Background and significance

Cognitive bias may lead to diagnostic error in the patient encounter. There are hundreds of different cognitive biases, but certain biases are more likely to affect patient diagnosis and management. As during morbidity and mortality rounds, retrospective evaluation of a given case, with comparison to an optimal diagnosis, can pinpoint errors in judgment and decision-making. The study of cognitive bias also illuminates how we might improve the diagnostic process. In Part 1 of this series, cognitive bias is defined and placed within the background of dual process theory, emotion, heuristics, and the more neutral term judgment and decision-making bias.

Debiasing using an adaptive toolbox

Cognitive bias may lead to medical error, and awareness of cognitive pitfalls is a potential first step to addressing the negative consequences of cognitive bias (see Part 1). For decision-making processes that occur under uncertainty, which encompass most physician decisions, a so-called "adaptive toolbox" is beneficial for good decisions. The adaptive toolbox is inclusive of broad strategies like cultural humility, emotional intelligence, and self-care that help combat implicit bias, negative consequences of affective bias, and optimize cognition. Additionally, the adaptive toolbox includes situational-specific tools such as heuristics, narratives, cognitive forcing functions, and fast and frugal trees. Such tools may mitigate against errors due to cultural, affective, and cognitive bias. Part 2 of this two-part series covers metacognition and cognitive bias in relation to broad and specific strategies aimed at better decision-making.

Avoidance biases for vaping stimuli among college students with electronic-cigarette use

Previous research has suggested that individuals who smoke demonstrate a behavioral tendency to approach rather than avoid smoking-related stimuli (i.e., approach bias). This study assessed whether 149 undergraduates with varying levels of e-cigarette use demonstrated an approach bias for vaping-related stimuli on an Approach-Avoidance Task (AAT). In contrast to our hypotheses, participants with e-cigarette use demonstrated a significant avoidance bias to vaping-related stimuli, and this effect appeared to be primarily driven by female e-cigarette users. Further, we found that more severe e-cigarette use was associated with numerous adverse outcomes, including reduced quality of life and increased vaping cravings, depressive symptoms, perceived stress, and cannabis use severity. Overall, our findings elucidate various negative impacts of e-cigarette use and suggest a potential role for sex differences in approach-avoidance tendencies toward vaping-related stimuli among young adults.

Interpretation bias modification for hostility to facilitate smoking cessation in a sample with elevated trait anger: A randomized trial

Problematic anger is linked with multiple adverse smoking outcomes, including cigarette dependence, heavy smoking, and cessation failure. A smoking cessation intervention that directly targets anger and its maintenance factors may increase rates of smoking cessation. We examined the efficacy of an interpretation bias modification for hostility (IBM-H) to facilitate smoking cessation in smokers with elevated trait anger. Participants were 100 daily smokers (mean age = 38, 62% female, 55% white) with elevated anger were randomly assigned to eight computerized sessions of either IBM-H or a health and relaxation video control condition (HRVC). Participants in both conditions attempted to quit at mid-treatment. Measures of hostility, anger, and smoking were administered at pre-, mid-, post-treatment, as well as at up to three-month follow-up. Compared to HRVC, IBM-H led to greater reductions in hostile interpretation bias, both at posttreatment and follow-up. IBM-H also led to statistically significant reductions in hostility only at posttreatment, and trait anger only at three-month follow-up. Both conditions experienced reductions in smoking, although they did not differ in quit success. We discuss these findings in the context of literature on anger and smoking cessation and provide directions for future research.

Contamination fear and attention bias variability early in the COVID-19 pandemic

The onset of the COVID-19 pandemic resulted in a dramatic increase in the salience and importance of information relating to both the risk of infection, and factors that could mitigate against such risk. This is likely to have contributed to elevated contamination fear concerns in the general population. Biased attention for contamination-related information has been proposed as a potential mechanism underlying contamination fear, though evidence regarding the presence of such biased attention has been inconsistent. A possible reason for this is that contamination fear may be characterised by variability in attention bias that has not yet been examined. The current study examined the potential association between attention bias variability for both contamination-related and mitigation-related stimuli, and contamination fear during the early stages of the COVID-19 pandemic. A final sample of 315 participants completed measures of attention bias and contamination fear. The measure of average attention bias for contamination-related stimuli and mitigation-related stimuli was not associated with contamination fear (r = 0.055 and r = 0.051, p > 0.10), though both attention bias variability measures did show a small but statistically significant relationship with contamination fear (r = 0.133, p < 0.05; r = 0.147, p < 0.01). These attention bias variability measures also accounted for significant additional variance in contamination fear above the average attention bias measure (and controlling for response time variability). These findings provide initial evidence for the association between attention bias variability and contamination fear, underscoring a potential target for cognitive bias interventions for clinical contamination fear.

Cognitive Biases in High-Stakes Decision-Making: Implications for Joint Pediatric Cardiology and Cardiothoracic Surgery Conference

Extensive research has consistently demonstrated that humans frequently diverge from rational decision-making processes due to the pervasive influence of cognitive biases. This paper conducts an examination of the impact of cognitive biases on high-stakes decision-making within the context of the joint pediatric cardiology and cardiothoracic surgery conference, offering practical recommendations for mitigating their effects. Recognized biases such as confirmation bias, availability bias, outcome bias, overconfidence bias, sunk cost fallacy, loss aversion, planning fallacy, authority bias, and illusion of agreement are analyzed concerning their specific implications within this conference setting. To counteract these biases and enhance the quality of decision-making, practical strategies are proposed, including the implementation of a no-interruption policy until all data is reviewed, leaders refraining from immediate input, requiring participants to formulate independent judgments prior to sharing recommendations, explicit probability estimations grounded in base rates, seeking external opinions, and promoting an environment that encourages dissenting perspectives.

An Economic Model of Gambling Behaviour: A Two-Stage Approach

Gambling can cause significant harms and these can result in a net negative utility from participation, although lower levels of participation have potential benefits and can yield positive net utility. It is therefore important to understand and distinguish between these two stages of gambling behaviour. Currently, economic models have had limited focus on explaining why someone would gamble despite it yielding a negative utility. Here, we present a two-stage model, motivated by empirical literature and intuitive assumptions, that improves on existing economic models by distinguishing between the likelihood of gambling participation and of gambling that yields a negative utility. The model's predictions are empirically testable, consistent with existing literature, and add new insights. The model's ability to distinguish between the two stages helps to inform interventions that aim to reduce the prevalence of gambling-related harm while avoiding the need for restrictive approaches that aim to eliminate gambling altogether.

