Choking under pressure: the neuropsychological mechanisms of incentive-induced performance decrements

Model-free decision-making underlies motor errors in rapid sequential movements under threat

Our movements, especially sequential ones, are usually goal-directed, i.e., coupled with task-level goals. Consequently, cognitive strategies for decision-making and motor performance are likely to influence each other. However, evidence linking decision-making strategies and motor performance remains elusive. Here, we designed a modified version of the two-step task, named the two-step sequential movement task, where participants had to conduct rapid sequential finger movements to obtain rewards (n = 40). In the shock session, participants received an electrical shock if they made an erroneous or slow movement, while in the no-shock session, they only received zero reward. We found that participants who prioritised model-free decision-making committed more motor errors in the presence of the shock stimulus (shock sessions) than those who prioritised model-based decision-making. Using a mediation analysis, we also revealed a strong link between the balance of the model-based and the model-free learning strategies and sequential movement performances. These results suggested that model-free decision-making produces more motor errors than model-based decision-making in rapid sequential movements under the threat of stressful stimuli.

Pre-movement muscle co-contraction associated with motor performance deterioration under high reward conditions

Reward usually enhances task performance, but exceptionally large rewards can impede performance due to psychological pressure. In this study, we investigated motor activity changes in high-reward situations and identified indicators for performance decline. Fourteen healthy adults practiced a velocity-dependent right-hand motor task for three days, followed by a test day with varying monetary reward for each trial. Participants were divided into low performers (LPs) and high performers (HPs) according to whether success rate decreased or increased, respectively, on the highest reward trials compared to lower reward trials. Both LPs and HPs demonstrated increased hand velocity during higher reward trials, but only LPs exhibited a significant increase in velocity variance. There was also a negative correlation between the pre-movement co-contraction index (CCI) of the biceps and triceps muscles and success rate on the highest reward trials. This correlation was confirmed in a second experiment with 12 newly recruited participants, suggesting that pre-movement CCI is a marker for performance decline caused by high reward. These findings suggest that interventions to reduce pre-movement CCI such as biofeedback training could be useful for preventing the paradoxical decline in motor performance associated with high rewards.

The relationship between T7-Fz alpha coherence and peak performance in self-paced sports: a meta-analytical review

We examined whether the alpha-band coherence between the T7-Fz (verbal analytical-motor planning) brain areas were related to superior performance in sports. We searched for related papers across eight databases: ProQuest Central, ProQuest Psychology Journals, PsycARTICLES, PsycINFO, SPORTDiscus, MEDLINE, Scopus, and Web of Science using relevant keywords (i.e., EEG AND sports AND coherence). Seven studies, with a total of 194 participants, met our inclusion criteria and were shortlisted for statistical analysis. We compared EEG coherence data for both within-subject and between-subject experimental designs. Our analysis revealed that athletes had lower coherence in the T7-Fz brain pathway for alpha- band activation (Hedges' g = - 0.54; p = 0.03) when performing better. Theoretically, these results corroborate the notion that athletes become more "neurally efficient" as the verbal and motor areas of their brains function more independently, i.e., the neural efficiency hypothesis. Accordingly, athletes who can limit verbal interference are more likely to perform a sporting task successfully.

Playing for keeps or just playing with emotion? Studying tilt and emotion regulation in video games

Introduction

In video gaming, tilt is thought to relate to poor emotional control and game performance. Despite widespread recognition of tilt in video gaming, there is a lack of research examining tilt empirically.

Methods

One thousand and seven gamers took part in our online study examining gamers experience of tilt, the factors which contribute to and protect against tilt, and the emotion regulation strategies gamers employ to deal with tilt.

Results

Gamers who reported playing for more competitive reasons, were at higher risk of experiencing tilt. Additional factors associated with an increased risk of experiencing tilt were increased anger and more hours spent playing. Protective factors against experiencing tilt were also identified, inclusive of a greater number of years gaming experience and engagement in adaptive emotion regulation strategies.

Discussion

This study provides an important starting point for creating a better understanding of tilt in gaming, equipping us with new knowledge to better support gamers to improve their emotion regulation during game play performance.

