Anxiety and Depression in Metastatic Cancer: A Critical Review of Negative Impacts on Advance Care Planning and End-of-Life Decision Making With Practical Recommendations

PURPOSE

Providers treating adults with advanced cancer increasingly seek to engage patients and surrogates in advance care planning (ACP) and end-of-life (EOL) decision making; however, anxiety and depression may interfere with engagement. The intersection of these two key phenomena is examined among patients with metastatic cancer and their surrogates: the need to prepare for and engage in ACP and EOL decision making and the high prevalence of anxiety and depression.

METHODS

Using a critical review framework, we examine the specific ways that anxiety and depression are likely to affect both ACP and EOL decision making.

RESULTS

The review indicates that depression is associated with reduced compliance with treatment recommendations, and high anxiety may result in avoidance of difficult discussions involved in ACP and EOL decision making. Depression and anxiety are associated with increased decisional regret in the context of cancer treatment decision making, as well as a preference for passive (not active) decision making in an intensive care unit setting. Anxiety about death in patients with advanced cancer is associated with lower rates of completion of an advance directive or discussion of EOL wishes with the oncologist. Patients with advanced cancer and elevated anxiety report higher discordance between wanted versus received life-sustaining treatments, less trust in their physicians, and less comprehension of the information communicated by their physicians.

CONCLUSION

Anxiety and depression are commonly elevated among adults with advanced cancer and health care surrogates, and can result in less engagement and satisfaction with ACP, cancer treatment, and EOL decisions. We offer practical strategies and sample scripts for oncology care providers to use to reduce the effects of anxiety and depression in these contexts.

Relationship Between Mental Health Education Competency and Interpersonal Trust Among College Counselors: The Mediating Role of Neuroticism

Objective

Based on the motivated cognition account, this study aimed to explore the relationship between mental health education competency and interpersonal trust among college counselors, as well as the mediating effect of neuroticism.

Materials and Methods

A total of 483 college counselors were selected, including 155 men and 328 women. The youngest college counselor was 22 years old and the oldest was 56 years old (M = 31.69, SD = 6.12). The college counselors were asked to fill out the Mental Health Education Competency Scale for College Counselors, a 10-item short version of the Big Five Inventory, and an Interpersonal Trust Scale.

Results

(1) This study found a significantly positive correlation between mental health education competency and interpersonal trust. (2) Mental health education competency and interpersonal trust were negatively correlated with neuroticism. (3) The mediating role of neuroticism in the association between mental health education competency and interpersonal trust was significant.

Conclusion

Mental health education competency partly affected interpersonal trust via the mediating effect of neuroticism.

Taking gambles at face value: Effects of emotional expressions on risky decisions

Emotional facial expressions are ubiquitous and potent social stimuli that can signal favorable and unfavorable conditions. Previous research demonstrates that emotional expressions influence preference judgments, basic approach-avoidance behaviors, and reward learning. We examined whether emotional expressions can influence decisions such as choices between gambles. Based on theories of affective cue processing, we predicted greater risk taking after positive than negative expressions. This hypothesis was tested in four experiments across tasks that varied in implementation of risks, payoffs, probabilities, and temporal decision requirements. Facial expressions were presented unobtrusively and were uninformative about the choice. In all experiments, the likelihood of a risky choice was greater after exposure to positive versus neutral or negative expressions. Similar effects on risky choice occurred after presentation of different negative expressions (e.g., anger, fear, sadness, and disgust), suggesting involvement of general positive and negative affect systems. These results suggest that incidental emotional cues exert a valence-specific influence of on decisions, which could shape risk-taking behavior in social situations.

Being ethically resilient during COVID-19: a cross-sectional study of Indian supply chain companies

Purpose

The present study aims to examine the relationship between techno-ethical orientation and ethical decision-making (EDM) in Indian supply chain companies during the COVID-19 pandemic. It also aims to explore the moderating role of technological frames (TF) in the relationship between techno-ethical orientation and EDM.

Design/methodology/approach

The relationship between techno-ethical orientation and EDM is examined using correlation and regression analysis. The moderating effect of five dimensions of TFs (personal attitude, application value, organisational influence, supervisor influence and industry influence) is analysed using structural equation modelling.

Findings

The correlation coefficient between techno-ethical orientation and EDM is 0.513. Also, the regression coefficient (β = 0.213) is significant at 0.05, establishing a positive linkage between the two. R-square values showed a 45.2% variation in EDM is explained by techno-ethical orientation. Similarly, all variables of TFs have a positive and significant moderating effect on the relationship between techno-ethical orientation and EDM.

Originality/value

This is one of the pioneer studies exploring techno-ethical orientation’s impact on EDM in supply chain companies.

