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Rasmussen EB, Camp L, Lawyer SR. The Use of Nonmonetary Outcomes in Health-Related Delay Discounting Research: Review and Recommendations. Perspect Behav Sci 2024; 47:523-558. [PMID: 39099748 PMCID: PMC11294320 DOI: 10.1007/s40614-024-00403-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 08/06/2024] Open
Abstract
Delay discounting (DD) refers to the tendency to devalue an outcome as a function of its delay. Most contemporary human DD research uses hypothetical money to assess individual rates of DD. However, nonmonetary outcomes such as food, substances of misuse, and sexual outcomes have been used as well, and have advantages because of their connections to health. This article reviews the literature on the use of nonmonetary outcomes of food, drugs, and sexual outcomes in relation to health and reinforcer pathologies such as substance use disorders, obesity, and sexual risk behaviors, respectively, and makes a case for their use in discounting research. First, food, substances, and sex may be more ecologically valid outcomes than money in terms of their connections to health problems and reinforcer pathologies. Second, consistent trends in commodity-specific (i.e., domain) effects, in which nonmonetary outcomes are discounted more steeply than money, enhance variation in discounting values. Third, commodity-specific changes in discounting with treatments designed to change health choices are described. Finally, methodological trends such as test-retest reliability, magnitude effects, the use of hypothetical versus real outcomes, and age-related effects are discussed in relation to the three outcome types and compared to trends with monetary discounting. Limitations that center around individual preferences, nonsystematic data, and deprivation are discussed. We argue that researchers can enhance their DD research, especially those related to health problems and reinforcer pathologies, with the use of nonmonetary outcomes. Recommendations for future directions of research are delineated.
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Affiliation(s)
- Erin B. Rasmussen
- Department of Psychology, Idaho State University, Stop 8112, Pocatello, ID 83209-8112 USA
| | - Lillith Camp
- Department of Psychology, Idaho State University, Stop 8112, Pocatello, ID 83209-8112 USA
| | - Steven R. Lawyer
- Department of Psychology, Idaho State University, Stop 8112, Pocatello, ID 83209-8112 USA
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2
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van der Veer A, Madern T, van Lenthe FJ. Tunneling, cognitive load and time orientation and their relations with dietary behavior of people experiencing financial scarcity - an AI-assisted scoping review elaborating on scarcity theory. Int J Behav Nutr Phys Act 2024; 21:26. [PMID: 38439067 PMCID: PMC10910771 DOI: 10.1186/s12966-024-01576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/14/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The concept of a financial scarcity mindset has raised much attention as an explanation for poor decision-making and dysfunctional behavior. It has been suggested that financial scarcity could also impair dietary behavior, through a decline in self-control. Underlying cognitive mechanisms of tunneling (directing attention to financial issues and neglecting other demands), cognitive load (a tax on mental bandwidth interfering with executive functioning) and time orientation (a shift towards a present time horizon, versus a future time horizon) may explain the association between financial scarcity and self-control related dietary behavior. The current scoping review gathers recent evidence on how these mechanisms affect dietary behavior of people experiencing financial scarcity. It builds on a theoretical framework based on insights from behavioral economics and health psychology. METHODS A literature search was executed in six online databases, which resulted in 9.975 papers. Search terms were tunneling, cognitive load and time orientation, financial scarcity, and dietary behavior. Screening was performed with ASReview, an AI-ranking tool. In total, 14 papers were included in the scoping review. We used PRISMA-ScR guidelines for reporting. RESULTS Limited evidence indicates that a scarcity mindset could increase tunneling, through attentional narrowing on costs of food, which then directly impacts dietary behavior. A scarcity mindset involves experiencing financial stress, which can be understood as cognitive load. Cognitive load decreases attentional capacity, which could impair self-control in dietary choices. Financial scarcity is related to a present time orientation, which affects dietary choices by shifting priorities and decreasing motivation for healthy dietary behavior. CONCLUSIONS A scarcity mindset affects dietary behavior in different ways. Tunneling and a shift in time orientation are indicative of an attentional redirection, which can be seen as more adaptive to the situation. These may be processes indirectly affecting self-control capacity. Cognitive load could decrease self-control capacity needed for healthy dietary behavior because it consumes mental bandwidth. How a changing time orientation when experiencing financial scarcity relates to motivation for self-control in dietary behavior is a promising theme for further inquiry.