Instructed motivational states bias reinforcement learning and memory formation

Motivation influences goals, decisions, and memory formation. Imperative motivation links urgent goals to actions, narrowing the focus of attention and memory. Conversely, interrogative motivation integrates goals over time and space, supporting rich memory encoding for flexible future use. We manipulated motivational states via cover stories for a reinforcement learning task: The imperative group imagined executing a museum heist, whereas the interrogative group imagined planning a future heist. Participants repeatedly chose among four doors, representing different museum rooms, to sample trial-unique paintings with variable rewards (later converted to bonus payments). The next day, participants performed a surprise memory test. Crucially, only the cover stories differed between the imperative and interrogative groups; the reinforcement learning task was identical, and all participants had the same expectations about how and when bonus payments would be awarded. In an initial sample and a preregistered replication, we demonstrated that imperative motivation increased exploitation during reinforcement learning. Conversely, interrogative motivation increased directed (but not random) exploration, despite the cost to participants' earnings. At test, the interrogative group was more accurate at recognizing paintings and recalling associated values. In the interrogative group, higher value paintings were more likely to be remembered; imperative motivation disrupted this effect of reward modulating memory. Overall, we demonstrate that a prelearning motivational manipulation can bias learning and memory, bearing implications for education, behavior change, clinical interventions, and communication.

Under pressure: the interaction between high-stakes contexts and individual differences in decision-making in humans and non-human species

Observed behavior can be the result of complex cognitive processes that are influenced by environmental factors, physiological process, and situational features. Pressure, a feature of a situation in which an individual's outcome is impacted by his or her own ability to perform, has been traditionally treated as a human-specific phenomenon and only recently have pressure-related deficits been considered in relation to other species. However, there are strong similarities in biological and cognitive systems among mammals (and beyond), and high-pressure situations are at least theoretically common in the wild. We hypothesize that other species are sensitive to pressure and that we can learn about the evolutionary trajectory of pressure responses by manipulating pressure experimentally in these other species. Recent literature indicates that, as in humans, pressure influences responses in non-human primates, with either deficits in ability to perform ("choking") or an ability to thrive when the stakes are high. Here, we synthesize the work to date on performance under pressure in humans and how hormones might be related to individual differences in responses. Then, we discuss why we would expect to see similar effects of pressure in non-humans and highlight the existing evidence for how other species respond. We argue that evidence suggests that other species respond to high-pressure contexts in similar ways as humans, and that responses to pressure are a critical missing piece of our understanding of cognition in human and non-human animals. Understanding pressure's effects could provide insight into individual variation in decision-making in comparative cognition and the evolution of human decision-making.

Effects of Expressive Writing on "Choking under Pressure" in High Test-Anxious Individuals

(1) Background: High test-anxious students often fail to perform at their actual level and are prone to choking under pressure (CUP). The aim of the present study was to investigate whether expressive writing (EW) can help high test-anxious individuals reduce the degree of the CUP effect, and whether the intervention effects were different in people with different working memory capacities. (2) Methods: High test-anxious participants wrote expressively (EW group) or neutrally (control group) according to guidance, and then completed a modular arithmetic (MA) task under a high-stress condition. (3) Results: The state anxiety score of the control group was significantly higher than that of the EW group in the high-pressure situation, indicating that the EW intervention was helpful to alleviate the state anxiety. Subjects with high working memory capacity in the control group performed the complex MA task significantly less accurately in the high-stress situation than in the low-stress situation, showing the CUP effect. There was no significant difference in complex MA task scores between high- and low-stress situations for subjects with high working memory capacity in the EW group, indicating that the EW intervention can reduce the degree of the CUP effect. (4) Conclusions: EW intervention was effective in reducing state anxiety levels and attenuating the detrimental effects of test stress on cognitive processing in test-anxious individuals with high working memory capacity.

Evaluation of changes in the cognitive function of adult cynomolgus monkeys under stress induced by audio-visual stimulation by applying modified finger maze test

Stress in life is ubiquitous and unavoidable. Prolonged exposure to severe stress can lead to physical intolerance and impair cognitive function. Non-human primates are considered to be the best animal model for studying cognitive function, especially memory and attention. The finger maze test, with the advantages of short training time and lower cost, is recommended to evaluate learning and memory in non-human primates. In this study, we modified the finger maze test method to evaluate the cognitive function of single-housed cynomolgus monkeys. The flexibility and attention of cynomolgus monkeys were assessed by performing the complex task test and the stranger intrusion interference test, respectively, which increased the difficulty of obtaining rewards, and the ability of long-term memory was also evaluated by the memory test. Furthermore, the changes in cognitive function of the cynomolgus monkeys were tested by using the finger maze test after audio-visual stimulation, and the changes in the cortisol levels during stimulation were also analyzed. We found that, after completing the learning test, there was no significant decrease in their success rate when monkeys processed multitasks at the same time. In the stranger intrusion interference test, all subjects were distracted, but the accuracy did not decrease. The monkeys completed the memory tests in the 1st and 2nd months after the learning tests, with a high success rate. However, the success rate decreased significantly at the end of the 4th month. During audio-visual stimulation, the plasma cortisol level significantly increased in the first 2 months and was maintained at a high level thereafter. One month after audio-visual stimulation, the accuracy of the memory test was significantly reduced, and the total time of distraction was significantly prolonged. In conclusion, chronic audio-visual stimulation can increase blood cortisol levels and impair cognitive function. The modified finger maze test can evaluate many aspects of cognitive function and assess the changes in the cognitive function of adult cynomolgus monkeys under stress.