Postural Correlates of Pollution Perception

In our contemporary societies, environmental issues are more and more important. An increasing number of studies explore the biological processes involved in environment perception and in particular try to highlight the mechanisms underlying the perception of environmental scenes by our brain. The main objective of the present study was to establish whether the visualization of clean and polluted environmental scenes would lead to differential postural reactions. Our hypothesis was based on a differential postural modulation that could be recorded when the subject is confronted with images representing a “polluted” environment, differential modulation which has been reported in previous studies in response to painful-scenes compared to non-painful scenes visualization.Thirty-one subjects participated in this study. Physiological measurements [heart rate variability (HRV) and electrodermal activity] and postural responses (Center Of Pression—COP—displacements) were recorded in response to perception of polluted or clean environmental scenes. We show, for the first time, that images representing polluted scenes evoke a weaker approach movement than images representing clean scenes. The displacement of the COP in the anteroposterior axis reflects an avoidance when subjects visualize “polluted” scenes. Our results demonstrate a clear distinction between “clean” and “polluted” environments according to the postural change they induce, correlated with the ratings of pleasure and approach evoked by images.

No matter how you mark the points on the fever curve – threatening shapes do not add to threat of climate change

Graphs have become an increasingly important means of representing data, for instance, when communicating data on climate change. However, graph characteristics might significantly affect graph comprehension. The goal of the present work was to test whether the marking forms usually depicted on line-graphs, can have an impact on graph evaluation. As past work suggests that triangular forms might be related to threat, we compared the effect of triangular marking forms with other symbols (triangles, circles, squares, rhombi, and asterisks) on subjective assessments. Participants in Study 1 (N = 314) received 5 different line-graphs about climate change, each of them using one out of 5 marking forms. In Study 1, the threat and arousal ratings of the graphs with triangular marking shapes were not higher than those with the other marking symbols. Participants in Study 2 (N = 279) received the same graphs, yet without labels and indeed rated the graphs with triangle point markers as more threatening. Testing whether local rather than global spatial attention would lead to an impact of marker shape in climate graphs, Study 3 (N = 307) documented that a task demanding to process a specific data-point on the graph (rather than just the line graph as a whole) did not lead to an effect either. These results suggest that marking symbols can principally affect threat and arousal ratings but not in the context of climate change. Hence, in graphs on climate change, choice of point markers does not have to take potential side-effects on threat and arousal into account. These seem to be restricted to the processing of graphs where form aspects face less competition from the content domain on judgments.

Neural correlates of cognitive bias modification for interpretation

The effectiveness of cognitive bias modification for interpretation (CBM-I), a treatment method employed to reduce social anxiety (SA), has been examined. However, the neural correlates of CBM-I remain unclear, and we aimed to elucidate brain activities during intervention and activity changes associated with CBM-I effectiveness in a pre–post intervention comparison. Healthy participants divided into two groups (CBM, control) were scanned before, during and after intervention using functional magnetic resonance imaging. Ambiguous social situations followed by positive outcomes were repeatedly imagined by the CBM group during intervention, while half of the outcomes in the control group were negative. Whole-brain analysis revealed that activation of the somatomotor and somatosensory areas, occipital lobe, fusiform gyrus and thalamus during intervention was significantly greater in the CBM than in the control group. Furthermore, altered activities in the somatomotor and somatosensory areas, occipital lobe and posterior cingulate gyrus during interpreting ambiguous social situations showed a significant group × change in SA interaction. Our result suggests that when facing ambiguous social situations, positive imagery instilled by CBM-I is recalled, and interpretations are modified to contain social reward. These findings may help to suggest an alternative manner of enhancing CBM-I effectiveness from a cognitive-neuroscience perspective.

An Effective Life-Sex-Emotions Course for Taiwanese Adolescents on Health Perceptions: A Cohort Study

Aim: Adolescence is a time of transition from childhood to adulthood, when young people go through a number of vital physical and psychological developments. It is surprising yet unfortunate that the number of teenage suicide deaths and teenage infections of gonorrhea have increased over the years, becoming serious public health concerns in Taiwan. The aim of this study was to investigate the effect of an education course on teenagers' understanding of adolescence and their attitudes toward life, sex, gender equality, and mental health.

Material and Methods: Participants were comprised of Taiwanese students in Grades 5 to 9 who completed a Life–Sex–Emotions course, titled “Sailing through Adolescence.” The effect of the course was measured using pre- and post-test scores on the Perception Index of Life–Sex–Emotions Education (PILSEE) instrument. Qualitative data included subjective responses to questions before and after the course. Data were collected between September 2017 and June 2020.

Results: A total of 10,506 completed questionnaires were collected. The mean PILSEE pretest scores for each subscale ranged from 8.71 to 13.37 (SD = 1.499–1.99); posttest subscale scores ranged from 9.30 to 13.95 (SD range = 1.490–2.288). The mean overall pretest score was 86.86 (SD = 10.83); the mean posttest score was 92.62 (SD = 10.30). The paired t-test demonstrated that post-test scores were significantly higher than pretest scores (t = 55.46; p < 0.01). Qualitative feedback indicated that the course improved students' self-esteem, their understanding adolescence, and awareness of influences of the media.