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Affiliation(s)
- Annemarieke van der Veer
- Research Group of Debt and Debt Collection, University of Applied Sciences Utrecht, Utrecht, PO Box 85397, 3508 AJ, The Netherlands.
| | - Tamara Madern
- Research Group of Debt and Debt Collection, University of Applied Sciences Utrecht, Utrecht, PO Box 85397, 3508 AJ, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
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Brown JM, Stein JS. Putting prospection into practice: Methodological considerations in the use of episodic future thinking to reduce delay discounting and maladaptive health behaviors. Front Public Health 2022; 10:1020171. [PMID: 36408004 PMCID: PMC9669959 DOI: 10.3389/fpubh.2022.1020171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
In recent years, episodic future thinking (EFT) has emerged as a promising behavioral intervention to reduce delay discounting or maladaptive health behaviors; however, considerable methodological heterogeneity in methods for eliciting engagement in EFT has been observed in prior research. In this narrative review, we briefly describe methods for generating EFT cues, the content of EFT cues, common control conditions for experiments utilizing EFT, and considerations for cue delivery and implementation. Where possible, we make suggestions for current best practices in each category while identifying gaps in knowledge and potential areas of future research. Finally, we conclude by using the NIH Stage model to better frame the current state of the literature on EFT and propose gaps to be addressed if EFT is to be both an efficacious and effective behavioral intervention.
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Affiliation(s)
- Jeremiah Michael Brown
- Fralin Biomedical Research Institute, Virginia Tech Carilion, Roanoke, VA, United States
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA, United States
| | - Jeffrey Scott Stein
- Fralin Biomedical Research Institute, Virginia Tech Carilion, Roanoke, VA, United States
- Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA, United States
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Bickel WK, Freitas-Lemos R, Tomlinson DC, Craft WH, Keith DR, Athamneh LN, Basso JC, Epstein LH. Temporal discounting as a candidate behavioral marker of obesity. Neurosci Biobehav Rev 2021; 129:307-329. [PMID: 34358579 DOI: 10.1016/j.neubiorev.2021.07.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
Although obesity is a result of processes operating at multiple levels, most forms result from decision-making behavior. The aim of this review was to examine the candidacy of temporal discounting (TD) (i.e. the reduction in the value of a reinforcer as a function of the delay to its receipt) as a behavioral marker of obesity. For this purpose, we assessed whether TD has the ability to: identify risk for obesity development, diagnose obesity, track obesity progression, predict treatment prognosis/outcomes, and measure treatment effectiveness. Three databases (Pubmed, PsycINFO, and Web of Science) were searched using a combination of terms related to TD and obesity. A total of 153 papers were reviewed. Several areas show strong evidence of TD's predictive utility as a behavioral marker of obesity (e.g., distinguishing obese from non obese). However, other areas have limited and/or mixed evidence (e.g., predicting weight change). Given the positive relationship for TD in the majority of domains examined, further consideration for TD as a behavioral marker of obesity is warranted.