Endogenous cortisol correlates with performance under pressure on a working memory task in capuchin monkeys

Humans often experience striking performance deficits when their outcomes are determined by their own performance, colloquially referred to as “choking under pressure.” Physiological stress responses that have been linked to both choking and thriving are well-conserved in primates, but it is unknown whether other primates experience similar effects of pressure. Understanding whether this occurs and, if so, its physiological correlates, will help clarify the evolution and proximate causes of choking in humans. To address this, we trained capuchin monkeys on a computer game that had clearly denoted high- and low-pressure trials, then tested them on trials with the same signals of high pressure, but no difference in task difficulty. Monkeys significantly varied in whether they performed worse or better on high-pressure testing trials and performance improved as monkeys gained experience with performing under pressure. Baseline levels of cortisol were significantly negatively related to performance on high-pressure trials as compared to low-pressure trials. Taken together, this indicates that less experience with pressure may interact with long-term stress to produce choking behavior in early sessions of a task. Our results suggest that performance deficits (or improvements) under pressure are not solely due to human specific factors but are rooted in evolutionarily conserved biological factors.

How learning unfolds in the brain: toward an optimization view

How do changes in the brain lead to learning? To answer this question, consider an artificial neural network (ANN), where learning proceeds by optimizing a given objective or cost function. This "optimization framework" may provide new insights into how the brain learns, as many idiosyncratic features of neural activity can be recapitulated by an ANN trained to perform the same task. Nevertheless, there are key features of how neural population activity changes throughout learning that cannot be readily explained in terms of optimization and are not typically features of ANNs. Here we detail three of these features: (1) the inflexibility of neural variability throughout learning, (2) the use of multiple learning processes even during simple tasks, and (3) the presence of large task-nonspecific activity changes. We propose that understanding the role of these features in the brain will be key to describing biological learning using an optimization framework.

Heuristics contribute to sensorimotor decision-making under risk

Research in psychophysics argues that incentivized sensorimotor decisions (such as deciding where to reach to get a reward) maximize expected gain, suggesting that these decisions may be impervious to cognitive biases and heuristics. We tested this hypothesis in two experiments, directly comparing the predictive accuracy of an optimal model and plausible suboptimal models. We obtained strong evidence that people deviated from the optimal strategy by excessively avoiding loss regions when the potential loss was zero and failing to shift far enough away from loss regions when potential losses outweighed the potential gains. Although allowing nonlinear distortions of value and probability information improved the fit of value-maximizing models, behavior was best described by a model encapsulating a simple heuristic strategy. This suggests that visuomotor decisions are likely influenced by biases and heuristics observed in more classical economic decision-making tasks.

Monkeys exhibit a paradoxical decrease in performance in high-stakes scenarios

Choking under pressure is a frustrating phenomenon experienced sometimes by skilled performers as well as during everyday life. The phenomenon has been extensively studied in humans, but it has not been previously shown whether animals also choke under pressure. Here we report that rhesus monkeys also choke under pressure. This indicates that there may be shared neural mechanisms that underlie the behavior in both humans and monkeys. Introducing an animal model for choking under pressure allows for opportunities to study the neural causes of this paradoxical behavior.

In high-stakes situations, people sometimes exhibit a frustrating phenomenon known as “choking under pressure.” Usually, we perform better when the potential payoff is larger. However, once potential rewards get too high, performance paradoxically decreases—we “choke.” Why do we choke under pressure? An animal model of choking would facilitate the investigation of its neural basis. However, it could be that choking is a uniquely human occurrence. To determine whether animals also choke, we trained three rhesus monkeys to perform a difficult reaching task in which they knew in advance the amount of reward to be given upon successful completion. Like humans, monkeys performed worse when potential rewards were exceptionally valuable. Failures that occurred at the highest level of reward were due to overly cautious reaching, in line with the psychological theory that explicit monitoring of behavior leads to choking. Our results demonstrate that choking under pressure is not unique to humans, and thus, its neural basis might be conserved across species.

