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Psychiatry Research. Neuroimaging Nov 2021The experience of doubt, the lack of confidence in one's perceptions, internal states, memory and attention, can be due to the variability in occurrence of a phenomenon...
The experience of doubt, the lack of confidence in one's perceptions, internal states, memory and attention, can be due to the variability in occurrence of a phenomenon or can be driven by the internal experience of uncertainty based on subjective evaluation of the environment. Although the experience of some doubt is adaptive in normal cognitive functioning, excessive doubt can significantly impair decision-making and in extreme cases give rise to psychopathology. Although neuroimaging studies have provided some insight into the network of brain areas that is engaged when decision-making involves uncertainty, it remains unclear if dysfunction in these areas also gives rise to the experience and pathological expression of doubt. This study examined the neural correlates of doubt using neuroimaging during the performance of a forced-choice perceptual decision-making task under varying levels of uncertainty in participants who reported either low or high doubt. Participants reporting high doubt exhibited increased activation in the bilateral inferior parietal lobule (IPL) during perceptual decision-making which was not observed in participants who reported low doubt. Furthermore, activity in the IPL in high doubt participants was associated with clinical measures of doubt and showed functional connectivity differences between the high and low doubt groups. The findings of the current study suggest a key role of the IPL and provide a network of brain regions that may play a role in the experience and expression of doubt.
Topics: Brain; Brain Mapping; Decision Making; Humans; Magnetic Resonance Imaging; Uncertainty
PubMed: 34464764
DOI: 10.1016/j.pscychresns.2021.111370 -
Revue de L'infirmiere 2020Nurses can contribute to the decision-making process in emergency situations in cases of septic shock, particularly if the patient has not drawn up advance directives...
Nurses can contribute to the decision-making process in emergency situations in cases of septic shock, particularly if the patient has not drawn up advance directives and/or nominated a health care proxy. They can undertake or facilitate the collective decision making on the legal and ethical level. The team's habitus in terms of ethical analysis and the gathering of initial data can help to ensure the patients wishes are respected.
Topics: Decision Making; Humans; Shock, Septic
PubMed: 32600591
DOI: 10.1016/S1293-8505(20)30147-0 -
Health Affairs (Project Hope) Mar 2020
Topics: Decision Making; Decision Making, Shared; Humans; Patient Participation; Policy
PubMed: 32119606
DOI: 10.1377/hlthaff.2019.01783 -
Cognition Feb 2024Despite the importance of uncertainty in decision-making, few published studies have examined how individuals make moral judgments under uncertainty. Across four...
Despite the importance of uncertainty in decision-making, few published studies have examined how individuals make moral judgments under uncertainty. Across four experiments (N = 445), we examined whether a relatively small shift in probability affected participants' judgments of both moral acceptability and choice. Overall, reading dilemmas where the characters were either certain or likely to die, the probability of the sacrificed individual and the group at risk dying both had independent effects on participants' responses. That is, participants were more accepting of sacrificing the individual if they were not certain to die, but less accepting if the group was only likely to die when the individual was not sacrificed. Furthermore, a number of participants made acceptability ratings that did not match the action they endorsed, either finding the sacrificial decision more acceptable but refusing to make it, or choosing the sacrificial decision while viewing it as less acceptable. Many participants also stated that this was because they recognised a crucial difference between what they viewed as morally acceptable in a dilemma and what they were actually willing to do. Such mismatches may reflect the sensitivity and complexity of the moral principles that individuals employ during their moral decision-making.
Topics: Humans; Decision Making; Uncertainty; Judgment; Morals; Moral Obligations
PubMed: 38101081
DOI: 10.1016/j.cognition.2023.105692 -
Scientific Reports Jun 2021Successful responding to acutely threatening situations requires adequate approach-avoidance decisions. However, it is unclear how threat-induced states-like...