Lack of reinforcement is hard to "bear": Assessing judgment bias in grizzly bears (Ursus arctos horribilis)

Cognitive biases reveal underlying affective state by indicating optimism and pessimism. This methodology may permit assessment of positive welfare in animals that have few validated positive welfare indicators, such as bears. Our goal was to validate a judgment bias test for assessing optimism in brown bears, using a touchscreen. After training the bears on a conditional discrimination, we compared responses to an ambiguous stimulus in a 2 × 2 nested design involving four experimental conditions representing presence or absence of a behind-the-scenes tour and presence or absence of a keeper training session with food reinforcement. We recorded bears' behavior during the conditions as a measure of convergent validity. Testing revealed the possibility of pessimism in the absence of reinforcement in one bear. More frustration behaviors were also observed during the no food reinforcement conditions. This is the first experimental demonstration of brown bears using a touchscreen and one of only three reports in which bears have been reported to perform a conditional discrimination. This method of assessing underlying affective state shows promise for the future.

One research question, two meta-analyses, three conclusions: Commentary on "A systematic review with meta-analysis of Cognitive Bias Modification interventions for anger and aggression"

Recently two independent meta-analyses on the efficacy of Cognitive Bias Modification of Interpretation (CBM-I) to reduce aggressive behavior came to different conclusions: Ciesinski et al. (2023) concluded that "CBM demonstrates efficacy for the treatment of aggressive behavior" (Abstract), whereas our research team concluded that "findings show limited support for the efficacy of CBM-I to reduce aggressive behavior" (AlMoghrabi et al., 2023, Discussion). How can similar meta-analyses reach such different conclusions? In this commentary, we raise awareness concerning how 1) seemingly identical research questions can be based on meaningfully different definitions of the intervention and outcomes; 2) intervention efficacy conclusions can depend on outcome assessment type; and 3) the interpretation of underpowered moderator analyses should not depend on statistical significance. We end our commentary with a third, more nuanced conclusion that can reconcile the two disparate conclusions: that current CBM-I is an effective experimental manipulation to modify interpretation biases, but not an effective stand-alone treatment to reduce aggressive behavior.

Who shows the Unlikelihood Effect - and why?

Recent work shows that people judge an outcome as less likely when they learn the probabilities of all single pathways that lead to that outcome, a phenomenon termed the Unlikelihood Effect. The initial explanation for this effect is that the low pathway probabilities trigger thoughts that deem the outcome unlikely. We tested the alternative explanation that the effect results from people's erroneous interpretation and processing of the probability information provided in the paradigm. By reanalyzing the original experiments, we discovered that the Unlikelihood Effect had been substantially driven by a small subset of people who give extremely low likelihood judgments. We conducted six preregistered experiments, showing that these people are unaware of the total outcome probability and do formally incorrect calculations with the given probabilities. Controlling for these factors statistically and experimentally reduced the proportion of people giving extremely low likelihood judgments, reducing and sometimes eliminating the Unlikelihood Effect. Our results confirm that the Unlikelihood Effect is overall a robust empirical phenomenon, but suggest that the effect results at least to some degree from a few people's difficulties with encoding, understanding, and integrating probabilities. Our findings align with current research on other psychological effects, showing that empirical effects can be caused by participants engaging in qualitatively different mental processes.

Cognitive Biases and Insomnia Symptoms in People With and Without Chronic Pain

Chronic pain and insomnia symptoms are highly comorbid; however, the psychological mechanisms driving this comorbidity are not well understood. The aim of the present study was to assess whether 2 cognitive biases that occur separately in chronic pain and insomnia, that is, interpretation bias and attentional bias, are heightened in people with comorbid chronic pain and elevated insomnia symptoms. A final sample of N = 109 people with chronic pain and N = 79 people without pain who varied in insomnia symptoms were recruited through Prolific Academic to complete this cross-sectional study. Participants completed measures of sleep and pain-related interpretation bias (ambiguous sentences task) and attentional bias (dot-probe task), as well as questionnaires assessing insomnia symptoms, pain symptoms, and general psychological symptoms. We found an interaction between pain status and insomnia symptoms for sleep-related interpretation bias. That is, people with chronic pain showed greater sleep-related interpretation bias than those without pain, but only when insomnia symptoms were also elevated. This interaction did not extend to pain interpretation bias or attentional bias, although we did find an elevated pain interpretation bias in people with chronic pain compared to pain-free individuals. We also found that both pain and sleep-related interpretation bias were associated with depression symptoms, suggesting that interpretation bias could potentially drive a trimorbidity of chronic pain, insomnia, and depression. Taken together, these findings suggest promise for the role of interpretation bias in the mutual maintenance of chronic pain and insomnia symptoms and the importance of also considering depression. PERSPECTIVE: This article presents data on the cognitive biases that are present in chronic pain, and that are associated with increased insomnia symptoms. Identifying such cognitive biases could help in explaining the high comorbidity between chronic pain and insomnia, leading to more effective and targeted treatments.

Enhancing human-AI collaboration: The case of colonoscopy

Diagnostic errors impact patient health and healthcare costs. Artificial Intelligence (AI) shows promise in mitigating this burden by supporting Medical Doctors in decision-making. However, the mere display of excellent or even superhuman performance by AI in specific tasks does not guarantee a positive impact on medical practice. Effective AI assistance should target the primary causes of human errors and foster effective collaborative decision-making with human experts who remain the ultimate decision-makers. In this narrative review, we apply these principles to the specific scenario of AI assistance during colonoscopy. By unraveling the neurocognitive foundations of the colonoscopy procedure, we identify multiple bottlenecks in perception, attention, and decision-making that contribute to diagnostic errors, shedding light on potential interventions to mitigate them. Furthermore, we explored how existing AI devices fare in clinical practice and whether they achieved an optimal integration with the human decision-maker. We argue that to foster optimal Human-AI collaboration, future research should expand our knowledge of factors influencing AI's impact, establish evidence-based cognitive models, and develop training programs based on them. These efforts will enhance human-AI collaboration, ultimately improving diagnostic accuracy and patient outcomes. The principles illuminated in this review hold more general value, extending their relevance to a wide array of medical procedures and beyond.

Sociocrinology: Impact of Social Media on Endocrine Health - A Review

Social media (SM) refers to social networking sites (SNSs), which are defined as online services that enable individuals to build a public or semi-public profile and give them the opportunity to create a network of contacts and interact. SM affects all aspects of life and may offer new opportunities to explore new experiences and perspectives of life because of its feasibility. But several times, because of feasibility, misinformation is generated intentionally or unintentionally, which spreads rapidly, and such misinformation can affect all aspects of life. However, health-related misinformation can be life-threatening to individuals. Endocrinology is the branch of medicine that deals with endocrine glands and hormones, which regulates mood, growth, development, metabolism and the way our organ works to maintain internal homeostasis. SM usage and endocrine health impact each other in both positive and negative ways. So, in this review, we will discuss about the effect of SM on Endocrine health.