US Physicians' Perspective on the Sudden Shift to Telehealth: Survey Study

Background

Given the sudden shift to telemedicine during the early COVID-19 pandemic, we conducted a survey of practicing physicians’ experience with telehealth during the prepandemic and early pandemic periods. Our survey estimates that most patient visits in the United States during the early COVID-19 pandemic period were conducted via telehealth. Given this magnitude and the potential benefits and challenges of telehealth for the US health care system, in this paper, we obtain, summarize, and analyze telehealth views and experiences of US-based practicing-physicians.

Objective

The aim of this study was to examine the extent of shift toward telehealth training and care provision during the early pandemic from the US-based practicing physicians’ perspective. We also sought to determine the short- and long-term implications of this shift on the quality, access, and mode of US health care delivery.

Methods

We conducted a purposive, snowball-sampled survey of US practicing-physicians. A total of 148 physician completed the survey. Data were collected from July 17, 2020, through September 4, 2020.

Results

Sample training intensity scaled 21-fold during the early pandemic period, and patient-care visits conducted via telehealth increased, on average, from 13.1% directly before the pandemic to 59.7% during the early pandemic period. Surveyed physician respondents reported that telehealth patient visits and face-to-face patient visits are comparable in quality. The difference was not statistically significant based on a nonparametric sign test (P=.11). Moreover, physicians feel that telehealth care should continue to play a larger role (44.9% of total visits) in postpandemic health care in the United States. Our survey findings suggest a high market concentration in telehealth software, which is a market structural characteristic that may have implications on the cost and access of telehealth. The results varied markedly by physician employer type.

Conclusions

During the shift toward telehealth, there has been a considerable discovery among physicians regarding US telehealth physicians. Physicians are now better prepared to undertake telehealth care from a training perspective. They are favorable toward a permanently expanded telehealth role, with potential for enhanced health care access, and the realization of enhanced access may depend on market structural characteristics of telehealth software platforms.

Exploring the Brain Activity Related to Missing Penalty Kicks: An fNIRS Study

At vital moments in professional soccer matches, penalties were often missed. Psychological factors, such as anxiety and pressure, are among the critical causes of the mistakes, commonly known as choking under pressure. Nevertheless, the factors have not been fully explored. In this study, we used functional near-infrared spectroscopy (fNIRS) to investigate the influence of the brain on this process. An in-situ study was set-up (N = 22), in which each participant took 15 penalties under three different pressure conditions: without a goalkeeper, with an amiable goalkeeper, and with a competitive goalkeeper. Both experienced and inexperienced soccer players were recruited, and the brain activation was compared across groups. Besides, fNIRS activation was compared between sessions that participants felt anxious against sessions without anxiety report, and between penalty-scoring and -missing sessions. The results show that the task-relevant brain region, the motor cortex, was more activated when players were not experiencing performance anxiety. The activation of task-irrelevant areas was shown to be related to players experiencing anxiety and missing penalties, especially the prefrontal cortex (PFC). More particularly, an overall higher activation of the PFC and an increase of PFC lateral asymmetry were related to anxious players and missed penalties, which can be caused by players' worries about the consequences of scoring or missing the penalty kicks. When experienced players were feeling anxious, their left temporal cortex activation increased, which could be an indication that experienced overthink the situation and neglect their automated skills. Besides, the left temporal cortex activation is higher when inexperienced players succeeded to score a penalty. Overall, the results of this study are in line with the neural efficiency theory and demonstrate the feasibility and ecological validity to detect neurological clues relevant to anxiety and performance from fNIRS recordings in the field.