Conclusion: Our findings indicate that an educational course about life, sex, and emotions during adolescence can be an effective intervention to help teenagers understand the impact of adolescence on attitudes toward life, sex, mental health, and gender equality.

The affect of negativity: testing the Foreign Language Effect in three types of valence framing and a moral dilemma

In decision-making people react differently to positive wordings than to negatives, which may be caused by negativity bias: a difference in emotional force of these wordings. Because emotions are assumed to be activated more strongly in one's mother tongue, we predict a Foreign Language Effect, being that such framing effects are larger in a native language than in a foreign one. In two experimental studies (N = 475 and N = 503) we tested this prediction for balanced and unbalanced second language users of Spanish and English and for three types of valence framing effects. In Study 1 we observed risky-choice framing effects and attribute framing effects, but these were always equally large for native and foreign-language speakers. In our second study, we added a footbridge dilemma to the framing materials. Only for this task we did observe a Foreign Language Effect, indicating more utilitarian choices when the dilemma is presented in L2. Hence, across two studies, we find no Foreign Language Effect for three types of valence framing but we do find evidence for such an effect in a moral decision task. We discuss several alternative explanations for these results.

The demographics of knowledge, attitudes and emotions toward coyotes

Abstract ContextA coyote-caused human fatality in Cape Breton Highlands National Park of Canada (CBHNPC) occurred in 2009. Because CBHNPC is federally protected, rangers have a limited number of management options for dealing with human–coyote conflict. The park initiated the present study to understand the publics’ acceptance of coyotes. AimsThis article examined relationships between each of four independent variables (respondent type (resident vs visitor), sex, age, education) and each of four dependent variables (knowledge, attitude, two emotions) related to coyotes in CBHNPC. Researchers have repeatedly suggested that demographics are related to cognitions and emotions toward wildlife. Managers can use demographic findings to target education campaigns to specific stakeholders. MethodsSurvey data were obtained from (a) residents living around CBHNPC (n=556, response rate=70%), and (b) visitors hiking two popular trails in CBHNPC (n=443, response rate=60%). Key resultsAll four independent variables were related to knowledge. Visitors were more knowledgeable about coyotes than were residents. Females were more knowledgeable than were males. Younger respondents were more knowledgeable than were older individuals. All education categories differed from each other. Findings for the attitude construct were similar. Residents held negative attitudes toward coyotes, whereas visitors were slightly positive. Males and females both held negative attitudes. The youngest age category held a positive attitude, whereas the oldest group was the most negative. Respondents with a high-school degree had a negative attitude; those with a college degree held a positive attitude. For the first emotion concept, residents were more emotional than were visitors. Males were more emotional than were females, and high-school graduates were more emotional than were college graduates. For the second emotion, there were statistical differences between residents and visitors, as well as between males and females. However, age and education were not related to this scenario. ConclusionsAlthough there were statistical differences for 13 of 16 tests, over 80% of the effect sizes were minimal and there were interaction effects among the four demographic variables. ImplicationsFindings highlighted complexities managers should consider when designing communication strategies aimed at influencing stakeholders’ knowledge of and attitudes and emotions toward wildlife.

Metastereotypes impairing doctor-patient relations: The roles of intergroup anxiety and patient trust

This study examined whether patients' negative metastereotypes undermine their perception of doctor-patient relations through raising their intergroup anxiety and decreasing their trust level. One hundred twenty-four outpatients from a Chinese hospital participated in this study; they were randomly assigned to either the negative metastereotype activation (NMSA) or the non-NMSA condition according to different instructions. Then, they were asked to complete the Intergroup Anxiety, Patient Trust, and Doctor-Patient Relations Scale. Patients' negative metastereotypes undermined doctor-patient relations through the mediation of intergroup anxiety and patient trust (i.e., the independent mediation effect of intergroup anxiety and patient trust) and the serial mediation effect of intergroup anxiety and patient trust. These findings suggest that future research consider intergroup anxiety and patient trust in developing interventions to improve doctor-patient relations.

Dissociable Effects of Monetary, Liquid, and Social Incentives on Motivation and Cognitive Control

Humans are social creatures and, as such, can be motivated by aspects of social life (e.g., approval from others) to guide decision-making in everyday contexts. Indeed, a common view is that people may have stronger orientation toward social goals or incentives relative to other incentive modalities, such as food or money. However, current studies have only rarely addressed how social incentives compare to other types of rewards in motivating goal-directed behavior. The current study tested this claim; across two separate experiments, the effects of liquid and social incentives were compared in terms of their subsequent impact on task performance and self-reported affect and motivation. Critically, valenced social incentives offered both ecological validity (short video clips—Experiment 1) and continuity with prior stimuli used in the social reward and motivation literature (static images—Experiment 2) when examining their effect on behavior. Across both studies, the results replicate and extend prior work, demonstrating robust effects of liquid incentives on task performance and self-reported affect and motivation, while also supporting an interpretation of weaker motivational and affective effects for social incentives. These patterns of results highlight the complex and wide-ranging effects of social incentives and call into question the effectiveness of social incentives, relative to other incentive modalities, in motivating behavior.