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Affiliation(s)
- Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
| | | | - Devin C Tomlinson
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, USA
| | - William H Craft
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, USA
| | - Diana R Keith
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Julia C Basso
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
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Epstein LH, Carr KA. Food reinforcement and habituation to food are processes related to initiation and cessation of eating. Physiol Behav 2021; 239:113512. [PMID: 34217735 DOI: 10.1016/j.physbeh.2021.113512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 01/11/2023]
Abstract
An individual bout of eating involves cues to start eating, as well as cues to terminate eating. One process that determines initiation of eating is food reinforcement. Foods with high reinforcing value are also likely to be consumed in greater quantities. Research suggests both cross-sectional and prospective relationships between food reinforcement and obesity, food reinforcement is positively related to energy intake, and energy intake mediates the relationship between food reinforcement and obesity. A process related to cessation of eating is habituation. Habituation is a general behavioral process that describes a reduction in physiological or affective response to a stimulus, or a reduction in the behavioral responding to obtain a stimulus. Repeated exposure to the same food during a meal can result in habituation to that food and a reduction in consumption. Habituation is also cross-sectionally and prospectively related to body weight, as people who habituate slower consume more in a meal and are more overweight. Research from our laboratory has shown that these two processes independently influence eating, as they can account for almost 60% of the variance in ad libitum intake. In addition, habituation phenotypes show reliable relationships with reinforcing value, such that people who habituate faster also find food less reinforcing. Developing a better understanding of cues to start and stop eating is fundamental to understanding how to modify eating behavior. An overview of research on food reinforcement, habituation and food intake for people with a range of weight status and without eating disorders is provided, and ideas about integrating these two processes that are related to initiation and termination of a bout of eating are discussed.
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Affiliation(s)
- Leonard H Epstein
- Jacobs School of Medicine and Biomedical Sciences, Department of Pediatrics, University at Buffalo, G56 Farber Hall, 3435 Main Street, Building #26, Buffalo, New York 14214-3000, USA.
| | - Katelyn A Carr
- Jacobs School of Medicine and Biomedical Sciences, Department of Pediatrics, University at Buffalo, G56 Farber Hall, 3435 Main Street, Building #26, Buffalo, New York 14214-3000, USA.
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Epstein LH, Paluch RA, Stein JS, Quattrin T, Mastrandrea LD, Bree KA, Sze YY, Greenawald MH, Biondolillo M, Bickel WK. Delay Discounting, Glycemic Regulation and Health Behaviors in Adults with Prediabetes. Behav Med 2021; 47:194-204. [PMID: 32275202 PMCID: PMC8462992 DOI: 10.1080/08964289.2020.1712581] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The majority of people with prediabetes transition to type 2 diabetes. Research has suggested that persons with type 2 diabetes are likely to discount the future and focus on immediate rewards. This study was designed to assess whether this process of delay discounting (DD) is associated with glycemic regulation, medication adherence and eating and exercise behaviors in adults with prediabetes. Participants included 81 adults with prediabetes who were also prescribed hypertension or dyslipidemia drugs, which is common for people with prediabetes. Participants completed adjusting amount DD $100 and $1000 tasks, as well assessments of glycemic control (Hemoglobin (Hb) A1c), medication adherence, diet quality, and objectively measured physical activity. Relationships between DD and these variables were assessed. Results showed higher rates of DD were related to higher HbA1c; as well as poorer medication adherence, lower diet quality and lower physical activity. Hierarchical regression showed that the association between minority status, a known risk factor for type 2 diabetes, was moderated by DD, as minorities with higher DD had greater HbA1c values. Delay discounting may represent a novel target to prevent progression from prediabetes to type 2 diabetes.
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Affiliation(s)
| | - Rocco A. Paluch
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
| | | | - Teresa Quattrin
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
| | | | - Kyle A. Bree
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
| | - Yan Yan Sze
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences
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Stancato SS, Schneider TD, Reed DD, Lemley SM, Carrillo A, Jarmolowicz DP. Reinforcer pathology II: Reward magnitude, reward delay, and demand for alcohol collectively relate to college students' alcohol related problems. J Exp Anal Behav 2020; 114:354-367. [PMID: 33184869 DOI: 10.1002/jeab.635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 01/08/2023]
Abstract
The reinforcer pathologies model of addiction posits that two characteristic patterns of operant behavior characterize addiction. Specifically, individuals suffering from addiction have elevated levels of behavioral economic demand for their substances of abuse and have an elevated tendency to devalue delayed rewards (reflected in high delay discounting rates). Prior research has demonstrated that these behavioral economic markers are significant predictors of many of college students' alcohol-related problems. Delay discounting, however, is a complex behavioral performance likely undergirded by multiple behavioral processes. Emerging analytical approaches have isolated the role of participants' sensitivity to changes in reinforcer magnitude and changes in reinforcer delay. The current study uses these analytic approaches to compare participants' discounting of money versus alcohol, and to build regression models that leverage these new insights to predict a wider range of college students' alcohol related problems. Using these techniques, we were able to 1) demonstrate that individuals differed in their sensitivity to magnitudes of alcohol versus money, but not sensitivity to delays to those commodities and 2) that we could use our behavioral economic measures to predict a range of students' alcohol related problems.
