10,000. people interviewed, it was found that the drop in an individual's life satisfaction following unemployment was significantly moderated by their conscientiousness so much so that they experienced a 120% higher decrease in life satisfaction than those that did not have levels of high conscientiousness. Yep. And I hope if you're listening to this and you do therapy and you have like a super high conscientious person in front of you and you're not high conscientiousness, like understand

why this would be so devastating. And I think giving that empathy to them might sound like this. Hey, you value work. You value moving forward in your career. And it would be so hard, devastating to lose that ability, even for this period of time of six months. And so I could see why you would get down on yourself, you know? And the other thing you might not understand if you're not high conscientious, or as high as the person sitting across from you, is just how important career is going to be for them, like for their happiness, right? And I think different people are going to have different levels of happiness that comes from career, you know?

Anything else on this study? Not on that one, no. The other thing is that they may fare poorly under conditions of high stress. So what do you mean by that? So basically this correlates to pathological states of every single facet we talked about. So if you have somebody that is dealing with a lot of stress, they're in a time of their life where they feel like they don't have a lot of control, they can really sort of fall back on their personality traits to try and gain traction when it comes to any forward movement of their goals that they feel like they're not meeting. So extremely conscientious individuals engage in obsessive-compulsive behavior, which would mean they experience a greater negative effect, react more poorly to negative performance feedback, and have more adverse reactions to negative life events. They perform more poorly at work, than their moderate counterparts.

So it seems as if the foundation is in trouble, the foundation of their conscientiousness also gets a little bit shaky. So this is talking about the extreme, right? So the extreme being someone with obsessive, compulsive personality disorder, specifically, not OCD. So OCD, you know, you have like an obsession, like I need to wash my hand, you have a compulsion, I'm going to go wash my hand. OCPD is like conscientious is taken to the extreme, right? So they may not be able to get started in the morning unless all of their, you know, to-do lists are organized. And, you know, it's like it's the, it's like when orderliness takes such a level that it actually gets in the way of getting things done.

Yeah. So somebody that's struggling with these aspects of personality, competence can turn into perfectionism. orderliness can turn into an obsession with cleanliness and order. Dutifulness can turn into obsession with attaining moral behavior standards, such as they can never fail, they can never be wrong, they can never bend the rules, not even a little bit, not even if it's beneficial. Achievement motivation can turn into workaholism, an obsession with achievement and perfection and work-related tasks such as joggedness, single-mindedness, somebody that has very rigid mindset and consciousness can turn into a ruminative, ruminative deliberation. A ruminative deliberation where they overthink and stall about every single action that's going through their mind because they want to avoid unwanted or uncertain outcomes. Yeah, there's a lot there.

And I think this is, I'm thinking about myself and my own journey here, definitely struggles to some, perfectionism and that stopped me from being creative actually like starting the podcast sat on the gear for a long time i think it was about a year before i actually released one episode and part of it was i would record things and i didn't think it was good enough and so if you're listening to this and you're highly conscientious and you're also struggling with getting started in some dream passion project or whatever this is this is actually a good area to get some help help with yeah and i think that this is something that's really, really common,

right? What I thought was super interesting is during the second year of medical school before we start board setting, we start preparing for step one, we're really getting into the thick of medical school. Lowell and it is actually really cool, and they have us complete this mental assessment, right, just to kind of see where we're at,

if there's any sort of areas that we could be struggling in so that we can get help preemptively before it gets out. And pretty much all of my friends, my friends got their performance report back, and it said, hey, you need to worry about perfectionism. And everybody was freaking out. They said, oh, no. It was just so funny because pretty much every single medical student that took this test got a red flag for perfectionism. Interesting. Yeah. I mean, it's like it's hard to get into medical school if you're not high conscientious, right? So then this is kind of like, it's like when I meet a medical student,

I know that they're going to have certain issues, right? Third year especially. Issues of there is no way to be perfect third year because you're on a new rotation. You don't know much at all and you're expected to know a lot. Like OBGYN was that rotation for me. It's a whole new world. It's like a whole new world.

It's like you can be competent in medicine. You can understand high blood pressure, fluid balance, renal stuff. You go on to OB and it's like, what is going on. And you're not, you don't get a lot of lectures on it before. And so it's like one of the, it was that, it was that rotation for me. Yeah. Where I was totally out of my, I was like on Mars.

I was like, what am I doing here? And then, you know, at the end of six weeks, you're feeling a little bit more comfortable. You kind of know what's going on and you go onto another rotation. Right. And you have to start this process all over again. And you started over and over again. And then, you know, you get some feedback from residents, which are, and attendings, which is like, you don't know what you're talking about.