Survey data on dysfunctional attitudes, personality traits, and agreement with persuasive techniques

Persuasion techniques play a vital role in human communication, influencing various aspects of our lives. With the increasing prevalence of digital platforms, these techniques have permeated online spaces such as websites, mobile apps, games, and social media. This article presents a dataset collected via a survey, designed to gather information about individuals' demographics, personality traits, dysfunctional attitudes, and their responses to statements embedded with persuasion techniques. Core messages promoting paid news subscriptions, blood donations, and exercise serve as the focus, while definitions and examples of persuasive techniques are provided. By analyzing this comprehensive dataset, researchers could gain valuable insights into the influence and impact of persuasive communication strategies.

Cognitive bias in pathology, as exemplified in dermatopathology

Cognitive bias refers to human thinking patterns, as well as pitfalls, that are reproducible. Importantly, cognitive bias is not intentionally discriminatory and is necessary to properly interpret the world around us, including microscopic slides. Thus, it is a useful exercise to examine cognitive bias in pathology, as exemplified in dermatopathology.

Interpretations of ambiguous situations in combat veterans with and without post-traumatic stress disorder

Deployed combat personnel are at increased risk of post-traumatic stress disorder (PTSD). People with PTSD often judge ambiguous information as negative or threatening (interpretation bias). However, this may be adaptive during deployment. The current study aimed to investigate the extent to which interpretation bias in combat personnel is associated with PTSD symptoms, rather than with appropriate situational awareness. Combat veterans with and without PTSD and civilians without PTSD generated explanations for ambiguous situations and judged the likelihood of various possible explanations. They also made judgements about future consequences of worst-case scenarios, and their coping ability. Veterans with PTSD generated more negative explanations for ambiguous situations, judged negative interpretations as more likely and felt less able to cope with the worst-case scenario than veteran and civilian controls. Veterans with versus without PTSD judged worst-case scenarios to have more severe and insurmountable consequences, although they did not differ significantly from civilians. Veteran versus civilian controls rated their coping ability as higher; this was the only difference between control groups. In summary, group differences in interpretation bias were associated with PTSD symptoms rather than combat role. Veterans without PTSD may be particularly resilient when coping with everyday adversity.

Investigating the impact of cognitive biases in radiologists' image interpretation: A scoping review

RATIONALE AND OBJECTIVE

Image interpretation is a fundamental aspect of radiology. The treatment and management of patients relies on accurate and timely imaging diagnosis. However, errors in radiological reports can negatively impact on patient health outcomes. These misdiagnoses can be caused by several different errors, but cognitive biases account for 74 % of all image interpretation errors. There are many biases that can impact on a radiologist's perception and cognitive processes. Several recent narrative reviews have discussed these cognitive biases and have offered possible strategies to mitigate their effects. However, these strategies remain untested. Therefore, the purpose of this scoping review is to evaluate the current knowledge on the extent that cognitive biases impact on medical image interpretation.

MATERIAL AND METHODS

Scopus and Medline Databases were searched using relevant keywords to identify papers published between 2012 and 2022. A subsequent hand search of the narrative reviews was also performed. All studies collected were screened and assessed against the inclusion and exclusion criteria.

RESULTS

Twenty-four publications were included and categorised into five main themes: satisfaction of search, availability bias, hindsight bias, framing bias and other biases. From these studies, there were mixed results regarding the impact of cognitive biases, highlighting the need for further investigation in this area. Moreover, the limited and untested debiasing methods offered by a minority of the publications and narrative reviews also suggests the need for further research. The potential of role of artificial intelligence is also highlighted to further assist radiologists in identifying and mitigating these cognitive biases.

CONCLUSION

Cognitive biases can impact radiologists' image interpretation, however the effectiveness of debiasing strategies remain largely untested.

Scarcity affects cognitive biases: The case of the illusion of causality

Previous research indicates that economic scarcity affects people's judgments, decisions, and cognition in a variety of contexts, and with various consequences. We hypothesized that scarcity could sometimes reduce cognitive biases. Specifically, it could reduce the causal illusion, a cognitive bias that is at the heart of superstitions and irrational thoughts, and consists of believing that two events are causally connected when they are not. In three experiments, participants played the role of doctors deciding whether to administer a drug to a series of patients. The drug was ineffective, because the percentage of patients recovering was identical regardless of whether they took the drug. We manipulated the budget available to buy the drugs, tough all participants had enough for all their patients. Even so, participants in the scarce group reduced the use of the drug and showed a lower causal illusion than participants in the wealthy group. Experiments 2 and 3 added a phase in which the budget changed. Participants who transitioned from scarcity to wealth exhibited a reduced use of resources and a lower causal illusion, whereas participants transitioning from wealth to scarcity were unaffected by their previous history.

Pandemic management: Analysis of availability and relevance of surveillance indicators by COVID-Task-Forces in the German federal state of Lower Saxony

Background

Locally, the introduction of measures during times of a pandemic emergency is embodied in a pandemic containment plan created by the Robert Koch Institute in 2017. In addition to central indicators such as incidence rates and number of deaths, various indicators are used at the local level to assess the pandemic situation. So far, there hasn't been analyses of the availability and perceived relevance of the surveillance indicators used to manage the SARS-CoV-2 pandemic by the local German pandemic task forces.

Aim

This study examined whether local decision-makers had access to surveillance-related indicators in a way that they could be used to make informed decisions in response to the pandemic situation.

Methods

A cross sectional study was conducted, using an online questionnaire developed by experts of The Public Health Agency of Lower Saxony and The University Medical Center Göttingen (UMG). All local COVID-19 task forces of the German state of Lower-Saxony were enrolled in the study.

Findings

The surveillance indicators assessed by survey respondents as most available and relevant are included under the German Infection Protection Act (IfSG). In contrast, the indicators that are not bound by the IfSG have a significantly lower availability and an inconsistent assessment of relevance.

Conclusion

Against the background of efficiency, it seems central to be able to reliably provide the highly weighted surveillance indicators. Nevertheless, the relevance assessment gap between the indicators embedded in the IfSG and the ones that are not may be explained by cognitive processes such as anchoring bias. The collection and use of indicators to assess the pandemic situation and to evaluate measures should be the subject of continuous multidisciplinary discussions.