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Affiliation(s)
| | | | - Derek D Reed
- University of Kansas.,Cofrin Logan Center for Addiction Research and Treatment
| | | | | | - David P Jarmolowicz
- University of Kansas.,Cofrin Logan Center for Addiction Research and Treatment
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8
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Bickel WK, Athamneh LN. A Reinforcer Pathology perspective on relapse. J Exp Anal Behav 2020; 113:48-56. [PMID: 31789442 PMCID: PMC10424315 DOI: 10.1002/jeab.564] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/19/2019] [Indexed: 12/18/2022]
Abstract
The Reinforcer Pathology theory proposes conditions under which drugs emerge as excessively preferred reinforcers compared to other available reinforcers among drug users. The theory highlights 2 key variables as important determinants of drug preference: (a) excessive preference for immediate rewards (high discounting of future rewards); and (b) excessive valuation for addictive reinforcers (e.g., drugs). Two iterations of the Reinforcer Pathology theory exist with the latest iteration (i.e., Reinforcer Pathology 2.0) specifying that the temporal window of reinforcer integration (measured by delay discounting) is a determinant of reinforcer value. The 2 iterations of the Reinforcer Pathology theory are described. A novel insight and understanding of abstinence and relapse from a Reinforcer Pathology perspective, limitations, and future directions are discussed. The Reinforcer Pathology theory continues the long-standing efforts to scientifically understand and better define novel concepts and methods to further translational research and improve treatment outcomes. Exploring the complementary relation between the Reinforcer Pathology perspective and other current approaches could have a valuable effect.
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Affiliation(s)
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at VTC
- Virginia Polytechnic Institute and State University
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Bickel WK, Athamneh LN, Snider SE, Craft WH, DeHart WB, Kaplan BA, Basso JC. Reinforcer Pathology: Implications for Substance Abuse Intervention. Curr Top Behav Neurosci 2020; 47:139-162. [PMID: 32462615 DOI: 10.1007/7854_2020_145] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The rate at which individuals discount future rewards (i.e., discounting rate) is strongly associated with their propensity for substance abuse as well as myriad other negative health behaviors. An excessive preference for immediately available rewards suggests a shortened time horizon in which immediate rewards are overvalued and future, potentially negative consequences are undervalued. This review outlines Reinforcer Pathology Theory (i.e., the interaction between excessive preference for immediately available rewards and the overvaluation of a particular commodity that offers brief, intense reinforcement), its neurobiological/behavioral underpinnings, and its implications for treating substance use disorders. In doing so, the current review provides an overview of a variety of ways in which interventions have been used to manipulate aspects of reinforcer pathology in an individual, including narrative theory, framing manipulations, and neuromodulation (e.g., working memory training, TMS) which may serve as promising avenues for the modulation of the temporal window and/or valuation of reinforcers.
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Affiliation(s)
- Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA. .,Center for Transformative Research on Health Behaviors, Fralin Biomedical Research Institute, Roanoke, VA, USA.
| | - Liqa N Athamneh
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA.,Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Sarah E Snider
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA
| | - William H Craft
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA.,Graduate Program in Translational Biology, Medicine, and Health, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - William B DeHart
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA
| | - Brent A Kaplan
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA
| | - Julia C Basso
- Addiction Recovery Research Center, Fralin Biomedical Research Institute, Roanoke, VA, USA
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