Educating Intuition: Reducing Risky Decisions Using Fuzzy-Trace Theory

Debiasing System 1: Training favours logical over stereotypical intuiting

Whereas people’s reasoning is often biased by intuitive stereotypical associations, recent debiasing studies suggest that performance can be boosted by short training interventions that stress the underlying problem logic. The nature of this training effect remains unclear. Does training help participants correct erroneous stereotypical intuitions through deliberation? Or does it help them develop correct intuitions? We addressed this issue in four studies with base-rate neglect and conjunction fallacy problems. We used a two-response paradigm in which participants first gave an initial intuitive response, under time pressure and cognitive load, and then gave a final response after deliberation. Studies 1A and 2A showed that training boosted performance and did so as early as the intuitive stage. After training, most participants solved the problems correctly from the outset and no longer needed to correct an initial incorrect answer through deliberation. Studies 1B and 2B indicated that this sound intuiting persisted over at least two months. The findings confirm that a short training can debias reasoning at an intuitive “System 1” stage and get reasoners to favour logical over stereotypical intuitions.

From bias to sound intuiting: Boosting correct intuitive reasoning

Although human thinking is often biased by erroneous intuitions, recent de-bias studies suggest that people's performance can be boosted by short training interventions, where the correct answers to reasoning problems are explained. However, the nature of this training effect remains unclear. Does training help participants correct erroneous intuitions through deliberation? Or does it help them develop correct intuitions? We addressed this issue in three studies, by focusing on the well-known Bat-and-Ball problem. We used a two-response paradigm in which participants first gave an initial intuitive response, under time pressure and cognitive load, and then gave a final response after deliberation. Studies 1 and 2 showed that not only did training boost performance, it did so as early as the intuitive stage. After training, most participants solved the problems correctly from the outset and no longer needed to correct an initial incorrect answer through deliberation. Study 3 indicated that this sound intuiting sustained over at least two months. The findings confirm that a short training can boost sound reasoning at an intuitive stage. We discuss key theoretical and applied implications.

Decision-making and risk in bipolar disorder: A quantitative study using fuzzy trace theory

OBJECTIVES

This study characterizes risk-taking behaviours in a group of people with a self-reported diagnosis of BD using fuzzy trace theory (FTT). FTT hypothesizes that risk-taking is a 'reasoned' (but sometimes faulty) action, rather than an impulsive act associated with mood fluctuations.

DESIGN

We tested whether measures of FTT (verbatim and gist-based thinking) were predictive of risk-taking intentions in BD, after controlling for mood and impulsivity. We hypothesized that FTT scales would be significant predictors of risk-taking intentions even after accounting for mood and impulsivity.

METHODS

Fifty-eight participants with BD (age range 21-78, 68% female) completed a series of online questionnaires assessing risk intentions, mood, impulsivity, and FTT.

RESULTS

Fuzzy trace theory scales significantly predicted risk-taking intentions (medium effect sizes), after controlling for mood and impulsivity consistent with FTT (part range .26 to .49). Participants with BD did not show any statistically significant tendency towards verbatim-based thinking.

CONCLUSIONS

Fuzzy trace theory gist and verbatim representations were both independent predictors of risk-taking intentions, even after controlling for mood and impulsivity. The results offer an innovative conceptualization of the mechanisms behind risk-taking in BD.

PRACTITIONER POINTS

Risk-taking behaviour in bipolar disorder is not just a consequence of impulsivity. Measures of fuzzy trace theory help to understand risk-taking in bipolar disorder. FTT measures predict risk-taking intentions, after controlling for mood and impulsivity.