Judging others makes me forget: Assessing the cognitive, behavioural, and emotional consequences of other-evaluations on self-evaluations for social anxiety

BACKGROUND AND OBJECTIVES

People with Social Anxiety Disorder (SAD) evaluate themselves negatively before, during, and after anxiety-provoking social situations, which leads to negative consequences (e.g., performance deficits, memory impairments, and post-event processing). Despite decades of research, little is known regarding whether these evaluations generalize to how they view others. Social projection theory-the belief that others are similar to oneself-might further extend the basic Cognitive Behavioural Therapy (CBT) model. Our aim was to understand whether the degree to which people negatively evaluate a visibly anxious person causes them to negatively evaluate themselves.

METHODS

172 unselected participants completed several baseline questionnaires. We then randomly assigned participants to provide high-, medium-, or no-evaluation of a videotaped anxious person (i.e., other-evaluations) while we assessed their state anxiety. After, they evaluated the anxious person on multiple criteria. Participants then participated in an impromptu conversation task and subsequently evaluated their own performance.

RESULTS

Although our manipulation was effective, we found no emotional or behavioural differences between conditions. However, people in the high-evaluation condition recalled significantly fewer facts about their conversation partner than did people in the medium- and no-evaluation conditions.

LIMITATIONS

After data cleaning, the sample size was slightly smaller than planned; most analyses were nonetheless appropriately powered. Our findings may not generalize beyond unselected undergraduate students; replication in a clinical sample is warranted.

CONCLUSIONS

These findings highlight the cognitive consequences (i.e., memory impairments) of other-evaluations, which cognitive behavioural therapists should consider when treating individuals with SAD.

Educational strategies in the health professions to mitigate cognitive and implicit bias impact on decision making: a scoping review

BACKGROUND

Cognitive and implicit biases negatively impact clinicians' decision-making capacity and can have devastating consequences for safe, effective, and equitable healthcare provision. Internationally, health care clinicians play a critical role in identifying and overcoming these biases. To be workforce ready, it is important that educators proactively prepare all pre-registration healthcare students for real world practice. However, it is unknown how and to what extent health professional educators incorporate bias training into curricula. To address this gap, this scoping review aims to explore what approaches to teaching cognitive and implicit bias, for entry to practice students, have been studied, and what are the evidence gaps that remain.

METHODS

This scoping review was guided by the Joanna Briggs Institute (JBI) methodology. Databases were searched in May 2022 and included CINAHL, Cochrane, JBI, Medline, ERIC, Embase, and PsycINFO. The Population, Concept and Context framework was used to guide keyword and index terms used for search criteria and data extraction by two independent reviewers. Quantitative and qualitative studies published in English exploring pedagogical approaches and/or educational techniques, strategies, teaching tools to reduce the influence of bias in health clinicians' decision making were sought to be included in this review. Results are presented numerically and thematically in a table accompanied by a narrative summary.

RESULTS

Of the 732 articles identified, 13 met the aim of this study. Most publications originated from the United States (n=9). Educational practice in medicine accounted for most studies (n=8), followed by nursing and midwifery (n=2). A guiding philosophy or conceptual framework for content development was not indicated in most papers. Educational content was mainly provided via face-to-face (lecture/tutorial) delivery (n=10). Reflection was the most common strategy used for assessment of learning (n=6). Cognitive biases were mainly taught in a single session (n=5); implicit biases were taught via a mix of single (n=4) and multiple sessions (n=4).

CONCLUSIONS

A range of pedagogical strategies were employed; most commonly, these were face-to-face, class-based activities such as lectures and tutorials. Assessments of student learning were primarily based on tests and personal reflection. There was limited use of real-world settings to educate students about or build skills in biases and their mitigation. There may be a valuable opportunity in exploring approaches to building these skills in the real-world settings that will be the workplaces of our future healthcare workers.

Reducing the impact of cognitive bias in decision making: Practical actions for forensic science practitioners

Previously published methods for reducing the impact of cognitive bias in forensic decision making have focused primarily on actions at the laboratory or organizational levels. This paper presents generalized and specific actions that forensic science practitioners can take to reduce the impact of cognitive bias in their work. Practical examples illustrating ways that practitioners can implement many of the specific actions are also provided, along with some suggestions for handling court testimony about cognitive bias. The actions presented in this paper provide a means through which individual practitioners can take ownership for minimizing cognitive bias in their work. Such actions can provide supporting evidence to stakeholders that forensic practitioners acknowledge the existence of cognitive bias and its potential influence on their work, and they can also stimulate implementation of methods that focus on solutions at the laboratory and organizational levels.

Error and bias in race and ethnicity descriptions in medical examiner records in New Mexico: Consequences for understanding mortality among Hispanic/Latinos

Researchers use public records from deceased individuals to identify trends in manners and causes of death. Errors in the description of race and ethnicity can affect the inferences researchers draw, adversely impacting public health policies designed to eliminate health inequity. Using the New Mexico Decedent Image Database, we examine: 1) the accuracy of death investigator descriptions of race and ethnicity by comparing their reports to those from next of kin (NOK), 2) the impact of decedent age and sex on disagreement between death investigators and NOK, and 3) the relationship between investigators' descriptions of decedent race and ethnicity and cause and manner of death from forensic pathologists (n = 1813). Results demonstrate that investigators frequently describe race and ethnicity incorrectly for Hispanic/Latino decedents, especially regarding homicide manner of death and injury and substance abuse causes of death. Inaccuracies may cause biased misperceptions of violence within specific communities and affect investigative processes.

Cognitive Bias and Dissonance in Surgical Practice: A Narrative Review

A cognitive bias describes "shortcuts" subconsciously applied to new scenarios to simplify decision-making. Unintentional introduction of cognitive bias in surgery may result in surgical diagnostic error that leads to delayed surgical care, unnecessary procedures, intraoperative complications, and delayed recognition of postoperative complications. Data suggest that surgical error secondary to the introduction of cognitive bias results in significant harm. Thus, debiasing is a growing area of research which urges practitioners to deliberately slow decision-making to reduce the effects of cognitive bias.

Images of Australian alcoholic and non-alcoholic beverages: A validation dataset

For multi-session alcohol cognitive bias modification, a large image dataset depicting both alcohol and non-alcoholic beverages is required. We photographed a wide range of beverages and then validated them in a group of Australian community participants: 47 women and 39 men, aged from 18 to 73, who drank alcohol at least occasionally in the last year, with Alcohol Use Disorder Identification Test (AUDIT) scores ranging from 1 to 33. Participants were asked to categorize images as alcoholic vs non-alcoholic, rate the familiarity of each beverage and rate their craving for each beverage. The dataset includes all images and ratings for each image, stratified by gender and high/low AUDIT scores. Mean ratings per participant per beverage category are also provided.