Successful responding to acutely threatening situations requires adequate approach-avoidance decisions. However, it is unclear how threat-induced states-like freezing-related bradycardia-impact the weighing of the potential outcomes of such value-based decisions. Insight into the underlying computations is essential, not only to improve our models of decision-making but also to improve interventions for maladaptive decisions, for instance in anxiety patients and first-responders who frequently have to make decisions under acute threat. Forty-two participants made passive and active approach-avoidance decisions under threat-of-shock when confronted with mixed outcome-prospects (i.e., varying money and shock amounts). Choice behavior was best predicted by a model including individual action-tendencies and bradycardia, beyond the subjective value of the outcome. Moreover, threat-related bradycardia (high-vs-low threat) interacted with subjective value, depending on the action-context (passive-vs-active). Specifically, in action-contexts incongruent with participants' intrinsic action-tendencies, stronger bradycardia related to diminished effects of subjective value on choice across participants. These findings illustrate the relevance of testing approach-avoidance decisions in relatively ecologically valid conditions of acute and primarily reinforced threat. These mechanistic insights into approach-avoidance conflict-resolution may inspire biofeedback-related techniques to optimize decision-making under threat. Critically, the findings demonstrate the relevance of incorporating internal psychophysiological states and external action-contexts into models of approach-avoidance decision-making.
Topics: Adolescent; Adult; Anxiety; Autonomic Nervous System; Avoidance Learning; Biofeedback, Psychology; Bradycardia; Choice Behavior; Conflict, Psychological; Decision Making; Emotions; Female; Freezing; Hippocampus; Humans; Learning; Male; Negotiating; Psychophysiology; Reinforcement, Psychology; Sensitivity and Specificity; Young Adult
PubMed: 34103543
DOI: 10.1038/s41598-021-90968-z -
Journal of Clinical Epidemiology Jan 2022To explore and characterize published evidence on the ways decision analysis has been used to inform shared decision-making. (Review)
Review
OBJECTIVE
To explore and characterize published evidence on the ways decision analysis has been used to inform shared decision-making.
STUDY DESIGN AND SETTING
For this scoping review, we searched five bibliographic databases (from inception until February 2021), reference lists of included studies, trial registries, a thesis database and websites of relevant interest groups. Studies were eligible if they evaluated the application of decision analysis in a shared decision-making encounter. Pairs of reviewers independently screened and selected studies for inclusion, extracted study information using a data extraction form developed by the research team and assessed risk of bias for all studies with an experimental or quasi-experimental design. Data were narratively synthesized.
RESULTS
We identified 27 studies that varied greatly with regard to their patient population, design, content and delivery. A range of outcomes were evaluated to explore the effectiveness and acceptability of decision analytic interventions, with little information about the implementation process. Most studies found that decision analysis was broadly beneficial.
CONCLUSION
Despite the compelling rationale on the potential for decision analysis to support shared decision-making, rigorous randomized controlled trials are needed to confirm these interventions' effectiveness, while qualitative studies should seek to understand their potential implementation.
Topics: Decision Making; Decision Making, Shared; Decision Support Techniques; Humans
PubMed: 34628018
DOI: 10.1016/j.jclinepi.2021.10.001 -
Journal of Neuroscience Research Jun 2020Goal-directed and habitual decision-making are fundamental processes that support the ongoing adaptive behavior. There is a growing interest in examining their... (Review)
Review
Goal-directed and habitual decision-making are fundamental processes that support the ongoing adaptive behavior. There is a growing interest in examining their disruption in psychiatric disease, often with a focus on a disease shifting control from one process to the other, usually a shift from goal-directed to habitual control. However, several different experimental procedures can be used to probe whether decision-making is under goal-directed or habitual control, including outcome devaluation and contingency degradation. These different experimental procedures may recruit diverse behavioral and neural processes. Thus, there are potentially many opportunities for these disease phenotypes to manifest as alterations to both goal-directed and habitual controls. In this review, we highlight the examples of behavioral and neural circuit divergence and similarity, and suggest that interpretation based on behavioral processes recruited during testing may leave more room for goal-directed and habitual decision-making to coexist. Furthermore, this may improve our understanding of precisely what the involved neural mechanisms underlying aspects of goal-directed and habitual behavior are, as well as how disease affects behavior and these circuits.