Putting Attention on the Spot in Coaching: Shifting to an External Focus of Attention With Imagery Techniques to Improve Basketball Free-Throw Shooting Performance

Attentional focus is an area that has garnered considerable attention in the sport psychology and motor performance literature. This is unsurprising given that attentional focus has been directly linked to performance outcomes and is susceptible to coaching input. While research has amassed supporting benefits of an external focus of attention (EFA) on motor performance using verbal instruction, other studies have challenged the notion that an EFA is more beneficial than an internal focus of attention (IFA) for sport-related performance. Further, it is unclear what type of instructions may serve to direct an athlete to an EFA and, in particular, if coaching can utilize imagery to orient an athlete toward an EFA. In the present exploratory study, we evaluate the effectiveness of instruction to improve free-throw shooting performance with an emphasis on an EFA brought about by implementing techniques borrowed from the imagery literature. This was tested relative to an alternate approach with an IFA induced through an emphasis on technique, devised to more closely resemble input typical of coach-to-athlete instruction. Twenty-five male and female university basketball players completed both conditions in a fully counterbalanced within-subject design. Results confirmed that participants in the EFA imagery condition had greater shooting accuracy than in the IFA technique condition. The study provides initial evidence that EFA coaching can borrow from imagery techniques, though future research should elucidate the underlying mechanisms of the effect.

Factors of choking under pressure in musicians

Under pressure, motor actions, such as those required in public speech, surgery, or musical performance, can be compromised, even when these have been well-trained. The latter is often referred to as 'choking' under pressure. Although multifaceted problems mediate such performance failure in anxiogenic situations, such as compromised motor dexterity and cognitive disruption, the fundamental set of abnormalities characterizing choking under pressure and how these abnormalities are related have not been elucidated. Here, we attempted, first, to classify behavioural, psychological, and physiological abnormalities associated with choking under pressure in musicians and, second, to identify their relationship based on datasets derived from a questionnaire with 258 pianist respondents. Explorative factor analysis demonstrated eight functional abnormalities related to the musicians' choking, such as attention to the audience, erroneous motor actions, perceptual confusion, and failure of memory recall, which however did not include exaggerated attention to the performance. This suggests distraction of attention away from skill execution, which may underlie the spoiled performance under pressure. A structural equation analysis further inferred causal relationships among them. For instance, while failure of memory recall was influenced by passive behaviours manifesting under pressure, erroneous motor actions during performance were influenced by feeling rushed and a loss of body control. In addition, some specific personal traits, such as neuroticism, public self-consciousness, and a lack of confidence, were associated with the extent to which pressure brought about these abnormalities. These findings suggest that distinct psycho-behavioural abnormalities and personal traits underlie the detrimental effects of pressure on musical performance.

The Role of Motivation and Anxiety on Error Awareness in Younger and Older Adults

Aging is associated with several changes in cognitive functions, as well as in motivational and affective processes, which in turn interact with cognitive functions. The present study aimed to investigate error awareness (EA), which declines with aging, in relation to motivation and anxiety. Adopting an experimental task, we firstly tested the hypothesis that EA could be enhanced through reward motivation. Secondly, we explored the relation between state and trait anxiety and EA, investigating the hypothesis of an association between EA and anxiety, and between anxiety and the potential benefit of motivation on EA. Thirty healthy younger (age range: 19-35 years; mean age 25.4 ± 5.1; 10 M) and 30 healthy older adults (age range: 61-83 years; mean age 69.7 ± 5.5; 12 M) took part in the study and performed both the classic Error Awareness Task (EAT) and one experimental task, called the Motivational EAT. In this new task, motivational incentives were delivered after aware correct responses and aware errors. For every participant, standard measures of state and trait anxiety and cognitive functions were collected. Confirming the presence of a significant age-related EA decline, results did not reveal any influence of reward motivation on EA, nor any relation between EA and anxiety. However, both younger and older adults had longer response times (RTs) and made more errors during the Motivational EAT, with the more anxious participants showing the greater RT slowing. Findings suggest that reward motivation might not be always beneficial for cognitive performance, as well as that anxiety does not relate to EA capacity. Results also recommend further investigation, as well as the assessment of EA in patients with either motivational deficits like apathy, and/or with anxiety disorders.

Future Portrait of the Athletic Brain: Mechanistic Understanding of Human Sport Performance Via Animal Neurophysiology of Motor Behavior

Sport performances are often showcases of skilled motor control. Efforts to understand the neural processes subserving such movements may teach us about general principles of behavior, similarly to how studies on neurological patients have guided early work in cognitive neuroscience. While investigations on non-human animal models offer valuable information on the neural dynamics of skilled motor control that is still difficult to obtain from humans, sport sciences have paid relatively little attention to these mechanisms. Similarly, knowledge emerging from the study of sport performance could inspire innovative experiments in animal neurophysiology, but the latter has been only partially applied. Here, we advocate that fostering interactions between these two seemingly distant fields, i.e., animal neurophysiology and sport sciences, may lead to mutual benefits. For instance, recording and manipulating the activity from neurons of behaving animals offer a unique viewpoint on the computations for motor control, with potentially untapped relevance for motor skills development in athletes. To stimulate such transdisciplinary dialog, in the present article, we also discuss steps for the reverse translation of sport sciences findings to animal models and the evaluation of comparability between animal models of a given sport and athletes. In the final section of the article, we envision that some approaches developed for animal neurophysiology could translate to sport sciences anytime soon (e.g., advanced tracking methods) or in the future (e.g., novel brain stimulation techniques) and could be used to monitor and manipulate motor skills, with implications for human performance extending well beyond sport.