Zero the hero: Evidence for involvement of the ventromedial prefrontal cortex in affective bias for free items

Recent evidence from psycho-economics shows that when the price of an item decreases to the extent that it becomes available for free, one can observe a remarkable increase of subjective utility toward this item. This phenomenon, which is not observed for any other price but zero, has been termed the zero-price effect (ZPE). The ZPE is attributed to an affective heuristic where the positive affect elicited by the free status of an item provides a mental shortcut biasing choice towards that item. Given that the ZPE relies on affective processing, a key role of the ventromedial prefrontal cortex (vmPFC) has been proposed, yet neuroscientific studies of the ZPE remain scarce. This study aimed to explore the role of the vmPFC in the ZPE using a novel, within-subject assessment in participants with either an acquired (lesion patients) or degenerative (behavioural-variant frontotemporal dementia patients) lesion of the vmPFC, and age-matched healthy controls. All participants were asked to make a series of choices between pairs of items that varied in price. One choice trial involved an equal decrease of both item prices, such that one of the items was priced zero. In contrast to controls, patients with both vmPFC-lesion and behavioural-variant frontotemporal dementia showed marked reductions in zero-related changes of preference in pairs of gift-cards, but not for pairs of food items. Our findings suggest that affective evaluations driving the ZPE are altered in patients with focal or degenerative damage to the vmPFC. This supports the notion of a key role of the vmPFC in the ZPE and, more generally, the importance of this region in value-based affective decision-making. Our findings also highlight the potential utility of affective heuristic tasks in future clinical assessments.

Associations between acceptance of the implausible bias, theory of mind and delusions in first-episode psychosis patients; A longitudinal study

Multiple different cognitive biases, among them the liberal acceptance (LA) bias, have been suggested to contribute to reality distortion in psychotic disorders. Earlier studies have been cross-sectional and considered a limited set of cognitive correlates of psychosis, thus the relationship between LA bias and psychosis remains poorly known. We studied a similar bias (acceptance of the implausible (AOI)) in 62 first-episode psychosis (FEP) patients and 62 control subjects, who watched movie scenes with varying degrees of realism and were asked to evaluate the probability of these events occurring in real life. We assessed theory of mind (ToM) performance using the Hinting task and delusion severity using Brief Psychiatric Rating Scale item 11. We correlated the magnitude of AOI with the severity of delusions and performance in the ToM task. Furthermore, we used 1-year follow-up data from 40 FEP patients and 40 control subjects to disentangle state vs trait-like characteristics of AOI. At baseline FEP patients expressed more AOI than control subjects, and the magnitude of AOI correlated positively with the severity of delusions and negatively with ToM performance. At the one-year follow-up, when most patients were in remission, patients still displayed increased AOI, which no longer correlated with delusions. These findings support the notion that the AOI bias could represent a trait rather than a state feature and support further studies to test the hypothesis that it could be one of the causal factors of psychotic disorders, possibly associated with ToM.

Repeatability of an attention bias test for sheep suggests variable influence of state and trait affect on behaviour

Understanding the effects of repeated testing on behaviour is essential for behavioural tests that are re-applied to the same individuals for research and welfare assessment purposes. Assessing the repeatability of behaviour can also help us understand the influence of persistent traits vs transient states on animal responses during testing. This study examined the repeatability of behavioural responses in an attention bias test developed for sheep as a measure of affective state. Sheep were assessed in the attention bias test three times (n = 81 sheep), with testing occurring at intervals of 1 year then 2 weeks. During testing, individual sheep were exposed to a dog located behind a window for 3 s in a 4 × 4 m arena, then the dog was obscured from view, removed and sheep behaviours were recorded for 180 s. We hypothesised that behaviours in the test would have moderate-high repeatability but that the mean behavioural responses would change over consecutive trials as sheep habituated to the test environment. To estimate repeatability, data were modelled using restricted maximum likelihood linear mixed-effects models, fitting animal ID as a random effect. Vigilance behaviour, defined as having the head at or above shoulder height, was moderately repeatable (r = 0.58). Latency to eat (r = 0.20) and duration spent looking towards the previous location of the dog (attention to the dog wall) (r = 0.08) had low repeatability. Mean latency to eat did not differ significantly between trials (P = 0.2) and mean vigilance behaviour tended to decrease over the trials (P = 0.07). Mean duration of attention to the dog wall significantly decreased across the trials (P < 0.001), while mean zones crossed increased (P < 0.001), as did behaviours directed towards the exit door such as duration in proximity and pawing at the door. Overall, vigilance behaviour was moderately repeatable, suggesting it may have been driven by temperament or personality traits, while attention and feeding behaviours may have been more influenced by transient affective states or other factors, however further research is needed to better tease apart these potential effects. Sheep demonstrated some habituation to the test over consecutive trials. Care should therefore be taken during future application of the test to ensure all animals undergoing attention bias testing have equivalent experience for a valid interpretation of their relative behavioural responses.

Sleep-related attentional and interpretive-bias in insomnia: A systematic review and meta-analysis

Cognitive models of insomnia highlight internal and external cognitive-biases for sleep-related "threat" in maintaining the disorder. This systematic review of the sleep-related attentional and interpretive-bias literature includes meta-analytic calculations of each construct. Searches identified N = 21 attentional-bias and N = 8 interpretive-bias studies meeting the inclusion/exclusion criteria. Seventeen attentional-bias studies compared normal-sleepers and poor-sleepers/insomnia patients. Using a random effects model, meta-analytic data based on standardized mean differences of attentional-bias studies determined the weighted pooled effect size to be moderate at 0.60 (95%CI:0.26-0.93). Likewise, seven of eight interpretive-bias studies involved group comparisons. Meta-analytic data determined the weighted pooled effect size as moderate at .44 (95%CI:0.19-0.69). Considering these outcomes, disorder congruent cognitive-biases appear to be a key feature of insomnia. Despite statistical support, absence of longitudinal data limits causal inference concerning the relative role cognitive-biases in the development and maintenance of insomnia. Methodological factors pertaining to task design, sample and stimuli are discussed in relation to outcome variation. Finally, we discuss the next steps in advancing the understanding of sleep-related biases in insomnia.

Measuring base-rate bias error in workplace safety investigators

INTRODUCTION

This study explored the magnitude of professional industrial investigators' bias to attribute cause to a person more readily than to situational factors (i.e., human error bias). Such biased opinions may relieve companies from responsibilities and liability, as well as compromise efficacy of suggested preventative measures.

METHOD

Professional investigators and undergraduate participants were given a summary of a workplace event and asked to allocate cause to the factors they found causal for the event. The summary was crafted to be objectively balanced in its implication of cause equally between two factors: a worker and a tire. Participants then rated their confidence and the objectivity of their judgment. We then conducted an effect size analysis, which supplemented the findings from our experiment with two previously published research studies that used the same event summary.

