Numeracy and the Motivational Mind: The Power of Numeric Self-efficacy

BACKGROUND

Objective numeracy appears to support better medical decisions and health outcomes. The more numerate generally understand and use numbers more and make better medical decisions, including more informed medical choices. Numeric self-efficacy-an aspect of subjective numeracy that is also known as numeric confidence-also relates to decision making via emotional reactions to and inferences from experienced difficulty with numbers and via persistence linked with numeric comprehension and healthier behaviors over time. Furthermore, it moderates the effects of objective numeracy on medical outcomes.

PURPOSE

We briefly review the numeracy and decision-making literature and then summarize more recent literature on 3 separable effects of numeric self-efficacy. Although dual-process theories can account for the generally superior decision making of the highly numerate, they have neglected effects of numeric self-efficacy. We discuss implications for medical decision-making (MDM) research and practice. Finally, we propose a modification to dual-process theories, adding a "motivational mind" to integrate the effects of numeric self-efficacy on decision-making processes (i.e., inferences from experienced difficulty with numbers, greater persistence, and greater use of objective-numeracy skills) important to high-quality MDM.

CONCLUSIONS

The power of numeric self-efficacy (confidence) has been little considered in MDM, but many medical decisions and behaviors require persistence to be successful over time (e.g., comprehension, medical-recommendation adherence). Including numeric self-efficacy in research and theorizing will increase understanding of MDM and promote development of better decision interventions.

HIGHLIGHTS

Research demonstrates that objective numeracy supports better medical decisions and health outcomes.The power of numeric self-efficacy (aka numeric confidence) has been little considered but appears critical to emotional reactions and inferences that patients and others make when encountering numeric information (e.g., in decision aids) and to greater persistence in medical decision-making tasks involving numbers.The present article proposes a novel modification to dual-process theory to account for newer findings and to describe how numeracy mechanisms can be better understood.Because being able to adapt interventions to improve medical decisions depends in part on having a good theory, future research should incorporate numeric self-efficacy into medical decision-making theories and interventions.

Novel Approaches and Cognitive Neuroscience Perspectives on False Memory and Deception

The DRM (Deese-Roediger-McDermott) paradigm produces robust false memories of non-presented critical words. After studying a thematic word list (e.g., bed, rest, and pillow) participants falsely remember the critical item "sleep." We report two false memory experiments. Study One introduces a novel use of the lexical decision task (LDT) to prime critical words. Participants see two letter-strings and make timed responses indicating whether they are both words. The word pairs Night-Bed and Dream-Thweeb both prime "sleep" but only one pair contains two words. Our primary purpose is to introduce this new methodology via two pilot experiments. The results, considered preliminary, are promising as they indicate that participants were as likely to recognize critical words (false memories) and presented words (true memories) just as when studying thematic lists. Study Two actually employs the standard DRM lists so that semantic priming is in play there as well. The second study, however, uses functional near-infrared spectroscopy (fNIRS) to measure activity in the prefrontal cortex during a DRM task which includes a deception phase where participants intentionally lie about critical lures. False and true memories occurred at high levels and activated many of the same brain regions but, compared to true memories, cortical activity was higher for false memories and lies. Accuracy findings are accompanied by confidence and reaction time results. Both investigations suggest that it is difficult to distinguish accurate from inaccurate memories. We explain results in terms of activation-monitoring theory and Fuzzy Trace Theory. We provide real world implications and suggest extending the present research to varying age groups and special populations. A nagging question has not been satisfactorily answered: Could neural pathways exist that signal the presence of false memories and lies? Answering this question will require imaging experiments that focus on regions of distinction such as the anterior prefrontal cortex.

Manipulations of List Type in the DRM Paradigm: A Review of How Structural and Conceptual Similarity Affect False Memory

The use of list-learning paradigms to explore false memory has revealed several critical findings about the contributions of similarity and relatedness in memory phenomena more broadly. Characterizing the nature of "similarity and relatedness" can inform researchers about factors contributing to memory distortions and about the underlying associative and semantic networks that support veridical memory. Similarity can be defined in terms of semantic properties (e.g., shared conceptual and taxonomic features), lexical/associative properties (e.g., shared connections in associative networks), or structural properties (e.g., shared orthographic or phonological features). By manipulating the type of list and its relationship to a non-studied critical item, we review the effects of these types of similarity on veridical and false memory. All forms of similarity reviewed here result in reliable error rates and the effects on veridical memory are variable. The results across a variety of paradigms and tests provide partial support for a number of theoretical explanations of false memory phenomena, but none of the theories readily account for all results.