Multitasking and Time Pressure in the Operating Room: Impact on Surgeons' Brain Function

OBJECTIVE

To assess the impact of multitasking and time pressure on surgeons' brain function during laparoscopic suturing.

SUMMARY BACKGROUND DATA

Recent neuroimaging evidence suggests that deterioration in surgical performance under time pressure is associated with deactivation of the prefrontal cortex (PFC), an area important for executive functions. However, the effect of multitasking on operator brain function remains unknown.

METHODS

Twenty-nine surgical residents performed an intracorporeal suturing task under four conditions: 1) self-paced suturing, 2) time-pressured suturing, 3) self-paced suturing plus decision-making, and 4) time-pressured suturing plus decision-making. Subjective workload was quantified using the Surgical Task Load Index. Technical skill was objectively assessed using task progression scores, error scores, leak volumes, and knot tensile strengths. PFC activation was measured using optical neuroimaging.

RESULTS

Compared with self-paced suturing, subjective workload (au) was significantly greater in time-pressured suturing (146.0 vs 196.0, P < 0.001), suturing with decision-making (146.0 vs 182.0, P < 0.001), and time-pressured suturing with decision-making (146.0 vs 227.0, P < 0.001). Technical performance during combined suturing and decision-making tasks was inferior to suturing alone under time pressure or self-paced conditions (P < 0.001). Significant dorsolateral PFC (DLPFC) activations were observed during self-paced suturing, and ventrolateral PFC (VLPFC) deactivations were identified during time-pressured suturing. However, suturing in conjunction with decision-making resulted in significant deactivation across both the VLPFC and DLPFC (P < 0.05). Random effects regression analysis confirmed decision-making predicts VLPFC and DLPFC deactivation (z = -2.62, P < 0.05).

CONCLUSIONS

Performance degradation during high workload conditions is associated with deactivation of prefrontal regions important for attentional control, working memory, and cognitive flexibility, particularly during tasks involving simultaneous motor and cognitive engagement.

Association of Residents' Neural Signatures With Stress Resilience During Surgery

Importance

Intraoperative stressors may compound cognitive load, prompting performance decline and threatening patient safety. However, not all surgeons cope equally well with stress, and the disparity between performance stability and decline under high cognitive demand may be characterized by differences in activation within brain areas associated with attention and concentration such as the prefrontal cortex (PFC).

Objective

To compare PFC activation between surgeons demonstrating stable performance under temporal stress with those exhibiting stress-related performance decline.

Design, Setting, and Participants

Cohort study conducted from July 2015 to September 2016 at the Imperial College Healthcare National Health Service Trust, England. One hundred two surgical residents (postgraduate year 1 and greater) were invited to participate, of which 33 agreed to partake.

Exposures

Participants performed a laparoscopic suturing task under 2 conditions: self-paced (SP; without time-per-knot restrictions), and time pressure (TP; 2-minute per knot time restriction).

Main Outcomes and Measures

A composite deterioration score was computed based on between-condition differences in task performance metrics (task progression score [arbitrary units], error score [millimeters], leak volume [milliliters], and knot tensile strength [newtons]). Based on the composite score, quartiles were computed reflecting performance stability (quartile 1 [Q1]) and decline (quartile 4 [Q4]). Changes in PFC oxygenated hemoglobin concentration (HbO2) measured at 24 different locations using functional near-infrared spectroscopy were compared between Q1 and Q4. Secondary outcomes included subjective workload (Surgical Task Load Index) and heart rate.