RESULTS

Professionals exhibited a human error bias, but nevertheless believed that they were objective and confident in their conclusions. The lay control group also showed this human error bias. These data, along with previous research data, revealed that, given the equivalent investigative circumstances, this bias was significantly larger with the professional investigators, with an effect size of d_unb = 0.97, than the control group with an effect size of only d_unb = 0.32.

CONCLUSIONS

The direction and strength of the human error bias can be quantified, and is shown to be larger in professional investigators compared to lay people.

PRACTICAL APPLICATIONS

Understanding the strength and direction of bias is a crucial step in mitigating the effects of the bias. The results of the current research demonstrate that mitigation strategies such as proper investigator training, a strong investigation culture, and standardized techniques, are potentially promising interventions to mitigate human error bias.

Selective exposure bias predicts views on diversity over time

Despite growing diversity, many individuals do not support it, posing a challenge to the successful functioning of societies, institutions, and organizations. We investigated the role of the selective exposure bias on diversity beliefs. In a large-scale nationally representative Spanish sample (N = 2,297), we conducted a time-lagged experiment with two time points 5 months apart in which we offered participants a monetary incentive to (allegedly) read attitude contradictory versus conforming information about societal support for refugees. The selective exposure bias asymmetrically predicted future diversity beliefs. Among individuals with a positive intergroup orientation, the selective exposure bias did not predict future diversity beliefs. However, among individuals with a negative intergroup orientation, the selective exposure bias predicted lower pro-diversity beliefs over time, over and above initial pro-diversity beliefs and ideological dispositions. These findings suggest that the absence of pro-diversity beliefs partly originates from a cognitive bias, holding critical implications for policymakers seeking to improve intergroup relations.

Clinical decision making in physical therapy - Exploring the 'heuristic' in clinical practice

Clinical decision-making (CDM) plays an integral role in the work of a physical therapist and has ramifications for patient outcomes and experience. Rational decision-making - acting in a manner that helps us achieve our goals - is influenced by cognitive, emotional, and social variables. The dual process theory helps us understand how clinicians make what they perceive to be rational decisions. Within dual process is the use of cognitive decisional shortcuts, commonly referred to as 'heuristics,' which are either developed through experience or the use of fast and frugal trees (FFT). The use of heuristics in physical therapy practice has yet to be explored. This paper aims to describe this subset of physical therapy decision-making and to identify the typical cognitive biases - the error in heuristic-driven decision making - inherent in this style of reasoning. Common heuristics and their related biases are described and illustrated with vignettes, including the anchoring, availability, confirmatory, and representative heuristics. The authors conclude by proposing interventions to optimize physical therapists' awareness of their use of heuristics in clinical decision-making and to identify and minimize the influence of potential bias.

Threat biases associate with anxiety and depression in physically-abused young people with a history of child labour

BACKGROUND AND OBJECTIVES

Young people who have experienced early-life maltreatment preferentially attend to threat and draw more threatening interpretations. In turn, these threat biases may explain elevated risk for lifelong anxiety and/or depression. We investigated whether adolescent labourers with a history of physical abuse showed threat biases relative to non-abused labourers, and whether these threat biases associated with anxiety and depression.

METHODS

100 young people (aged 13-18 years, 64% female) from Nepal rescued from illegal child work were assessed for childhood maltreatment and anxiety and/or depression disorders. Participants completed an emotional visual search task (to measure attention engagement of positive versus negative faces) and an ambiguous scenarios questionnaire (to measure the endorsement of negative versus benign interpretations).

RESULTS

Seventy young people reported a history of physical (and emotional) abuse. They were more likely to meet symptom thresholds for depression, and marginally, for anxiety disorders than non-physically abused participants. Abused and non-abused participants did not differ on attention engagement/disengagement of threat or on interpretational style. Abused participants with anxiety were slower to disengage from negative faces to engage with a positive face than non-anxious abused participants. Abused participants with depression endorsed more negative interpretations of ambiguous situations than those without depression.

LIMITATIONS

The cross-sectional design limits our ability to infer whether threat biases reflect risk markers of psychopathology.

CONCLUSIONS

If threat biases are shown to confer risk for anxiety and depression in future studies, they could be targeted in mental health prevention programs for these vulnerable young people.

Clinical decision making in physical therapy - Exploring the 'heuristic' in clinical practice

Clinical decision-making (CDM) plays an integral role in the work of a physical therapist and has ramifications for patient outcomes and experience. Rational decision-making - acting in a manner that helps us achieve our goals - is influenced by cognitive, emotional, and social variables. The dual process theory helps us understand how clinicians make what they perceive to be rational decisions. Within dual process is the use of cognitive decisional shortcuts, commonly referred to as 'heuristics,' which are either developed through experience or the use of fast and frugal trees (FFT). The use of heuristics in physical therapy practice has yet to be explored. This paper aims to describe this subset of physical therapy decision-making and to identify the typical cognitive biases - the error in heuristic-driven decision making - inherent in this style of reasoning. Common heuristics and their related biases are described and illustrated with vignettes, including the anchoring, availability, confirmatory, and representative heuristics. The authors conclude by proposing interventions to optimize physical therapists' awareness of their use of heuristics in clinical decision-making and to identify and minimize the influence of potential bias.

Cognitive bias in workplace investigation: Problems, perspectives and proposed solutions

Psychological research demonstrates how our perceptions and cognitions are affected by context, motivation, expectation, and experience. A mounting body of research has revealed the many sources of bias that affect the judgments of experts as they execute their work. Professionals in such fields as forensic science, intelligence analysis, criminal investigation, medical and judicial decision-making find themselves at an inflection point where past professional practices are being questioned and new approaches developed. Workplace investigation is a professional domain that is in many ways analogous to the aforementioned decision-making environments. Yet, workplace investigation is also unique, as the sources, magnitude, and direction of bias are specific to workplace environments. The workplace investigation literature does not comprehensively address the many ways that the workings of honest investigators' minds may be biased when collecting evidence and/or rendering judgments; nor does the literature offer a set of strategies to address such happenings. The current paper is the first to offer a comprehensive overview of the important issue of cognitive bias in workplace investigation. In it I discuss the abilities and limitations of human cognition, provide a framework of sources of bias, as well as, offer suggestions for bias mitigation in the investigation process.

Sex differences in inflammation in the hippocampus and amygdala across the lifespan in rats: associations with cognitive bias

Background

Cognitive symptoms of major depressive disorder, such as negative cognitive bias, are more prevalent in women than in men. Cognitive bias involves pattern separation which requires hippocampal neurogenesis and is modulated by inflammation in the brain. Previously, we found sex differences in the activation of the amygdala and the hippocampus in response to negative cognitive bias in rats that varied with age. Given the association of cognitive bias to neurogenesis and inflammation, we examined associations between cognitive bias, neurogenesis in the hippocampus, and cytokine and chemokine levels in the ventral hippocampus (HPC) and basolateral amygdala (BLA) of male and female rats across the lifespan.