Lay beliefs about risk: relation to risk behaviors and to probabilistic risk perceptions

Lay illness risk beliefs are commonly held philosophies about how risk works. These include beliefs that one's personal illness risk is unknowable and beliefs that thinking about one's risk can actually increase that risk. Beliefs about risk may impact risk behaviors and thereby subsequent health status. However, limited research examines the relation between lay risk beliefs and health behavior. This paper explores this possible relation. A nationally representative sample of adults (N = 1005) recruited from an internet panel were surveyed about lay risk beliefs and risk perceptions regarding diabetes and colorectal cancer, psychosocial factors (i.e., health literacy, need for cognition, locus of control), demographics, and current health behaviors (i.e., cigarette smoking, red meat intake, physical activity). In separate sets of regressions controlling for either demographics, psychosocial factors, or risk perceptions, lay risk beliefs remained significantly related to health behaviors. It may be important to consider how to address lay risk beliefs in intervention content and targeting in order to increase adaptive health behaviors and thereby prevent chronic disease.

Decision making processes and alcohol use among college students

Objective: The neurobiological model of risk-taking and the dual-process model of decision making each provide possible explanations of risky behavior among youth, but their interconnections have rarely been explored, especially among college students, a time of increased alcohol use. Participants: n = 382; Mage = 19.25, SD = 1.33. Method: Participants completed a survey about their deliberative and intuitive decision making style (based on the dual-process model), their socioemotional and cognitive control processes (based on the neurobiological model), and alcohol use. Results: Structural equation modeling showed that dual-process variables and neurobiological variables were positively related. Deliberative decision making and cognitive control were negatively related to alcohol use whereas intuitive decision making was not. Comment: Discussion focuses on the integration of theoretical models with real-world health behaviors and considers implications of the current findings in terms of prevention and intervention to reduce drinking among college students.

Heightened Adolescent Risk-Taking? Insights From Lab Studies on Age Differences in Decision-Making

Surveys concur that adolescents disproportionately engage in many real-world risk behaviors, compared with children and adults. Recently researchers have employed laboratory risky decision-making tasks to replicate this apparent heightened adolescent risk-taking. This review builds on the main findings of the first meta-analysis of such age differences in risky decision-making in the laboratory. Overall, although adolescents engage in more risky decision-making than adults, adolescents engage in risky decision-making equal to children. However, adolescents take fewer risks than children on tasks that allow the option of opting out of taking a risk. To reconcile findings on age differences in risk-taking in the real-world versus the laboratory, an integrative framework merges theories on neuropsychological development with ecological models that emphasize the importance of risk exposure in explaining age differences in risk-taking. Policy insights and recent developments are discussed.

Determining Best Practices for Management of Bacteriuria in Spinal Cord Injury: Protocol for a Mixed-Methods Study

Background

Bacteriuria, either asymptomatic (ASB) or symptomatic, urinary tract infection (UTI), is common in persons with spinal cord injury (SCI). Current Veterans Health Administration (VHA) guidelines recommend a screening urinalysis and urine culture for every veteran with SCI during annual evaluation, even when asymptomatic, which is contrary to other national guidelines. Our preliminary data suggest that a positive urine culture (even without signs or symptoms of infection) drives antibiotic use.

Objective

Through a series of innovative studies utilizing mixed methods, administrative databases, and focus groups, we will gain further knowledge about the attitudes driving current urine testing practices during the annual exam, as well as quantitative data on the clinical outcomes of these practices.

Methods

Aim 1 will identify patient, provider, and facility factors driving bacteriuria testing and subsequent antibiotic use after the SCI annual evaluation through qualitative interviews and quantitative surveys. Aim 2 will use national VHA databases to identify the predictors of urine testing and subsequent antibiotic use during the annual examination and compare the clinical outcomes of those who received antibiotics with those who did not. Aim 3 will use the information gathered from the previous 2 aims to develop the Test Smart, Treat Smart intervention, a combination of patient and provider education and resources that will help stakeholders have informed conversations about urine testing and antibiotic use; feasibility will be tested at a single site.