Results

Of the 33 participants, the median age was 33 years, the range was 29 to 56 years, and 27 were men (82%). The Q1 residents demonstrated task-induced increases in HbO2 across the bilateral ventrolateral PFC (VLPFC) and right dorsolateral PFC in the SP condition and in the VLPFC in the TP condition. In contrast, Q4 residents demonstrated decreases in HbO2 in both conditions. The magnitude of PFC activation (change in HbO2) was significantly greater in Q1 than Q4 across the bilateral VLPFC during both SP (mean [SD] left VLPFC: Q1, 0.44 [1.30] μM; Q4, -0.21 [2.05] μM; P < .001; right VLPFC: Q1, 0.46 [1.12] μM; Q4, -0.15 [2.14] μM; P < .001) and TP (mean [SD] left VLPFC: Q1, 0.44 [1.36] μM; Q4, -0.03 [1.83] μM; P = .001; right VLPFC: Q1, 0.49 [1.70] μM; Q4, -0.32 [2.00] μM; P < .001) conditions. There were no significant between-group differences in Surgical Task Load Index or heart rate in either condition.

Conclusions and Relevance

Performance stability within TP is associated with sustained prefrontal activation indicative of preserved attention and concentration, whereas performance decline is associated with prefrontal deactivation that may represent task disengagement.

Activity in the dorsal ACC causes deterioration of sequential motor performance due to anxiety

Performance anxiety can profoundly affect motor performance, even in experts such as professional athletes and musicians. Previously, the neural mechanisms underlying anxiety-induced performance deterioration have predominantly been investigated for individual one-shot actions. Sports and music, however, are characterized by action sequences, where many individual actions are assembled to develop a performance. Here, utilizing a novel differential sequential motor learning paradigm, we first show that performance at the junctions between pre-learnt action sequences is particularly prone to anxiety. Next, utilizing functional magnetic resonance imaging (fMRI), we reveal that performance deterioration at the junctions is parametrically correlated with activity in the dorsal anterior cingulate cortex (dACC). Finally, we show that 1 Hz repetitive transcranial magnetic stimulation of the dACC attenuates the performance deterioration at the junctions. These results demonstrate causality between dACC activity and impairment of sequential motor performance due to anxiety, and suggest new intervention techniques against the deterioration.

A Pavlovian account for paradoxical effects of motivation on controlling response vigour

In high stakes situations, people sometimes choke under pressure, performing below their abilities. Here, we suggest a novel mechanism to account for this paradoxical effect of motivation: the automatic adjustment of action vigour to potential reward. Although adaptive on average, this mechanism may impede fine motor control. Such detrimental effect was observed in three studies (n = 74 in total), using behavioural tasks where payoff depended on the precision of handgrip squeezing or golf putting. Participants produced more force for higher incentives, which aggravated their systematic overshooting of low-force targets. This reward bias was specific to action vigour, as reward did not alter action timing, direction or variability across trials. Although participants could report their reward bias, they somehow failed to limit their produced force. Such an automatic link between incentive and force level might correspond to a Pavlovian response that is counterproductive when action vigour is not instrumental for maximizing reward.

Temporal Stress in the Operating Room: Brain Engagement Promotes "Coping" and Disengagement Prompts "Choking"

OBJECTIVE

To investigate the impact of time pressure (TP) on prefrontal activation and technical performance in surgical residents during a laparoscopic suturing task.

BACKGROUND

Neural mechanisms enabling surgeons to maintain performance and cope with operative stressors are unclear. The prefrontal cortex (PFC) is implicated due to its role in attention, concentration, and performance monitoring.

METHODS

A total of 33 residents [Postgraduate Year (PGY)1-2 = 15, PGY3-4 = 8, and PGY5 = 10] performed a laparoscopic suturing task under "self-paced" (SP) and "TP" conditions (TP = maximum 2 minutes per knot). Subjective workload was quantified using the Surgical Task Load Index. PFC activation was inferred using optical neuroimaging. Technical skill was assessed using progression scores (au), error scores (mm), leak volumes (mL), and knot tensile strengths (N).

RESULTS

TP led to greater perceived workload amongst all residents (mean Surgical Task Load Index score ± SD: PGY1-2: SP = 160.3 ± 24.8 vs TP = 202.1 ± 45.4, P < 0.001; PGY3-4: SP = 123.0 ± 52.0 vs TP = 172.5 ± 43.1, P < 0.01; PGY5: SP = 105.8 ± 55.3 vs TP = 159.1 ± 63.1, P < 0.05). Amongst PGY1-2 and PGY3-4, deterioration in task progression, error scores and knot tensile strength (P < 0.05), and diminished PFC activation was observed under TP. In PGY5, TP resulted in inferior task progression and error scores (P < 0.05), but preservation of knot tensile strength. Furthermore, PGY5 exhibited less attenuation of PFC activation under TP, and greater activation than either PGY1-2 or PGY3-4 under both experimental conditions (P < 0.05).