Results

After cognitive bias testing, males had more IFN-γ, IL-1β, IL-4, IL-5, and IL-10 in the ventral HPC than females in adolescence. In young adulthood, females had more IFN-γ, IL-1β, IL-6, and IL-10 in the BLA than males. Middle-aged rats had more IL-13, TNF-α, and CXCL1 in both regions than younger groups. Adolescent male rats had higher hippocampal neurogenesis than adolescent females after cognitive bias testing and young rats that underwent cognitive bias testing had higher levels of hippocampal neurogenesis than controls. Neurogenesis in the dorsal hippocampus was negatively associated with negative cognitive bias in young adult males.

Conclusions

Overall, the association between negative cognitive bias, hippocampal neurogenesis, and inflammation in the brain differs by age and sex. Hippocampal neurogenesis and inflammation may play greater role in the cognitive bias of young males compared to a greater role of BLA inflammation in adult females. These findings lay the groundwork for the discovery of sex-specific novel therapeutics that target region-specific inflammation in the brain and hippocampal neurogenesis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12979-022-00299-4.

• Adolescent male rats had more hippocampal inflammation than females after cognitive bias testing.

• Adult female rats had more basolateral amygdalar inflammation than males after cognitive bias testing.

• HPC neurogenesis was negatively associated to cognitive bias in young adult male rats.

EEG reading with or without clinical information - a real-world practice study

We sought to investigate electroencephalographers' real-world behaviors and opinions concerning reading routine EEG (rEEG) with or without clinical information. An eight-question, anonymous, online survey targeted at electroencephalographers was disseminated on social media from the authors' personal accounts and emailed to authors' select colleagues. A total of 389 responses were included. Most respondents reported examining clinical information before describing rEEG findings. Nonetheless, only a minority of respondents believe that EEG analysis/description should be influenced by clinical information. We recommend reviewing clinical data only after an unbiased EEG read to prevent history bias and ensure generation of reliable electrodiagnostic information.

The quest for simplicity in human learning: Identifying the constraints on attention

For better or worse, humans live a resource-constrained existence; only a fraction of physical sensations ever reach conscious awareness, and we store a shockingly small subset of these experiences in memory for later use. Here, we examined the effects of attention constraints on learning. Among models that frame selective attention as an optimization problem, attention orients toward information that will reduce errors. Using this framing as a basis, we developed a suite of models with a range of constraints on the attention available during each learning event. We fit these models to both choice and eye-fixation data from four benchmark category-learning data sets, and choice data from another dynamic categorization data set. We found consistent evidence for computations we refer to as "simplicity", where attention is deployed to as few dimensions of information as possible during learning, and "competition", where dimensions compete for selective attention via lateral inhibition.

Contextual information in medicolegal death investigation decision-making: Manner of death determination for cases of a single gunshot wound

To explore the role of contextual information in determining manner of death, four cases involving single gunshot wounds were presented to participants (n = 252) involved in medicolegal death investigation. The participants received identical autopsy information but different contextual information. The data demonstrated that participants tended to rely on contextual information more than autopsy information: In the suicide context, participants across the four cases reached 153 final decisions of suicide (and 25 of homicide), whereas in the homicide context, participants reached only 10 final decisions of suicide (and 181 of homicide) --all while examining identical autopsy information. The impact of the contextual information was so powerful that many participants changed initial autopsy-based conclusions to align with the contextual information. Given the significant role and impact that contextual information has on expert decision making, one must consider what, how, and when contextual information should be used.

Cognitive and implicit biases in nurses' judgment and decision-making: A scoping review

BACKGROUND

Cognitive and implicit biases of healthcare providers can lead to adverse events in healthcare and have been identified as a patient safety concern. Most research on the impact of these systematic errors in judgment has been focused on diagnostic decision-making, primarily by physicians. As the largest component of the workforce, nurses make numerous decisions that affect patient outcomes; however, literature on nurses' clinical judgment often overlooks the potential impact of bias on these decisions. The aim of this study was to map the evidence and key concepts related to bias in nurses' judgment and decision-making, including interventions to correct or overcome these biases.

METHODS

We conducted a scoping review using Joanna Briggs methodology. In November 2020 we searched CINAHL, PsychInfo, and PubMed databases to identify relevant literature. Inclusion criteria were primary research about nurses' bias; evidence of a nursing decision or action; and English language. No date or geographic limitations were set.

RESULTS

We found 77 items that met the inclusion criteria. Over half of these items were published in the last 12 years. Most research focused on implicit biases related to racial/ethnic identity, obesity, and gender; other articles examined confirmation, attribution, anchoring, and hindsight biases. Some articles examined heuristics and were included if they described the process of, and the problems with, nurse decision-making. Only 5 studies tested interventions to overcome or correct biases. 61 of the studies relied on vignettes, surveys, or recall methods, rather than examining real-world nursing practice. This could be a serious oversight because contextual factors such as cognitive load, which have a significant impact on judgment and decision-making, are not necessarily captured with vignette or survey studies. Furthermore, survey and vignette studies make it difficult to quantify the impact of these biases in the healthcare system.

CONCLUSIONS

Given the serious effects that bias has on nurses' clinical judgment, and thereby patient outcomes, a concerted, systematic effort to identify and test debiasing strategies in real-world nursing settings is needed.

TWEETABLE ABSTRACT

Bias affects nurses' clinical judgment - we need to know how to fix it.

Is interpretation bias for threat content specific to youth anxiety symptoms/diagnoses? A systematic review and meta-analysis

Anxiety is the most common mental health problem in youth. Numerous studies have identified that youth anxiety is associated with interpretation bias or the attribution of threatening meaning to ambiguity. Interpretation bias has been proposed as a mechanism underlying the development and maintenance of pediatric anxiety. Theoretically, interpretation bias should be content-specific to individual youth anxiety symptom domains. However, extant studies have reported conflicting findings of whether interpretation bias is indeed content specific to youth anxiety symptoms or diagnoses. The present meta-analysis aimed to synthesize the literature and answer the question: is the relationship between interpretation bias and anxiety content specific? Search of PubMed and PsycINFO databases from January 1, 1960 through May 28, 2019 yielded 9967 citations, of which 19 studies with 20 comparisons and 2976 participants met eligibility criteria. Meta-analysis with random effects models was conducted to examine an overall effect (Pearson r) between anxiety domain and content-specific interpretation bias in single sample studies, and an overall effect size difference (Cohen's d) in studies comparing anxious to non-anxious youth. Results support a content specific correlation between interpretation bias and anxiety symptom domain in single sample studies (r = 0.18, p = 0.03). However, it is currently undetermined whether this relationship holds in studies that compare the relationship between content-specific interpretation bias and anxiety in anxious versus non-anxious youth. A variety of methodologic considerations across studies are discussed, with implications for further investigation of interpretation bias and youth anxiety.