You got to, like, work harder. And that feedback just kind of like eats into you if you're, if you have any perfectionism at all. So I definitely struggle with this, and that's probably a huge shocker to all of you with how high my scorings are. And I just remember going through third year last year. And at the end of every rotation, you get a final eval, right? And anybody in medical school knows, you can get. get a one, a two, a three, a four, or a five. And straight threes, you're doing pretty good. You're doing

pretty good. So, but none of us wanted straight threes, right? We wanted fours and fives because that would mean you're the top 99% of your cohort. So I just remember there was so many times last year where I would get straight threes after working my butt off for six weeks, six weeks, and I would go home and cry. Literally, I would cry for getting an average score because I felt like I could have gotten a five if I tried harder. Well, I'm glad that you're able to do this project with me and I can give you a five, Alexis, because your digging here was amazing and phenomenal. And yeah, I just love to tell medical students they're doing awesome. So you're doing awesome. Okay.

Yeah, anything else you want to do. wanted to pull out from, let's see, we're on page like 13 of 44. Oh, man. There's just a lot of graphs. So there's one table that I really like out of this paper in particular, looking at dutyfulness and punctiliousness, punctiliousness as an obsession of attaining moral behavior standards. So what you find is that as dutyfulness goes up, one standard deviation, two standard aviation, three standard deviations, all of a sudden, it's not like a linear relationship. It's more like a, the slope starts to increase, right? So why that's important is because, you know, as the slope increases, now your punctiliousness is going up and up and up, standard deviations as well.

We don't always look at a linear relationship for how things are modeled correctly. So if you look at the data, it's a linear relationship, which is like the, the association is not going to be the most accurate thing to represent this. It's going to be like, it's more like a, um, this, the slope starts to go down a little bit and then it starts to curve up and then it curves up faster and faster. So this is what we're talking about. As you get into the extremes of conscientiousness, the difficulty of maybe obtaining moral behavior standards for yourself goes way up and it's much more difficult. So a little bit may be good. A lot may lead to a lot of guilt. So with this sort of big picture of high conscientiousness people having a moral

scrupulosity or increased punitiveness maybe with moral things, we have guilt, right? Guilt being the main emotion. I think you found a great article, Faire 2012, that talked about this. tell me about just their like results, what they found. So when it comes to guilt, conscientiousness showed a significant relationship to measures of guilt proneness with a correlation of negative 2.1 and the experience of guilt with a correlation of negative 0.32. So in general, conscientious individuals experienced less guilt on average, yet they're also prone to experience guilt if they commit some sort of transgression. Oh man. It's like when I'm reading this, I'm reading about myself.

Yeah. It's like this one time I was switching my insurance. And I knew that if I reported that I had a speeding ticket, that I would have to pay more for my insurance, right? So I called my old insurance and they hadn't. And just to let you know, like, how this weighed on me. Like I was up several nights really bothered by this sort of moral conundrum. Do I report the ticket or do I not report the ticket? Part of me did not want to report the ticket to not have to pay increase, but then they ask you, you know, if you have any tickets. So I wanted to report it. Yeah.

Right. And just I'll leave that story there. I mean, the ending of the story is kind of funny. I end up calling the first insurance that I already had and they had not got in the report. so I made sure that they knew that I actually had got a ticket. And the lady that I was on the phone with was like, dear, you're so cute. It's okay. I'm not going to put in anything there.

And I was like, no, you need to because I got a ticket. I should be charged more. And like for me at that point, you know, like it was like weighing on me. And she's like, dear, you're so cute. So what does a high conscientious person look like? How do they interact, talk, relate? You found one study that looked kind of at some interesting correlations. Right.

Talk to me about this study. So this is such a random list, right? But they really focused in on these extra characteristics that people with high conscientiousness do. So people that are. are high in conscientiousness are less likely to discuss sexual matters with male friends. They are less likely to lounge around the house without any clothes on. Wait, wait, wait. The sexual matters with a male friend. I would also say that that's probably also something, like they would be less likely to talk about sexual matters with their therapist

or psychiatrist as well, like even if it's going on, right? Which is why we need to bring it up. like, hey, did you have any decreased libido with that SSRI, any sexual issues? And the shame is just right there, right? Higher shame. Okay, keep you on. Yep. And they were less likely to lounge around the house without any clothes on. They were less likely to be picked up by a hitchhiker,

less likely to read tabloid papers, less likely to drive or ride around in a car without a seatbelt on, less likely to swear, less likely to spend an hour at a time daydreaming. That's funny. They were less likely to shop at secondhand thrift stores. Disgusting. Less likely to tell dirty jokes, but more likely to listen to music. You know, I have my list of interview questions. Yeah. Do you ever lounge around your house without any clothes on? I don't know if that would go over very well.

It would go horrible. Are you kidding me? It's a joke. Have you ever picked up a hitchhiker? Do you read a tabloid paper? Do you ever read the tabloid paper? That's hilarious. So what do we know about brain studies?

I know they've done some brain studies, and they've found that the brains of those who were more conscientious had a thicker cortex and a smaller area and folding in the prefrontal region. This is a really cool article. I got super excited about this when I found it. So this is an article by Richelli done in 2017 in the cognitive and effective neuroscience journal. And so they took MRI scans from healthy adults and they all also underwent the NEO5 personalities test that we talked about in podcast one. So at the end of looking at their MRIs and looking at their testing scores from the Big Five, they found that conscientious individuals were characterized by higher cortical

thickness in the prefrontal cortex, as well as lower surface area and cortical volume in the middle and inferior temporal gyrus and lateral occipital gyrus. So people scoring high in conscientious showed lower cortical folding in the superior prefrontal cortex, superior temporal gyrus, fusiform cortex, and lateral occipital gyrus. So this basically goes to say, that conscientious individuals may have a more efficient or at least different functioning executive control system. Right. And I'm not surprised by this.