The effect of early list manipulations on the DRM illusion

The Deese-Roediger-McDermott (DRM) paradigm is widely used to study false memory in the laboratory. It tests memory for lists of semantically related words (correct list item memories) and their non-presented associates (false lure memories). Evidence suggests that early items in DRM lists could make an especially significant contribution to false memories of lures, as they may critically influence the underlying associative activation and/or gist extraction processes. The present study tested this suggestion by using two manipulations that were intended to affect processing of early DRM list items. The first was interpolation of a semantically unrelated distractor item among the list items (Experiments 1 and 2). The second was arranging for these items to be either the strongest or weakest associates of the lure (Experiment 2). In Experiment 1, a distractor item reduced both list item and lure recall when presented early in a DRM list, but selectively disrupted list item recall when presented late in the list. In Experiment 2, arranging for the early list items to be the weakest associates of the lure reduced false recall of the lure but had no effect on list item recall. The findings are discussed with respect to theories that explain false memory in the DRM protocol, including fuzzy trace theory (FTT) and activation-monitoring theory (AMT). They are also discussed with respect to general theories of memory and the potential role of category/context information in generating false memories.

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

OBJECTIVES

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTITIONER POINTS

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

Patients' and Clinicians' Perceptions of Antibiotic Prescribing for Upper Respiratory Infections in the Acute Care Setting

Reducing inappropriate prescribing is key to mitigating antibiotic resistance, particularly in acute care settings. Clinicians' prescribing decisions are influenced by their judgments and actual or perceived patient expectations. Fuzzy trace theory predicts that patients and clinicians base such decisions on categorical gist representations that reflect the bottom-line understanding of information about antibiotics. However, due to clinicians' specialized training, the categorical gists driving clinicians' and patients' decisions might differ, which could result in mismatched expectations and inefficiencies in targeting interventions. We surveyed clinicians and patients from 2 large urban academic hospital emergency departments (EDs) and a sample of nonpatient subjects regarding their gist representations of antibiotic decisions, as well as relevant knowledge and expectations. Results were analyzed using exploratory factor analysis (EFA) and multifactor regression. In total, 149 clinicians (47% female; 74% white), 519 online subjects (45% female; 78% white), and 225 ED patients (61% female; 56% black) completed the survey. While clinicians demonstrated greater knowledge of antibiotics and concern about side effects than patients, the predominant categorical gist for both patients and clinicians was "why not take a risk," which compares the status quo of remaining sick to the possibility of benefit from antibiotics. This gist also predicted expectations and prior prescribing in the nonpatient sample. Other representations reflected the gist that "germs are germs" conflating bacteria and viruses, as well as perceptions of side effects and efficacy. Although individually rational, reliance on the "why not take a risk" representation can lead to socially suboptimal results, including antibiotic resistance and individual patient harm due to adverse events. Changing this representation could alter clinicians' and patients' expectations, suggesting opportunities to reduce overprescribing.

Negativity bias in false memory: moderation by neuroticism after a delay

The negativity bias is the tendency for individuals to give greater weight, and often exhibit more rapid and extreme responses, to negative than positive information. Using the Deese-Roediger-McDermott illusory memory paradigm, the current study sought to examine how the negativity bias might affect both correct recognition for negative and positive words and false recognition for associated critical lures, as well as how trait neuroticism might moderate these effects. In two experiments, participants studied lists of words composed of semantic associates of an unpresented word (the critical lure). Half of the lists were comprised of positive words and half were comprised of negative words. As expected, individuals remembered negative list words better than positive list words, consistent with a negativity bias in correct recognition. When tested immediately (Experiment 1), individuals also exhibited greater false memory for negative versus positive critical lures. When tested after a 24-hr delay (Experiment 2), individuals higher in neuroticism maintained greater false memory for negative versus positive critical lures, but those lower in neuroticism showed no difference in false memory between negative and positive critical lures. Possible mechanisms and implications for mental health disorders are discussed.