Divergent thinking in Italian elementary school children: the key role of probabilistic reasoning style

Divergent thinking is widely recognised as an individual creative potential and an essential factor in fostering creativity since the early stages of life. Albeit previous research revealed that creativity could be pursued through controlled mental processes (e.g. reasoning), the debate about the impact of children's reasoning on divergent thinking and, ultimately, creativity is still open. The present study sought to deepen the relationships between probabilistic reasoning and divergent thinking in a sample of 106 Italian children (mean_age = 8.64, SD_age = 1.34; 58 F). The Beads Task was used to evaluate probabilistic reasoning, whereas the Alternative Uses Task was administered to assess divergent thinking. Results revealed that analytical, slow, and effortful forms of thought underpinned by high probabilistic competencies predict children's divergent production. These findings suggest that a higher score for divergence of thinking depends on a high involvement of reasoning style, which in this study relies on the ability to make probabilistic decisions in ambiguous situations. Future research directions were discussed.

Emotion recognition bias depends on stimulus morphing strategy

Emotion recognition is vital for social interactions, and atypical (or biased) emotion recognition has been linked to mental health disorders including depression and anxiety. However, biases in emotion recognition vary across studies, and it is unclear whether this reflects genuine group differences in psychological processes underlying emotion recognition or differences in methodologies. One common method to measure biases in emotion recognition involves morphing a face between two emotional expressions in different ratios and asking participants to categorise the faces as belonging to one of the two emotion categories (‘direct-morphing’ method). However, this method creates morphed faces that are not ecologically valid. Alternatively, faces may be morphed through a neutral expression (‘morphing-through-neutral’ method), which is more ecologically valid since emotional expressions usually start from a neutral face. To compare these two approaches, we measured emotion recognition biases using two morphing techniques in 136 participants who also completed measures of anxiety (GAD-7) and depression (PHQ-9). Biases obtained using the two methods differed significantly: In the direct-morphing method, participants perceived the central 50% happy/50% angry face as slightly happy, whereas in the morphing-through-neutral method the neutral face was seen as angry. There were no associations between biases and depression or anxiety scores for either morphing method. This study is the first to directly compare emotion recognition biases obtained using two different morphing methods and is a first step towards reconciling discrepancies in the literature.

Cognitive bias in animal behavior science: a philosophical perspective

Emotional states of animals influence their cognitive processes as well as their behavior. Assessing emotional states is important for animal welfare science as well as for many fields of neuroscience, behavior science, and biomedicine. This can be done in different ways, e.g. through assessing animals’ physiological states or interpreting their behaviors. This paper focuses on the so-called cognitive judgment bias test, which has gained special attention in the last 2 decades and has become a highly important tool for measuring emotional states in non-human animals. However, less attention has been given to the epistemology of the cognitive judgment bias test and to disentangling the relevance of different steps in the underlying cognitive mechanisms. This paper sheds some light on both the epistemology of the methods and the architecture of the underlying cognitive abilities of the tested animals. Based on this reconstruction, we propose a scheme for classifying and assessing different cognitive abilities involved in cognitive judgment bias tests.

[Perinatal beliefs: Neurocognitive mechanisms and cultural specificities]

Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.

Overconfidence in Managing Health Concerns: The Dunning-Kruger Effect and Health Literacy

Health literacy is often low within the general population. The Dunning–Kruger effect (DKE) suggests that individuals may experience a cognitive bias in which they overestimate their own knowledge base. This study examines the DKE regarding health literacy and health behaviors. A community sample (n = 504) completed questionnaires measuring objective health literacy, confidence in health knowledge, and health behaviors and medical conditions. Results support the presence of a DKE for health literacy; individuals with low health literacy reported equal or greater confidence in health knowledge than individuals with higher health literacy. Individuals with lower health literacy reported more problematic engagement in health behaviors. Low health literacy can impact engagement in health behavior and effect health outcomes, but individuals may not realize this deficit. Implications for clinical intervention include the need to address cognitive bias and enhance motivation to participate in health literacy interventions.

Cognitive bias and attitude distortion of a priority decision

The resource saving bias is a cognitive bias describing how resource savings from improvements of high-productivity units are overestimated compared to improvements of less productive units. Motivational reasoning describes how attitudes, here towards private/public health care, distort decisions based on numerical facts. Participants made a choice between two productivity increase options with the goal of saving doctor resources. The options described productivity increases in low-/high-productivity private/public emergency rooms. Jointly, the biases produced 78% incorrect decisions. The cognitive bias was stronger than the motivational bias. Verbal justifications of the decisions revealed elaborations of the problem beyond the information provided, biased integration of quantitative information, change of goal of decision, and motivational attitude biases. Most (83%) of the incorrect decisions were based on (incorrect) mathematical justifications illustrating the resource saving bias. Participants who had better scores on a cognitive test made poorer decisions. Women who gave qualitative justifications to a greater extent than men made more correct decision. After a first decision, participants were informed about the correct decision with a mathematical explanation. Only 6.3% of the participants corrected their decisions after information illustrating facts resistance. This could be explained by psychological sunk cost and coherence theories. Those who made the wrong choice remembered the facts of the problem better than those who made a correct choice.

Pharmacological compounds targeting emotional cognition in alcohol use disorder: A systematic review

Non-emotional (e.g., executive functions) and emotional cognitive (e.g., facial emotion recognition) impairments are a well-known aspect of alcohol use disorder (AUD). These deficits may impede on treatment outcomes, increase the risk of relapse, and lead to socio-occupational disabilities. Previous systematic reviews have examined the effectiveness of cognitive enhancing pharmacological agents (CEPAs) targeting non-emotional, but not emotional, cognition in AUD. Our aim was to systematically review the effectiveness of CEPAs targeting emotional cognition in subclinical and clinical AUD populations. A qualitative synthesis of controlled trials was conducted, and the studies were assessed for risk of bias. Eight studies were eligible (15 ≤ ns ≤ 143), and they all had a moderate risk of bias. Modafinil and nalmefene were the most examined agents, with the findings suggesting a potential beneficial effect of the agents on implicit emotional domains (i.e., reward processing). Methodological shortcomings and heterogeneous findings across the studies do not allow inferences about the effectiveness of these compounds in AUD. Future studies should examine CEPAs targeting emotional cognition in more detail.