It's really cool. Yeah. It's cool that it's like people are literally studying all sorts of stuff, trying to understand this, right? And this helps me understand it to some degree. Your frontal lobe is your planning system, right? The dorsolateral prefrontal cortex is where you're planning, orchestrating, working memory.

You know, this is all frontal lobe function, right? And coming back to what we learned about in the first episode, that conscientious has to do with parenting styles. More loving parents were associated with more conscientious, right? And so, like, part of emotional regulation and part of, you know, sort of developing that frontal lobe is that warmth that they're getting from their parents. And so here you have it.

a study that shows this connection. Very cool. Yeah. And so also because of the areas of the brain involved, right, the prefrontal cortex and the temporal gyrus, it's also possible that conscientious people are able or just more willing or have a better process to fall back on to inhibit short-term pleasure seeking and other types of impulsive responses as a function of their anatomical variability in cortical structures. Yep. And the other cool part about this is that we know that this is not purely genetic, right? It's only like around 40% genetic.

So a lot of this is the environment literally changing the brain, right? The environment of not only the parenting in the early environment, but also the choices that people are making changes the brain over time. if you go to my strength training, when I talk about how strength training causes a delay in the natural sort of deterioration of the brain. Or, you know, we lose so much brain per year as we get older. And strength training uniquely causes that to sort of freeze and not have that decline, at least in one study.

So that being said, like we can make choices to strengthen these areas of our brain. I think that couple that went on that budget, They subjected themselves to months and months of something, like planning, like they had increased meaning. They sat down and they organized their life. And that changes the brain, right? That changes the very nature of the brain. And we know this because meditation studies also show that meditation increases different areas of the brain, thickens certain areas.

And so there are practices that we can do that change the brain. That's really cool. Psychotherapy changed the brain. There's a bunch of studies on that. So when we're looking at this, we're not, I'm moving away from just a purely like, this is purely genetic and there's nothing you can do about it, right? Because I want you to believe that you can change your brain, right? There's a whole book on like, you can change your brain.

You know, if you pick up an instrument, you develop certain areas of your brain more and more over time. If you practice things, if you practice things over and over again, you're practicing and rewiring your brain. I think we can rewire how empathic we are by by practicing empathic stances. So try to practice empathy towards your political opposition this November. Good luck with that. But it's a good, it's a good practice. Honestly, like looking at both perspectives, right? And some people would say, I'm not going to look at both perspectives. I'm only going to look at my perspective. And, you know, they're going to get in an echo chamber on YouTube of only their perspective that they're really into. And I would say, no, listen to both and then try to empathize with both. And good luck with that.

But do it as like a, do it as a practice, right? Okay. So let's talk a little bit more about what people with low conscientious look like. How do they interact, talk relate? Okay, so when we talk about somebody that scores low in conscientiousness, where most likely talking about people that are disorganized, engaged in impulsive behavior, procrastinators, so this means that they most often fail to meet interpersonal responsibilities and to control their temptations. And the most typical symptom procrastination is underperformance. So because of tendency to start late,

a procrastinator doesn't have enough time to perform at the level that their capacities would allow. So there was a study by Schroenberg and Grunewood in 2001 that found that procrastinators discount future reward to a larger extent than did vary and moderately punctual students or those high in conscientiousness. Nevertheless, time-related increases in both study motivation and resistance to social temptation didn't differ as a function of trait procrastination. So this suggested that procrastinators do not have motivational deficits and may not have more troubles resisting social temptations than others. Rather, the core issue might be situated in their problem in enacting their intentions. So the question I have is how correlated conscientious is with procrastination. And it is negative 0.69. That's pretty high.

It's pretty high. I think that some procrastinators are perfectionistic. Like, I think you can, if you're conscientious and perfectionistic, I think you can be procrastinating because you're so perfectionistic, but also an aspect of conscientious and just how they ask conscientious is like, do you do things on time? Right? Like, that's an actual question they have.

So in general, people who are highly conscientious do not procrastinate. And they pulled out four factors for potential procrastination from this study, right? So it could either be that there was a lack of perseverance. So they couldn't really facilitate what they really wanted to say, strongly related to conscientiousness and all of its facets. Basically, you know, if you don't have that goal-oriented behavior, that linear process of how this is going to look in the future, if you can't put the pieces together of what you want the final endpoint to look like, then that would be really. really hard to kind of pull through your whole project to get the end point that you want. The correlation between perseverance and conscientious is 0.64.