The impact of legal expertise on moral decision-making biases

Traditional and mainstream legal frameworks conceive law primarily as a purely rational practice, free from affect or intuition. However, substantial evidence indicates that human decision-making depends upon diverse biases. We explored the manifestation of these biases through comparisons among 45 criminal judges, 60 criminal attorneys, and 64 controls. We examined whether these groups' decision-making patterns were influenced by (a) the information on the transgressor's mental state, (b) the use of gruesome language in harm descriptions, and (c) ongoing physiological states. Judges and attorneys were similar to controls in that they overestimated the damage caused by intentional harm relative to accidental harm. However, judges and attorneys were less biased towards punishments and harm severity ratings to accidental harms. Similarly, they were less influenced in their decisions by either language manipulations or physiological arousal. Our findings suggest that specific expertise developed in legal settings can attenuate some pervasive biases in moral decision processes.

How do different kinds of incidental emotions influence risk decision making?

Incidental emotions, which are irrelevant to the ongoing decision, play a significant role in decision-making processes. In this study, we investigated the influence of specific incidental emotions on behavioral, psychological, and electrophysiological responses during the process of decision making. Participants finished a forced-choice gambling task, during which incidental emotions (anger/fear/happiness) were elicited by recalling emotional experiences. Behavioral and event-related potential (ERP) data were recorded in the experiment. Behavioral results showed that risk preference was weaker in the fearful condition than in the angry and happy conditions, but emotional feelings to outcome feedback were not influenced by incidental emotions. The feedback-related negativity (FRN) amplitude was larger in the fearful condition than in the angry, happy, and neutral conditions for large outcomes, whereas there was no difference between the four conditions for small outcomes. In addition, the influence of outcome magnitude (small/large) on the P3 amplitude was stronger in the fearful condition than in the angry, happy, and neutral conditions. We suggest that incidental fear elicits risk-avoidant behavior (manifested in behavioral choices), stronger motivation (manifested in the FRN amplitude) and cognitive resources (manifested in the P3 amplitude) for risky outcomes of decision making unconsciously (indicated by unchanged subjective emotional experiences). The current findings have expanded our understanding of the role of specific incidental emotions in decision making.

Face perception without subjective awareness - Emotional expressions guide early gaze behavior in clinically depressed and healthy individuals

BACKGROUND

Major depressive disorder is associated with attentional biases in the explicit processing of emotional facial expressions. It is unclear if attentional biases for emotional faces also exist at an automatic level of perception.

METHOD

Gaze behavior of twenty-nine clinically depressed individuals and twenty-nine gender matched healthy controls was compared in an affective priming task. Happy, neutral, sad, angry, and fearful facial expressions were presented very briefly as primes with forward and backward masking, followed by a neutral expression. Participants' early gaze behavior on neutral faces was analyzed for the eyes and mouth as areas of interest. Only participants who were subjectively unaware of the emotional prime faces were included in the analyses.

RESULTS

Masked emotional facial expressions elicited early eye movements toward diagnostic features of the face. Both, depressed patients and healthy controls oriented their initial fixation on the face more often to the eye region after the presentation of fearful or sad compared to happy primes. However, depressed patients oriented their gaze generally far less to the eye and mouth region compared to healthy controls.

LIMITATION

Awareness of emotional prime faces was assessed by a systematic interview but not by an objective detection task.

CONCLUSION

Our data suggest enhanced attentional orienting toward the eye region due to fearful and sad faces in depressed and healthy individuals. In spite of this early expression-specific vigilance, depressed individuals oriented their gaze overall less to the eyes and mouth compared to healthy controls, which might represent an avoidance of facial features.

The role of affective states in potential applicants’ evaluations of employer attractiveness

What role do emotions play as a job seeker eyes up a potential employer? Our contribution to research into employer attractiveness explores the role that affective states play in potential applicants’ subjective perceptions of companies’ employer attractiveness in the early phase of job seeking. We adopt a concurrent verbalization approach to inquire into qualified potential applicants’ processes of interpreting employer branding material. Based on these data, we provide insights into the neglected role of emotions in research on potential applicants’ assessments of the appeal of an organization. The findings from a multistep qualitative data analysis produce the following four propositions: (1) strong emotions influence the outcome of the opinion-making process; (2) negative emotions play a crucial role in potential applicants’ evaluations of employer attractiveness; (3) some contents of employer information elicit negative emotions, whereas their complementary counterparts do not elicit positive affective reactions; and (4) expectations towards an employer and comparisons among employers influence potential applicants’ sentiments about individual employers.