Adolescents' and Young Adults' Online Risk Taking: The Role of Gist and Verbatim Representations

Young people are exposed to and engage in online risky activities, such as disclosing personal information and making unknown friends online. Little research has examined the psychological mechanisms underlying young people's online risk taking. Drawing on fuzzy trace theory, we examined developmental differences in adolescents' and young adults' online risk taking and assessed whether differential reliance on gist representations (based on vague, intuitive knowledge) or verbatim representations (based on specific, factual knowledge) could explain online risk taking. One hundred and twenty two adolescents (ages 13-17) and 172 young adults (ages 18-24) were asked about their past online risk-taking behavior, intentions to engage in future risky online behavior, and gist and verbatim representations. Adolescents had significantly higher intentions to take online risks than young adults. Past risky online behaviors were positively associated with future intentions to take online risks for adolescents and negatively for young adults. Gist representations about risk negatively correlated with intentions to take risks online in both age groups, while verbatim representations positively correlated with online risk intentions, particularly among adolescents. Our results provide novel insights about the underlying mechanisms involved in adolescent and young adults' online risk taking, suggesting the need to tailor the representation of online risk information to different age groups.

An Overview of Judgment and Decision Making Research Through the Lens of Fuzzy Trace Theory

We present the basic tenets of fuzzy trace theory, a comprehensive theory of memory, judgment, and decision making that is grounded in research on how information is stored as knowledge, mentally represented, retrieved from storage, and processed. In doing so, we highlight how it is distinguished from traditional models of decision making in that gist reasoning plays a central role. The theory also distinguishes advanced intuition from primitive impulsivity. It predicts that different sorts of errors occur with respect to each component of judgment and decision making: background knowledge, representation, retrieval, and processing. Classic errors in the judgment and decision making literature, such as risky-choice framing and the conjunction fallacy, are accounted for by fuzzy trace theory and new results generated by the theory contradict traditional approaches. We also describe how developmental changes in brain and behavior offer crucial insight into adult cognitive processing. Research investigating brain and behavior in developing and special populations supports fuzzy trace theory's predictions about reliance on gist processing.

Testing different communication formats on responses to imagined risk of having versus missing the GSTM1 gene

Genetic markers of lung cancer susceptibility, such as the common variant of the glutathione S-transferase Mu 1 gene (GSTM1-null), confer small probabilities of disease risk. The authors explored the influence of different approaches to communicating the small variations in risk associated with this biomarker. College smokers (N = 128) imagined that they had the GSTM1 wild-type variant versus the GSTM1 null-type variant. The authors presented lung cancer risk in 6 ways that varied the risk format (absolute risk vs. incremental risk) and the presentation style of the information (no graphics vs. graphic display of foreground only vs. graphic display of foreground + background). Presentation style had minor effects. However, absolute risk information increased negative emotions more than did incremental risk information. Perceptions of risk and negative emotions were most profoundly affected by the difference between having the GSTM1 wild-type variant versus the GSTM1 null-type variant. The authors discuss implications for conveying small probabilities related to genetic risk.

The effect of graphics on environmental health risk beliefs, emotions, behavioral intentions, and recall

Lay people have difficulty understanding the meaning of environmental health risk information. Visual images can use features that leverage visual perception capabilities and semiotic conventions to promote meaningful comprehension. Such evidence-based features were employed to develop two images of a color-coded visual scale to convey drinking water test results. The effect of these images and a typical alphanumeric (AN) lab report were explored in a repeated measures randomized trial among 261 undergraduates. Outcome measures included risk beliefs, emotions, personal safety threshold, mitigation intentions, the durability of beliefs and intentions over time, and test result recall. The plain image conveyed the strongest risk message overall, likely due to increased visual salience. The more detailed graded image conveyed a stronger message than the AN format only for females. Images only prompted meaningful risk reduction intentions among participants with optimistically biased safety threshold beliefs. Fuzzy trace theory supported some findings as follow. Images appeared to promote the consolidation of beliefs over time from an initial meaning of safety to an integrated meaning of safety and health risk; emotion potentially shaped this process. Although the AN report fostered more accurate recall, images were related to more appropriate beliefs and intentions at both time points. Findings hinted at the potential for images to prompt appropriate beliefs independent of accurate factual knowledge. Overall, results indicate that images facilitated meaningful comprehension of environmental health risk information and suggest foci for further research.