So it's people who are high consciousness are highly perseverant. And then you could also have a lack of premeditation. So this is strongly related to the deliberation facet of the conscientious dimension. Cool. Okay, so now let's talk a little bit about positive and negative correlations. Okay, so when we look at positive correlations for conscientiousness, we're going to be talking about areas of career success. So like we've discussed before, conscientiousness is manifested in three related facets, the achievement orientation, dependability, and orderliness. So you can kind of already see how this plays into a really good, sets you up to be successful in your job.

right? So you're hardworking, persistent, responsible and careful, planful, and organized. So this can be related to an individual's degree of self-control, as well as need for achievement order and persistence. So pretty much a predictor of success at work. Okay. Yeah. And if you look at the relationship between the Big Five traits and career success, neuroticism, childhood neuroticism is negative 0.22, whereas conscientiousness is 0.4, it's pretty high. It's the highest of them for career success. Openness to experience 0.2, childhood agreeableness,

didn't meet statistical significance. So the correlation between conscientious and job satisfaction was the most consistent result in this study. So the question also becomes, like, is there a longer lifespan in someone who is high conscientious? And interestingly, they looked at relative hazard ratios, and for some things like, you know, known biological risk, like systolic blood pressure

being really high or high serum cholesterol, you know, the hazard ratio is like 1.2, 1.3, basically. whereas for someone who is high or low conscientious, their relative hazard ratio is like 1.2. So it's around there with the risk of, you know, having high blood pressure or out of control lipids. Also interesting from this was that, do you know what's even more important is your social support,

including your marriage, quality of the marriage, your contact with friends and family, group membership. It was if you have really poor relationships, like if all those things are poor, no friends, poor marriage, you know, the hazard ratio ranges from 1.5 to 2. And I think about that in the context of this epidemic of suicidality that's going on right now in the world, 10% in a recent CDC study that I talked about in a prior podcast, up to 30% for unpaid caregivers, and around 23% I think for essential workers.

Meaning in the past, when they were asked, in the past month, have you had one suicidal thought? 30% of unpaid caregivers said yes. Okay, when I think about that, I think about this this really high hazard ratio with a lack of quality of relationships and just the world that we're living in right now it's just harder to have right if you're at home taking care of the kids working a job you know all the stresses of not being able to congregate right normally increases your risk of all-cause mortality, or an increase of that risk of just all those bad things that leads to the increased risk of all-cost mortality.

Really interesting study. Okay, there's another study that I think we should look at, Denev-1998, the happy personality, a meta-analysis of 137 personality traits in subjective wellbeing. What do they find in this study? Okay, so, So when we talk about the big five factors and how they correlate with subjective well-being,

it's found that neuroticism and conscientiousness are correlated most strongly with subjective well-being, neuroticism being negative 0.24 and conscientiousness being positive 0.22. Yeah. Not incredibly surprised, right? Like people who are high in neuroticism have a lot of negative emotion, or higher, you know, a lot more mood issues. People are high conscientious are striving forward. They've had, you know, they have lower levels of mood issues. So, okay.

There are also people high in consciousnesses are less likely to get involved in driving accidents. Can I submit my high consciousness to the insurance company to get a decrease in my insurance payment. Maybe it has something to do with that more likely to wear seatbelts. Yeah. So the results of this one study suggests that individuals who describe themselves as more self-disciplined, responsible, reliable, and dependable are less likely to be involved in driving accidents than those who describe themselves as lower in those attributes. Really cool. So I think that goes along with the general theme that we're talking about, that high conscientious people are careful, you know, maybe plan more and adhere to rules more as well, right? So let's talk about if you're

very, very high in conscientiousness, like what types of pathologies might those people have? Right. So this is when things go awry. So when people are so high in conscientiousness that it stops, that it starts affecting their functioning, we're going to be talking about areas of OCP, anorexia, depression, and guilt. So people high in conscientiousness have been given an attribution style that's related to clinical depression. So in Beck's theory of depression made in 1967, dysfunctional attitudes concerning the need to be perfect or gain others' approval are hypothesized to provide vulnerability to depression when people experience negative life events that impinge on these attitudes. And like we've talked about before, when we're kind of creeping

on the high end of conscientiousness, we're verging on perfectionism, we're verging on guilt. So when we take it one step further into psychopathology, if you're really ruminating on that need to be perfect and gain others' approval, that can make you susceptible to depression. So what we talked about earlier is that people with very, very high levels of conscientiousness can have OCPD. And there's another study that found that link. If you look at all the personality disorders and how they're linked to conscientiousness, the only one that is more likely is OCPD. Whereas you can get all of the other personality types, or not all, but there's a lot of other personality types that are negatively associated with high conscientiousness.

Probably the most strongly so are the antisocial and borderline precise order with negative correlations of like 0.26 and 0.23 respectively. But the OCPD, the link is a positive 0.23. So it is positively associated with conscientiousness. Whereas if you look at all of, of the mood issues in conscientiousness, all of them are negatively associated or have a negative effect size away from conscientiousness. So if someone's higher in consciousness, in general, they will have less depression, dyshthymia, general anxiety disorder. And the effect size

it around negative one for all of those things. Substance use all around negative one, social phobia negative one so that's really interesting now what we talked about before though was that if you are super high in it because the guilt may be high there are certain stressors in life that may push you into depression like losing a job and the OCPD that is also linked to the high conscientious whereas addiction you know substance use all of those things it's that if If you are low conscientious, you will be more likely to be prone to those with an effect size of one, which is a big effect size. It's a big effect size.