Influence of Suboptimally and Optimally Presented Affective Pictures and Words on Consumption-Related Behavior

Affective stimuli can influence immediate reactions as well as spontaneous behaviors. Much evidence for such influence comes from studies of facial expressions. However, it is unclear whether these effects hold for other affective stimuli, and how the amount of stimulus processing changes the nature of the influence. This paper addresses these issues by comparing the influence on consumption behaviors of emotional pictures and valence-matched words presented at suboptimal and supraliminal durations. In Experiment 1, both suboptimal and supraliminal emotional facial expressions influenced consumption in an affect-congruent, assimilative way. In Experiment 2, pictures of both high- and low-frequency emotional objects congruently influenced consumption. In comparison, words tended to produce incongruent effects. We discuss these findings in light of privileged access theories, which hold that pictures better convey affective meaning than words, and embodiment theories, which hold that pictures better elicit somatosensory and motor responses.

Decision Making on the Labor and Delivery Unit: An Investigation of Influencing Factors

Objective The aim of this study was to describe the relationship between negative affect (NA), decision-making style, time stress, and decision quality in health care. Background Health care providers must often make swift, high-stakes decisions. Influencing factors of the decision-making process in this context have been understudied. Method Within a sample of labor and delivery nurses, physicians, and allied personnel, we used self-report measures to examine the impact of trait factors, including NA, decision-making style, and perceived time stress, on decision quality in a situational judgment test (Study 1). In Study 2, we observed the influence of state NA, state decision-making style, state time stress, and their relationship with decision quality on real clinical decisions. Results In Study 1, we found that trait NA significantly predicted avoidant decision-making style. Furthermore, those who were higher on trait time stress and trait avoidant decision-making style exhibited poorer decisions. In Study 2, we observed associations between state NA with state avoidant and analytical decision-making styles. We also observed that these decision-making styles, when considered in tandem with time stress, were influential in predicting clinical decision quality. Conclusion NA predicts some decision-making styles, and decision-making style can affect decision quality under time stress. This is particularly true for state factors. Application Individual differences, such as affect and decision-making style, should be considered during selection. Training to reduce time stress perceptions should be provided.

I feel bad and look worse than you: Social comparisons moderate the effect of mood on face health judgement

Mood can bias the judgements people make about themselves and how people compare themselves to others. However, it is not yet clear whether mood also affects appearance-based self-evaluations and social comparisons. Given the importance of perceived health status for well-being, we investigated the effect of mood on self-image and social comparisons of healthiness during two versions of a face health judgement task. Thirty participants judged how they felt compared to healthy and unhealthy looking versions of their own (self version) and a stranger's face (stranger version), after a positive, negative and neutral mood induction. The effect of mood was dependent on self/stranger task order. Although mood did not affect face health judgement for participants who initially judged themselves against their own face, it did affect face health judgement for participants who initially judged themselves in comparison to a stranger's face. After the positive and negative mood inductions, these participants judged themselves as equivalent to healthier/unhealthier looking versions of their own and stranger's faces, respectively. Thus, social comparisons of facial healthiness could provide a perceptual measure of state well-being.

Effects of affective arousal on choice behavior, reward prediction errors, and feedback-related negativities in human reward-based decision making

Emotional experience has a pervasive impact on choice behavior, yet the underlying mechanism remains unclear. Introducing facial-expression primes into a probabilistic learning task, we investigated how affective arousal regulates reward-related choice based on behavioral, model fitting, and feedback-related negativity (FRN) data. Sixty-six paid subjects were randomly assigned to the Neutral-Neutral (NN), Angry-Neutral (AN), and Happy-Neutral (HN) groups. A total of 960 trials were conducted. Subjects in each group were randomly exposed to half trials of the pre-determined emotional faces and another half of the neutral faces before choosing between two cards drawn from two decks with different assigned reward probabilities. Trial-by-trial data were fit with a standard reinforcement learning model using the Bayesian estimation approach. The temporal dynamics of brain activity were simultaneously recorded and analyzed using event-related potentials. Our analyses revealed that subjects in the NN group gained more reward values than those in the other two groups; they also exhibited comparatively differential estimated model-parameter values for reward prediction errors. Computing the difference wave of FRNs in reward vs. non-reward trials, we found that, compared to the NN group, subjects in the AN and HN groups had larger “General” FRNs (i.e., FRNs in no-reward trials minus FRNs in reward trials) and “Expected” FRNs (i.e., FRNs in expected reward-omission trials minus FRNs in expected reward-delivery trials), indicating an interruption in predicting reward. Further, both AN and HN groups appeared to be more sensitive to negative outcomes than the NN group. Collectively, our study suggests that affective arousal negatively regulates reward-related choice, probably through overweighting with negative feedback.

Conflict adaptation is predicted by the cognitive, but not the affective alexithymia dimension

Stimulus-induced response conflict (e.g., in Simon or Stroop tasks) is often reduced after conflict trials—the Gratton effect. It is generally assumed that this effect is due to a strengthening of the representation of the current intention or goal, which in turn increases the degree of stimulus and/or response control. Recent evidence suggests that the motivational signal driving the Gratton effect might be affective in nature. If so, individual differences in either the strength of affective signals and/or the ability to interpret such signals might explain individual differences in cognitive-control adjustments as reflected in the Gratton effect. We tested this hypothesis by relating individual sizes of the Gratton effect in a Simon task to scores on the affective and the cognitive dimension of the Bermond/Vorst Alexithymia Questionnaire (BVAQ)—which we assumed to assess individual differences in affective-signal strength and ability to interpret affective signals, respectively. Results show that the cognitive, but not the affective dimension predicted control adjustment, while the accuracy of heartbeat detection was only (and only weakly) related to online control. This suggests that the motivation to fine-tune one's cognitive-control operations is mediated by, and may depend on one's ability to interpret one's own affective signals.