CONCLUSIONS

Senior residents cope better with temporal demands and exhibit greater technical performance stability under pressure, possibly due to sustained PFC activation and greater task engagement. Future work should seek to develop training strategies that recruit prefrontal resources, enhance task engagement, and improve performance under pressure.

State anxiety disorganizes finger movements during musical performance

Skilled performance, in many situations, exposes an individual to psychological stress and fear, thus triggering state anxiety and compromising motor dexterity. Suboptimal skill execution in people under pressure affects the future career prospects of trained individuals, such as athletes, clinicians, and musicians. However, it has not been elucidated in what manner state anxiety affects multijoint movements and thereby degrades fine motor control. Using principal component analysis of hand kinematics recorded by a data glove during piano performances, we tested whether state anxiety affects the organization of movements of multiple joints or merely constrains the amplitude of the individual joints without affecting joint movement coordination. The result demonstrated changes in the coordination of movements across joints in piano performances by experts under psychological stress. Overall, the change was characterized by reduction of synergistic movements between the finger responsible for the keypress and its adjacent fingers. A regression analysis further identified that the attenuation of the movement covariation between the fingers was associated with an increase in temporal error during performance under pressure. In contrast, neither the maximum nor minimum angles of the individual joints of the hand were susceptible to induced anxiety. These results suggest that degradation of fine motor control under pressure is mediated by incoordination of movements between the fingers in skilled piano performances. NEW & NOTEWORTHY A key issue in neuromuscular control of coordinated movements is how the nervous system organizes multiple degrees of freedom for production of skillful motor behaviors. We found that state anxiety disorchestrates the organization of finger movements so as to decrease synergistic motions between the fingers in musical performance, which degrades fine motor control. The findings are important to shed light on mechanisms underlying loss of motor dexterity under pressure.

Psychomotor Testing for Orthopedic Residency Applicants: A Pilot Study

OBJECTIVE

The purpose of this study was to develop an objective motor skills testing system to aid in the evaluation of potential orthopedic residents.

DESIGN

Participants attempted a battery of 5 motor skills tests (4 novel tests and the Grooved Pegboard [GPT] Test) in one 10-minute session. A percentile-based scoring system was created for each test based on raw scores. One-way analysis of variance was used to compare testing scores among 3 cohorts. Each novel test and overall scores were compared with GPT scores as a relative measure of validity.

SETTING

The 2015 orthopedic surgery residency interview season at an academic institution.

PARTICIPANTS

Thirty orthopedic residents and 72 nonresidents (15 community volunteers and 57 orthopedic surgery residency applicants).

RESULTS

Overall, residents performed better than nonresidents (p < 0.0001) and applicants performed worse than residents or volunteers (p < 0.0001). There were positive correlations between the GPT score and overall battery score (r = 0.63), screw and nut test (r = 0.40), and mimic a structure test (r = 0.26). The fracture reduction test and drilling test scores did not correlate to performance on the GPT.

CONCLUSIONS

Psychomotor testing for surgical applicants is an area in need of study. This investigation successfully piloted a novel battery of tests, which is easily reproducible and thus may be feasible for use in the orthopedic surgery residency interview setting. Longitudinal evaluation is required to explore correlation with future operative skill.

Stress potentiates decision biases: A stress induced deliberation-to-intuition (SIDI) model

Humans often make decisions in stressful situations, for example when the stakes are high and the potential consequences severe, or when the clock is ticking and the task demand is overwhelming. In response, a whole train of biological responses to stress has evolved to allow organisms to make a fight-or-flight response. When under stress, fast and effortless heuristics may dominate over slow and demanding deliberation in making decisions under uncertainty. Here, I review evidence from behavioral studies and neuroimaging research on decision making under stress and propose that stress elicits a switch from an analytic reasoning system to intuitive processes, and predict that this switch is associated with diminished activity in the prefrontal executive control regions and exaggerated activity in subcortical reactive emotion brain areas. Previous studies have shown that when stressed, individuals tend to make more habitual responses than goal-directed choices, be less likely to adjust their initial judgment, and rely more on gut feelings in social situations. It is possible that stress influences the arbitration between the emotion responses in subcortical regions and deliberative processes in the prefrontal cortex, so that final decisions are based on unexamined innate responses. Future research may further test this 'stress induced deliberation-to-intuition' (SIDI) model and examine its underlying neural mechanisms.