What about ADHD? If you have ADHD, are you more likely to be low in consciousness or high in conscientiousness? So we looked at the study done in 2002 by NIG, and they found mean correlations between ADHD scales and Big 5 self and spouse ratings across six samples. And they found that in regards to conscientiousness, there was a negative 0.58 correlation with attention problems and overall ADHD total of negative 0.38 correlation. Interestingly, the spouse, a spouse also rated the conscientious.

And it was a little bit lower of an association between the ADHD and the conscientious. negative 0.25 for ADHD total and negative 0.4 for attention problems. So I found that kind of interesting. And other things that were associated with ADHD included neuroticism, positive association 0.47, and agreeableness, negative association 0.41. That's interesting to me. So people with ADHD tended to be a little bit less agreeable, a little bit less conscientious, and a little bit more neurotic. All right. Well, we're going to pick up where we left off conscientiousness and psychopathology. I'm here with Maddie and Kyle.

They were part of the roundtable that you may remember from part one. They also were on several other episodes in the past. I'm kind of laughing over here because I had Maddie do two. on pedophilia to some degree. The sexualization of children. Sexualization of children, one on pedophilia. Kyle did one on strength training. I'm laughing because, like, I'm just, I'm like, oh gosh, did I scar your interview trail?

I'll be remembered. Like, oh, tell me about this interest. And you'd be like, well, actually. Okay. So conscientious is in psychopathology. who's going to start? Do you want to start it off, Mandy? Yeah.

The first thing, so the first thing that we looked at, yeah, is psychopathology and how conscientiousness is linked to different disorders, and we split them up into Axis 1 and Axis 2. So for Access 1, it seems like there's a pretty good link between conscientiousness and some of the different disorders. One of the quantitative reviews that we looked at showed association between higher order personality traits, specifically conscientiousness, with things like depression and anxiety and substance use disorders. And the effect size of this is pretty high. Yeah.

It's for MDD, it's 0.9. For GAD 1.13, these are a negative so that basically if you're lower conscientiousness, you're more likely to have, you know, these issues, more likely to have, if you're lower conscientious you're more likely to have PTSD 1.0 so that's one standard deviation right yeah it seems like the combination of high neuroticism low extraversion and low conscientiousness what were we reading mattie like yeah the triad of misery it's called the papers in one of the papers that we talk about in the therapy section he calls it the miserable triad oh gosh yeah yeah well I don't know if I would want to label that miserable.

Yeah. But if you feel miserable and you have all those, then maybe that would be empathic for you. Yeah. I don't know. Kind of squinting here. A higher rate of alcohol use, you know. So substance use is sort of 1.1. So if you're lower consciousness, more likely to use substances.

Mm-hmm. OCD even. 0.97. So lower consciousness is linked to more likely. to have OCD. All right, let's look at some of the personality disorders. It's pretty strongly linked to a couple of these. There's a really cool table here. We'll put it on the handout if you want to take a look at it. It's most linked to antisocial. Antisocial and obsessive compulsive personality disorder. There's actually a positive correlation.2.3. Right. So, okay. So if you are low conscientiousness,

you're more likely to be antisocial, more likely to be borderline, more likely to be dependent, personality disorder. These links are not as strong as what I was seen up above. So they're not as strongly linked as like the DSM or Access 1 type of disorders. So personality disorder is not as linked. but they're still like you know for antisocial 0.26 for borderline 0.23 and for the pendant 0.14 so that's those are the strongest linked ones and if you're high conscientiousness then you are more likely to be OCPD so obsessive compulsive personality disorder and that is a positive association of 0.23 is the only positive association. I thought that was interesting. That makes sense to me, and I know Alexis brought it up in part one, just the idea that if you're more conscientious, usually you're like more picky about certain things. You have like more stringent rules and regulation sometimes.

So having too high of that could lend to that type of personality disorder. Yeah. Okay. Let's kind of zoom in on substance use. Substance use is linked to low conscientiousness, especially when paired with low agreeableness. It was a nice 2004 article on that. And what did they find, Maddie? Yeah, they found a few different interesting things. When you look at the results, they found that heavy users scored lower than abstainers when they were comparing substance use.

So like I was saying, the heavy users scored lower on conscientiousness than abstainers. And also specifically in the facets of dutifulness and perfectionism. They similarly scored lower than moderate users even, so heavy users scored lower than moderate users in conscientiousness. They also scored higher on the impulsivity scale than abstainers. So there's also a connection between impulsivity and low conscientiousness. Okay, so basically the heavy users were not as cautious, we're not as dutiful, or not as perfectionistic. as either moderate or abstainers. Okay.