The Persistence of Experience: Prior Attentional and Emotional State Affects Network Functioning in a Target Detection Task

Efficient, adaptive behavior relies on the ability to flexibly move between internally focused (IF) and externally focused (EF) attentional states. Despite evidence that IF cognitive processes such as event imagination comprise a significant amount of awake cognition, the consequences of internal absorption on the subsequent recruitment of brain networks during EF tasks are unknown. The present functional magnetic resonance imaging (fMRI) study employed a novel attentional state switching task. Subjects imagined positive and negative events (IF task) or performed a working memory task (EF task) before switching to a target detection (TD) task also requiring attention to external information, allowing for the investigation of neural functioning during external attention based on prior attentional state. There was a robust increase of activity in frontal, parietal, and temporal regions during TD when subjects were previously performing the EF compared with IF task, an effect that was most pronounced following negative IF. Additionally, dorsolateral prefrontal cortex was less negatively coupled with ventromedial prefrontal and posterior cingulate cortices during TD following IF compared with EF. These findings reveal the striking consequences for brain activity following immersion in an IF attentional state, which have strong implications for psychiatric disorders characterized by excessive internal focus.

Peer Influences on Adolescent Decision Making

Research efforts to account for elevated risk behavior among adolescents have arrived at an exciting new stage. Moving beyond laboratory studies of age differences in "cool" cognitive processes related to risk perception and reasoning, new approaches have shifted focus to the influence of social and emotional factors on adolescent neurocognition. We review recent research suggesting that adolescent risk-taking propensity derives in part from a maturational gap between early adolescent remodeling of the brain's socio-emotional reward system and a gradual, prolonged strengthening of the cognitive control system. At a time when adolescents spend an increasing amount of time with their peers, research suggests that peer-related stimuli may sensitize the reward system to respond to the reward value of risky behavior. As the cognitive control system gradually matures over the course of the teenage years, adolescents grow in their capacity to coordinate affect and cognition, and to exercise self-regulation even in emotionally arousing situations. These capacities are reflected in gradual growth in the capacity to resist peer influence.

Neural correlates of affective priming effects based on masked facial emotion: an fMRI study

Affective priming refers to the phenomenon that subliminal presentation of facial emotion biases subsequent evaluation of a neutral object in the direction of the prime. The aim of the present study was to specify the neural correlates of evaluative shifts elicited by facial emotion shown below the threshold of conscious perception. We tested the hypotheses whether the amygdala is involved in negative priming, whereas the nucleus accumbens participates in positive priming. In addition, exploratory whole brain correlation analyses were conducted. During 3T fMRI scanning, pictures of sad, happy, and neutral facial expression masked by neutral faces were presented to 110 healthy adults who had to judge valence of masks on a four-point scale. There was evidence for significant negative priming based on sad faces. A correlation was observed between amygdala activation and negative priming. Activation in medial, middle, and superior frontal and middle temporo-occipital areas, and insula was also associated with negative priming. No significant priming based on happy faces was found. However, nucleus accumbens activation to happy faces correlated with the positive priming score. The present findings confirm that the amygdala but also other brain regions, especially the medial frontal cortex, appear involved in automatically elicited negative evaluative shifts.

Preparation for prenatal decision-making: a baseline of knowledge and reflection in women participating in prenatal screening

OBJECTIVE

This prospective study gathered baseline information about knowledge and intentions regarding prenatal testing from women attending their nuchal translucency (NT) ultrasound and first sequential blood screen.

METHOD

Surveys including questions about pregnancy history and hypotheticals about fetal diagnoses were distributed to all willing participants at an urban hospital and a suburban medical building during the waiting time for the NT (N = 659).

RESULTS

The majority "never thought anything could be wrong" with their fetus and had not talked with the father or the health providers about that possibility. Presented with varied fetal diagnoses, the larger group nearly always "had the baby", except in the case of a fatal condition where 28% said they would have the baby in contrast to 26% who would end the pregnancy (remainder undecided). Hypotheticals about varied fetal conditions were generally "undecided" by a quarter to nearly half of the respondents.

CONCLUSION

Women's baseline knowledge and reflection about the nature of prenatal screening and diagnosis are minimal in contrast to the large impact positive results could have on their lives. Providers need to weigh the benefit of priming decision-making by exposing women to the possibility of fetal diagnosis, against the cost of raised anxiety.