Results

This protocol received institutional review board and VHA Research and Development approval in July 2017, and Veterans Affairs Health Services Research and Development funding started on November 2017. As of submission of this manuscript, 10/15 (67%) of the target goal of provider interviews were complete, and 77/100 (77%) of the goal of surveys. With regard to patients, 5/15 (33%) of the target goal of interviews were complete, and 20/100 (20%) of the target goal of surveys had been completed. Preliminary analyses are ongoing; the study team plans to present these results in April 2019. Database analyses for aim 2 will begin in January 2019.

Conclusions

The negative consequences of antibiotic overuse and antibiotic resistance are well-documented and have national and even global implications. This study will develop an intervention aimed to educate stakeholders on evidence-based management of ASB and UTI and guide antibiotic stewardship in this high-risk population. The next step will be to refine the intervention and test its feasibility and effectiveness at multiple sites as well as reform policy for management of this common but burdensome condition.

International Registered Report Identifier (IRRID)

DERR1-10.2196/12272

Educating good decisions

Can we educate decision makers to make better decisions? In the present paper, I argue that we can in at least two broad ways: (1) teaching concrete knowledge about a specific decision or decision type and (2) teaching more abstract decision-making competencies thought to lead to better decisions. Teaching knowledge can be done using decision aids and similar techniques that provide important information about a specific choice (e.g., a medical treatment option). In these cases, information presented using evidence-based techniques to improve comprehension and use of information will have greater effects on judgments and choices. Teaching more abstract decision competencies, on the other hand, involves formal schooling (with the bulk of formal education falling during childhood) or training in a specific competency important to decision processes and outcomes; I use numeracy interventions as an exemplar.

The Influences of Described and Experienced Information on Adolescent Risky Decision Making

Adolescents are known to take more risks than adults, which can be harmful to their health and well-being. However, despite age differences in real-world risk taking, laboratory risk-taking paradigms often do not evince these developmental patterns. Recent findings in the literature suggest that this inconsistency may be due in part to differences between how adolescents process information about risk when it is described (e.g., in a description-based classroom intervention) versus when it is experienced (e.g., when a teenager experiences the outcome of a risky choice). The present review considers areas of research that can inform approaches to intervention by deepening our understanding of risk taking in described or experienced contexts. We examine the literature on the description-experience gap, which has generally been limited to studies of adult samples, but which highlights differential decision making when risk information is described versus experienced. Informed by this work, we then explore the developmental literature comparing adolescent to adult decision making, and consider whether inconsistencies in age-related findings might be explained by distinguishing between studies in which participants learn about decision outcomes through experience versus description. In light of evidence that studies using experience-based tasks more often show age differences in risk taking, we consider the implications of this pattern, and argue that experience-based tasks may be more ecologically valid measures of adolescent risky decision making, in part due to the heightened affective nature of these tasks. Finally, we propose a model to integrate our findings with theories of adolescent risk-taking, and discuss implications for risk-reduction messaging.

Beyond stereotypes of adolescent risk taking: Placing the adolescent brain in developmental context

Recent neuroscience models of adolescent brain development attribute the morbidity and mortality of this period to structural and functional imbalances between more fully developed limbic regions that subserve reward and emotion as opposed to those that enable cognitive control. We challenge this interpretation of adolescent development by distinguishing risk-taking that peaks during adolescence (sensation seeking and impulsive action) from risk taking that declines monotonically from childhood to adulthood (impulsive choice and other decisions under known risk). Sensation seeking is primarily motivated by exploration of the environment under ambiguous risk contexts, while impulsive action, which is likely to be maladaptive, is more characteristic of a subset of youth with weak control over limbic motivation. Risk taking that declines monotonically from childhood to adulthood occurs primarily under conditions of known risks and reflects increases in executive function as well as aversion to risk based on increases in gist-based reasoning. We propose an alternative Life-span Wisdom Model that highlights the importance of experience gained through exploration during adolescence. We propose, therefore, that brain models that recognize the adaptive roles that cognition and experience play during adolescence provide a more complete and helpful picture of this period of development.