Yeah. You know, someone commented on my YouTube, on the neuroticism, like, great job, guys, you spent an hour talking about things that are completely obvious. Yeah. And I was like, you know, well, you know, the fact that it's obvious means that the knowledge has been disseminated to the degree that it's like, it makes sense. Right? But one of the things that I liked is that, so I'll just quote it, the study said, the findings indicate that A, problem drug use is a symptom, not a cause of personal and social maladjustment, and B, the meaning of drug use can be understood only in context of an individual's personality structure and developmental history. So it suggested that current efforts at drug prevention are misguided to the extent that they focus on the symptom rather than on the psychological syndrome underlying drug abuse. So I just like that idea of like, maybe we should be looking at their traits more than just what they're doing because of their traits. Which is it, it's like a, is it causation, is it a correlation type of idea?

Right, what's causing what? Yeah. What comes first? Does the extensive drug use lead to lower consciousness or does the lower consciousness lead to drug use? Yeah. Yeah. In the Harvard longitudinal study, when they looked at the people who were drinking heavy in mid and late life. Interestingly, they, because they had done prior, in the Harvard longitudinal study,

they started following these guys in college at Harvard, and then they followed them. Now they're in their 90s or something. And they found that their perception of their childhoods were more off. So they thought that their childhoods were worse than they actually were. Interesting. So it's hard to do a study like this because you actually have to follow people for an extended period of time to see how the different things are affecting each other, right? Yeah. I think one of the things I'm picking up on in the nuances is like the interplays that might not have been apparent to me. Like if there was like an adolescent using drugs who's lower on the conscientious scale, parents higher in the conscientious scale, how could I help the parent be less just? judgmental if they are. You know what I mean? Just help them understand each other more.

Yeah. If you can see the other person as a different person than yourself, right? We want to imagine that other people are like us, think like us, especially our kids. It can be hard to, when there's large mismatches, to help them navigate that. Engage in antisocial and criminal behavior. So they found that people were who who are low conscientiousness, were more likely to engage in antisocial behavior. Yeah, criminal and antisocial actions and even suicide attempts,

which I thought was interesting according to one study. So this is a quote, low conscientious seemed to be consistently associated with the various aspects of criminal and antisocial actions. It is related to behavior problems in adolescent boys, antisocial behavior, deviance and suicide attempts, and along with low agreeableness, low conscientiousness is associated with substance abuse.

Webe 2004 reports that low agreeableness and low conscientious predict criminal acts in college students and in prison samples. So another study, low conscientiousness more likely to be unemployed and homeless. All right, kind of moving from antisocial criminal behavior, there's also been a link to low conscientiousness and ADHD. So there's this one study where they found that attention problems were most clearly associated with low conscientious with overall correlations of 0.58 for self-reported conscientiousness and 0.40 for spouse reported conscientious. Okay, so that can kind of take away your sort of self, you know,

know, critique being mistaken. If you look at ADHD total, conscientiousness is linked to it, like I said prior, but also neuroticism. For the self-report, it was 0.47, spouse report, 0.33. Agreeableness, actually, was like conscientious is also negatively correlated, negative 0.41, spouse report negative 0.21. Openness and extraversion not linked at all, which is interesting. So there seems to be a link between ADHD and conscientiousness. And like we talked about before in their discussion, they kind of go into like which came first, which they don't know the answer to like, does ADHD cause low conscientiousness or does low conscientiousness cause ADHD, do they develop at the same time?

Right. So what is happening first? What is happening in second? It's not very clear to me from reading this stuff. All right. Let's talk about high and low conscientious in therapy. So we have a study here showed that both low neuroticism and high conscientiousness scores were associated with better outcomes in therapy.

and the effect size for the higher conscientious patients was 0.35. Yeah, you know, I think that higher conscientious patients probably attend more. Like if you tell them to attend, they'll attend. They'll probably take your medications as prescribed as well. They'll be more likely to kind of keep the order to the point that they'll not miss doses. Interestingly, when I meet someone who's very low conscientiousness, I try to set up structures for them to be able to take their meds. So sometimes it's like getting a pill bottle

or having a medication that if they miss a dose, they can take two doses the next day, like fluoxetine. You know, if you miss seven doses, you can take them all once a week with fluoxetine, interestingly. They actually have a version of it that you could just do once a week. or with schizophrenia, you could do an injection, they're very inconsistently taking things. One of the study suggestions in the end was,

like in dealing with patients with low conscientiousness, clinicians may need to pay particular attention to motivating the client to work on his or her problems. Do you have any advice on how to get a low-conscious patient who is ambivalent about taking their meds to take them? something yeah i think if you look for their own motivation like a motivational interviewing william miller you know so you look for their own desire for change and you get them to talk about that you get them to talk about their maybe hesitancies to change and then you know you say summative comments like

oh it sounds like on one hand you know it's just really hard to remember but on the other hand you don't want to be depressed. You want to, you know, if you're not depressed, you said you'll more likely be able to do work well and get along well with your wife and kids, not be in bed all day. So kind of like, it sounds like that's, those are pretty strong reasons. What do you think might be some of the things that would keep you from doing it? And then you might see them more frequently. You might see them in a week or two weeks and kind of check to make sure that there are actually following through with the plan. It's hard to get people with low conscientious to exercise, right?