Who do you trust? The impact of facial emotion and behaviour on decision making

During social interactions, we use available information to guide our decisions, including behaviour and emotional displays. In some situations, behaviour and emotional displays may be incongruent, complicating decision making. This study had two main aims: first, to investigate the independent contributions of behaviour and facial displays of emotion on decisions to trust, and, second, to examine what happens when the information being signalled by a facial display is incongruent with behaviour. Participants played a modified version of the Trust Game in which they learned simulated players' behaviour with or without concurrent displays of facial emotion. Results indicated that displays of anger, but not happiness, influenced decisions to trust during initial encounters. Over the course of repeated interactions, however, emotional displays consistent with an established pattern of behaviour made independent contributions to decision making, strengthening decisions to trust. When facial display and behaviour were incongruent, participants used current behaviour to inform decision making.

Emotion and decision-making: affect-driven belief systems in anxiety and depression

Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches that link emotion and decision-making, and focus on research with anxious or depressed individuals to show how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression, and outline the broader implications of this approach.

Anxiety and decision-making

Although the everyday decision-making of clinically anxious individuals is clearly influenced by their excessive fear and worry, the relationship between anxiety and decision-making remains relatively unexplored in neuroeconomic studies. In this review, we attempt to explore the role of anxiety in decision-making with a neuroeconomic approach. We first review the neural systems mediating fear and anxiety, which overlap with a network of brain regions implicated in studies of economic decision-making. We then discuss the potential influence of cognitive biases associated with anxiety upon economic choice, focusing on a set of decision-making biases involving choice in the face of potential aversive outcomes. We propose that the neural circuitry supporting fear learning and regulation may mediate the influence of anxiety upon choice and suggest that techniques for altering fear and anxiety may also change decisions.

Social anxiety modulates subliminal affective priming

Background

It is well established that there is anxiety-related variation between observers in the very earliest, pre-attentive stage of visual processing of images such as emotionally expressive faces, often leading to enhanced attention to threat in a variety of disorders and traits. Whether there is also variation in early-stage affective (i.e. valenced) responses resulting from such images, however, is not yet known. The present study used the subliminal affective priming paradigm to investigate whether people varying in trait social anxiety also differ in their affective responses to very briefly presented, emotionally expressive face images.

Methodology/Principal Findings

Participants (n = 67) completed a subliminal affective priming task, in which briefly presented and smiling, neutral and angry faces were shown for 10 ms durations (below objective and subjective thresholds for visual discrimination), and immediately followed by a randomly selected Chinese character mask (2000 ms). Ratings of participants' liking for each Chinese character indicated the degree of valenced affective response made to the unseen emotive images. Participants' ratings of their liking for the Chinese characters were significantly influenced by the type of face image preceding them, with smiling faces generating more positive ratings than neutral and angry ones (F(2,128) = 3.107, p<0.05). Self-reported social anxiety was positively correlated with ratings of smiling relative to neutral-face primed characters (Pearson's r = .323, p<0.01). Individual variation in self-reported mood awareness was not associated with ratings.

Conclusions

Trait social anxiety is associated with individual variation in affective responding, even in response to the earliest, pre-attentive stage of visual image processing. However, the fact that these priming effects are limited to smiling and not angry (i.e. threatening) images leads us to propose that the pre-attentive processes involved in generating the subliminal affective priming effect may be different from those that generate attentional biases in anxious individuals.

Translational application of neuromodulation of decision-making

Recent cognitive neuroscience studies indicate that noninvasive brain stimulation can modulate a wide spectrum of behaviors in healthy individuals. Such modulation of behaviors provides novel insights into the fundamentals and neurobiology of cognitive functions in the healthy brain, but also suggests promising prospects for translational applications into clinical populations. One type of behavior that can be modulated with noninvasive brain stimulation is decision-making. For instance, brain stimulation can induce more cautious or riskier behaviors. The capacity of influencing processes involved in decision-making is of particular interest because such processes are at the core of human social and emotional functioning (or dysfunctioning). We review cognitive neuroscience studies that have successfully modulated processes involved in decision-making with transcranial direct current stimulation (tDCS) or transcranial magnetic stimulation (TMS), including risk taking, reward seeking, impulsivity, and fairness consideration. We also discuss potential clinical relevance of these findings for patients who have still unmet therapeutic need and whose alterations in decision-making represent hallmarks of their clinical symptomatology, such as individuals with addictive disorders.

Explicit and implicit approach motivation interact to predict interpersonal arrogance

Self-reports of approach motivation are unlikely to be sufficient in understanding the extent to which the individual reacts to appetitive cues in an approach-related manner. A novel implicit probe of approach tendencies was thus developed, one that assessed the extent to which positive affective (versus neutral) stimuli primed larger size estimates, as larger perceptual sizes co-occur with locomotion toward objects in the environment. In two studies (total N = 150), self-reports of approach motivation interacted with this implicit probe of approach motivation to predict individual differences in arrogance, a broad interpersonal dimension previously linked to narcissism, antisocial personality tendencies, and aggression. The results of the two studies were highly parallel in that self-reported levels of approach motivation predicted interpersonal arrogance in the particular context of high, but not low, levels of implicit approach motivation. Implications for understanding approach motivation, implicit probes of it, and problematic approach-related outcomes are discussed.