They have to kind of want it. You might have to tap into other pleasure centers. You know, so for them, it might be meeting with a group of people to do sports, might be going surfing, you know, something where it's like not as structured as, you know, you're working out in the garage every night by yourself. that's probably less likely to happen. Okay. How about working with a high conscientious person?

What do they talk about? So, patients with high conscientiousness, they're more likely to make an effort to tolerate discomfort and to delay gratification of impulses and desires, both in the world and in therapy. And that's what they were saying is kind of the biggest difference

between low conscientious and high conscientious people. The high conscientious people will be perceived by others to be relatively intelligent. And obviously the people who have less intelligence, but high conscientiousness can still do good because of the consistency that they will work towards their goals. Yeah, like it might take them longer, but they have that, the dutifulness, I think,

of wanting to achieve and like achievement striving, wanting to meet their goals. Yeah. Yeah. I think it's, um, thinking about like someone with work right so a high conscientious person may outrun the low conscientious person just like the turtle versus the hair you know maybe slower but very consistent keep going keep going keep going and may outrun the person who may be like you know sprints at times but then kind of you know gets distracted doing something else yeah yeah yeah

the article was also talking some about how high conscientious people they just naturally work towards values and goals and this leads to like external and internal rewards and this kind of cements that pathway as well of just building on it

building on itself so let's go into low conscientious people okay low conscientious people are relatively or can be relatively unsuccessful in school and in work. Not really meeting what they could,

not meeting their potential. It's not conscientious and IQ are not related. Once in a while, I'll find one of these students who was able to perform in high school, no problem because they're smart and they get to college and it's like all of a sudden they have to actually plan out their week, which is really, really hard.

They have to, they're used to just kind of being able to throw it all in their mind right at the last moment. So, yeah, what do they recommend for this type of situation? Well, like, one of the things, just going off of what you said, one of the things I like that they said in the paper is people low in conscientiousness are less likely to attain these types of things, like things they want, but they're not less likely to desire them. So they still want to get there.

They just don't have as much of a drive or a motivation to go through the steps it takes. Yeah. So it's not that they like don't want things for their life. They don't have goals and values. It's just harder for them to have that motivation and like the work ethic. Yeah. I think about this in terms of like conscientiousness and like planning for retirement. You know, if you are low conscientiousness, it might be better to work at a place where there's going to be a pension, right?

it's kind of ridden into the job so you don't have a choice. Whereas if you're high conscientious and you understand investing and how to put money away, it might be better to actually not have a pension because I think the rewards can be greater, just simply putting in money to index funds and stashing it away year by year. That'll be an interlude to our future episode. So in that article, he suggested that low conscientious clients' treatment might be more supportive as compared to like interpretive confrontation, treatment contracts, paradoxical approaches, self-monitoring and other methods.

And the author was talking about his own success with those, which was very little. And he was saying like low conscientious people might represent. one of the limits to the power of psychotherapy, primarily because, like, you know, low involvement, and that for very low conscientious clients, treatment should be, like, supportive. Yeah. Basically, like, the idea is you get a high conscientiousness patient. They're like the patient everybody wants because they're going to want to work on it. They're going to come to therapy.

They're going to take their medications. But low conscientiousness patients are more difficult because they don't have as much of that internal drive. So what do you do with that? How do you help them achieve their goals? And this one article, basically, the writer is frustrated because he's like, I haven't found a really good way to do that. Like, they're one of the most hardest, one of the hardest patient populations to treat. Yeah.

It seems like this person who's written this article, Miller, I had some pretty strong countertransference after a while towards low conscientious people. He was probably pretty high on conscientious himself. And so it was really hard to. relate to people who didn't think like him, who didn't like behave like him. It can be really fun at times to work with someone who's very very motivated. Like it always surprises me when I recommend an exercise routine that the person actually like does it the first time. Like that's a surprise. Yeah. Where there's people I know who are a little bit lower conscientious. It's very bright people

driven, you know, they've gone far in life, but not from maybe. their high conscientious driving them, maybe some other reason, like fear drives them or something. And so I talked to these patients differently. I talked to them out of like, okay, we're not, we're going to exercise to kind of like run away from the fear, right? Because their neuroticism is really high. So it's like, okay, we're going to, instead of we're going to aspire towards, we're going to run away from. Does that make sense? Yeah. So we also dived into, can conscientiousness be taught?

Part one, we really touched on this. That was like from a longitudinal point of view. And we do know that environment has a significant effect on conscientiousness. I think in the one before this, mono-zagatic twins raised apart only at a point-five-one correlation with conscientiousness. But there's just not a lot of research on interventions to increase conscientiousness in a therapeutic setting. Okay, so was there anything that you guys found on this? We found a paper that just kind of discusses that and kind of delves into what could we try based on the evidence that's out there already. So they're extrapolating a little bit, but they look at three different types of therapy and whether or not they might work.

The first one they look at is behavioral and cognitive behavioral therapy. And they say like basically it might work. it might not, the main cons for that is that you need to be able to reflect on your emotions when you do these types of things. And a lot of mental health problems that have low conscientiousness might also have low levels of reflective functioning. You also need, for CBT to work, you need to come to like multiple appointments and work at it over time. So that might also make it harder to do well in that type of setting. Huh. Yeah, it's interesting that they made that. Okay, so they said many forms of mental health problems characterized by low consciousness

are also associated with low levels of reflective functioning. And so that's kind of like... Just makes it more difficult to use that type of therapy. Yeah. So did they actually come to like what the effect size were or did they actually do this? They didn't do this paper, didn't do studies. They're extrapolating based on studies that already happened about the therapies and looking into what are the links that's already been done with conscientiousness. What should we try in the future? You know, here's my thought is like the best types of therapies for low conscientious people are really the group therapies. You get them into a group. You get them coming. They meet friends. They, after a while, feel like a part of the group.

and it can carry them through a lot of the treatment, right? Once they're coming to group, like an IOP, they'll see the psychiatrist once a week, once a month, or yeah, once a week. And then, you know, they get the benefits of the therapy and they kind of get it in a controlled environment. I think also a lot of chemical dependency programs. You know, you go there, you stay there for a month.

Yeah. You show up to groups. You don't really have a choice if you show up. to groups, it's like, that's what you're doing. That's the only thing to do. I'm always trying to get the low conscientious people to just stay in treatment, especially the first week or two. If they can stay in the IOP and the partial for the first week or two,

they're usually plugged in until the end. And then the question is, like, does their conscientiousness improve over time? And, you know, in our prior work looking at SSRIs and therapy, neuroticism improved. And so I imagine, you know, if you get someone sober off of alcohol, their conscientiousness is going to improve. You get them sober off of marijuana or other drugs. Their conscientious is going to improve, right? I've seen as people, I start to exercise more. It's like just the process of this healthy brain activity, right? Their frontal lobe is going to work better. If you get them off of things that slow down that frontal lobe,

you know, with sedating meds, get them off of muscle relaxers that are slow down their brain as well. Things like a baclophon, get them on robaxon, you know, get people off of benzos, get them off on things like that don't really affect the frontal lobe in a negative way, like an SSRI for anxiety maybe. So I think there's things that you can do that get someone to a place where their brain works a lot better. and I think that, you know, another one would be like obstructive sleep apnea. Like if their brain is not getting enough oxygen throughout the night, it's just not going to work as well. So you get these people who are low consciousness and sometimes I'll have to repeat to them 10 times. Hey, how are we doing on our sleep apnea machine? You know, they'll be like, oh, I wear it like 25% of the time.

I'll be like, oh, what could we do to get that up to 100%? Yeah. 100% really? Why? I'd be like, well, because, you know, get the oxygen to your brain all night long and, you know, it's, you're going to feel better. You do it for three, four weeks, you're going to 100% of the time want to continue that. Like, that's how good you're going to feel.

So you kind of have to like encourage, encourage, encourage, encourage, encourage. Yeah, help them set their goals. Yeah. Oh, here's your goals. Yep. And then here's some steps we can take to meet the goals. Whether it's starting some exercise, creating some structure that might allow them to continue the exercise or, you know, wearing their CPAP, stuff like that. Yeah.

So I feel like just like an important overview, you get a patient who's low in conscientiousness. What are like the big steps you should take to try to help them? Yeah. So I would say consider something, a program with a little bit more structure. Think about like the IOP or the partial. Think about the early sort of starting into those things. It's going to be really, really hard. Right?

Yeah. And once they get connected to people, once they build relationships, then that can be really, really helpful for keeping them in. More accountability. And then I think is why. well, finding the things that are the underlying driving forces for them, the things that they actually care about, getting them to talk about that stuff over and over again, that's like motivational interviewing, right?

101. Yeah. And then rolling with resistance, not being judgmental if they don't figure it out all on once. Like, I would hope that you could walk away from this and have less countertransference towards this population. That actually will improve your ability to help these people, right? because, you know, whether you like it or not, people are going to feel how you feel towards them.

People know, you know, I think you guys know that I like you both. I just said a message to our program, assistant program director telling her that, how awesome you guys are. So, you know, I think, I think this is hopefully a good episode for you guys to sort of think through conscientiousness. I would hope that you would walk away kind of maybe thinking about your own level

where you're at and maybe different domains. Yeah. And how it affects your patient care. How it affects your patient care? Interacting with different levels of conscientiousness in your patients. Yep. You know, I have a, we have,

there's like ADHD calendars. Hey, that might be a good idea also if people are low conscientious. Yeah. I think, you know, there's a bell curve for this. So probably if you're listening to this and you're professional, you're probably a little bit above average, honestly. And so learning to have some patience for people who are on a different place of the bell curve. Yeah. Like it's important to remember that it is a personality trait for a reason. They're not just resisting therapy because

they don't like you or they don't want to be there. Bingo. Yeah. If that's if that's the one take way you have and it allows you to tolerate maybe what would be something of a natural countertransference, I think that would be a big win. Yeah. Okay, guys, well, we're going to leave it there for today. We'll put this up on the website, psychiatrypodcast.com. If you want, check it out. And let me know what your thoughts are.

Have a good day.