Bob Zajonc and the Unconscious Emotion

This article focuses on Bob Zajonc’s views on unconscious emotion, especially in the context of the debates about the independence of affect and cognition. Historically, Bob was always interested in the “mere”—basic, fundamental processes. His empirical demonstrations of precognitive and preconscious emotional processes, combined with his elegant expositions of them, sharply contrasted with cold and complex cognitive models. Interestingly, Bob tended to believe that whereas the causes of emotion can be unconscious, the emotional state itself tends to be conscious. However, he reconsidered this assumption and in his later work showed that subjects in affective priming experiments do not experience conscious affect, but instead act on basic preferences. Today, Bob’s insights continue to inspire research on “unconscious emotion.”

Increased amygdala activation during automatic processing of facial emotion in schizophrenia

Schizophrenia patients show abnormalities in the processing of facial emotion. The amygdala is a central part of a brain network that is involved in the perception of facial emotions. Previous functional neuroimaging studies on the perception of facial emotion in schizophrenia have focused almost exclusively on controlled processing. In the present study, we investigated the automatic responsivity of the amygdala to emotional faces in schizophrenia and its relationship to clinical symptomatology by applying an affective priming task. 3-T fMRI was utilized to examine amygdala responses to sad and happy faces masked by neutral faces in 12 schizophrenia patients and 12 healthy controls. The Positive and Negative Syndrome Scale (PANSS) was administered to assess current symptomatology. Schizophrenia patients exhibited greater automatic amygdala responses to sad and happy faces relative to controls. Amygdala responses to masked sad and happy expressions were positively correlated with the negative subscale of the PANSS. Schizophrenia patients appear to be characterized by amygdalar hyperresponsiveness to negative and positive facial expressions on an automatic processing level. Heightened automatic amygdala responsivity could be involved in the development and maintenance of negative symptoms in schizophrenia.

Morphometry of human insular cortex and insular volume reduction in Williams syndrome

Functional imaging in humans and anatomical data in monkeys have implicated the insula as a multimodal sensory integrative brain region. The topography of insular connections is organized by its cytoarchitectonic regions. Previous attempts to measure the insula have utilized either indirect or automated methods. This study was designed to develop a reliable method for obtaining volumetric magnetic resonance imaging (MRI) measurements of the human insular cortex, and to validate that method by examining the anatomy of insular cortex in adults with Williams syndrome (WS) and healthy age-matched controls. Statistical reliability was obtained among three raters for this method, supporting its reproducibility not only across raters, but within different software packages. The procedure described here utilizes native-space morphometry as well as a method for dividing the insula into connectivity-based sub-regions estimated from cytoarchitectonics. Reliability was calculated in both ANALYZE (N=3) and BrainImageJava (N=10) where brain scans were measured once in each hemisphere by each rater. This highly reliable method revealed total, anterior, and posterior insular volume reduction bilaterally (all p's<.002) in WS, after accounting for reduced total brain volumes in these participants. Although speculative, the reduced insular volumes in WS may represent a neural risk for the development of hyperaffiliative social behavior with increased specific phobias, and implicate the insula as a critical limbic integrative region. Native-space quantification of the insula may be valuable in the study of neurodevelopmental or neuropsychiatric disorders related to anxiety and social behavior.

The effect of positive emotion and perceived risk on usage intention to online decision aids

Although perceived risk has a negative effect on usage intention toward new information technology, both perceived risk and usage intention are the results of cognitive processes, so they are inevitably influenced by emotion. Based on positive mood theory and the appraisal-tendency framework (ATF), a laboratory experiment using online decision aids with 126 participants was conducted. The results indicate that positive emotion (happy emotion in the current study) can increase usage intention and decrease perceived risk, while perceived risk decreases usage intention. Further investigation finds that perceived risk is a mediator between emotion and usage intention.

Emotional evidence and jurors' judgments: the promise of neuroscience for informing psychology and law

This article is a review of psychological and neuroscience research addressing how juror decision making is influenced by emotion elicited from potentially disturbing evidence such as gruesome autopsy photographs, victim impact statements, and information about a defendant's tragic personal history presented as mitigating evidence. We review (a) converging evidence suggesting that the presence versus absence of such evidence results in more punitive juror judgments, (b) social cognition theories that provide potential explanations for these effects, and (c) neuroscience research aimed at understanding the role of emotion in moral judgments by identifying how brain activity is affected by emotion-eliciting stimuli. We argue that neuroimaging evidence showing that emotional stimuli cause heightened emotion and decreased effortful cognitive processing is relevant in understanding jurors' increased punitiveness after being exposed to emotional evidence, and in turn relevant to debates about the admissibility of emotional evidence in courts of law. Ultimately, we argue for more ecologically valid psychological research to clarify these important issues.