Topics: Animals; Brain; Decision Making; Goals; Habits
PubMed: 31642551
DOI: 10.1002/jnr.24545 -
Scientific Reports Oct 2023During insightful problem solving, the solution appears unexpectedly and is accompanied by the feeling of an AHA!. Research suggests that this affective component of...
During insightful problem solving, the solution appears unexpectedly and is accompanied by the feeling of an AHA!. Research suggests that this affective component of insight can have consequences beyond the solution itself by motivating future behavior, such as risky (high reward and high uncertainty) decision making. Here, we investigate the behavioral and neural support for the motivational role of AHA in decision making involving monetary choices. The positive affect of the AHA! experience has been linked to internal reward. Reward in turn has been linked to dopaminergic signal transmission in the Nucleus Accumbens (NAcc) and risky decision making. Therefore, we hypothesized that insight activates reward-related brain areas, modulating risky decision making. We tested this hypothesis in two studies. First, in a pre-registered online study (Study 1), we demonstrated the behavioral effect of insight-related increase in risky decision making using a visual Mooney identification paradigm. Participants were more likely to choose the riskier monetary payout when they had previously solved the Mooney image with high compared to low accompanied AHA!. Second, in an fMRI study (Study 2), we measured the effects of insight on NAcc activity using a similar Mooney identification paradigm to the one of Study 1. Greater NAcc activity was found when participants solved the Mooney image with high vs low AHA!. Taken together, our results link insight to enhanced NAcc activity and a preference for high but uncertain rewards, suggesting that insight enhances reward-related brain areas possibly via dopaminergic signal transmission, promoting risky decision making.
Topics: Humans; Nucleus Accumbens; Decision Making; Brain; Uncertainty; Problem Solving; Dopamine; Reward; Risk-Taking
PubMed: 37821507
DOI: 10.1038/s41598-023-44293-2 -
Trends in Neurosciences Feb 2022Suboptimal decision-making strategies have been proposed to contribute to the pathophysiology of addiction. Decision-making, however, arises from a collection of... (Review)
Review
Suboptimal decision-making strategies have been proposed to contribute to the pathophysiology of addiction. Decision-making, however, arises from a collection of computational components that can independently influence behavior. Disruptions in these different components can lead to decision-making deficits that appear similar behaviorally, but differ at the computational, and likely the neurobiological, level. Here, we discuss recent studies that have used computational approaches to investigate the decision-making processes underlying addiction. Studies in animal models have found that value updating following positive, but not negative, outcomes is predictive of drug use, whereas value updating following negative, but not positive, outcomes is disrupted following drug self-administration. We contextualize these findings with studies on the circuit and biological mechanisms of decision-making to develop a framework for revealing the biobehavioral mechanisms of addiction.
Topics: Animals; Behavior, Addictive; Decision Making; Humans; Reinforcement, Psychology; Substance-Related Disorders
PubMed: 34920884
DOI: 10.1016/j.tins.2021.11.007 -
The British Journal of General Practice... Aug 2022Shared decision making (SDM), utilising the expertise of both patient and clinician, is a key feature of good-quality patient care. Multimorbidity can complicate SDM,...
BACKGROUND
Shared decision making (SDM), utilising the expertise of both patient and clinician, is a key feature of good-quality patient care. Multimorbidity can complicate SDM, yet few studies have explored this dynamic for older patients with multimorbidity in general practice.
AIM
To explore factors influencing SDM from the perspectives of older patients with multimorbidity and GPs, to inform improvements in personalised care.
DESIGN AND SETTING
Qualitative study. General practices (rural and urban) in Devon, England.
METHOD
Four focus groups: two with patients (aged ≥65 years with multimorbidity) and two with GPs. Data were coded inductively by applying thematic analysis.
RESULTS
Patient acknowledgement of clinician medicolegal vulnerability in the context of multimorbidity, and their recognition of this as a barrier to SDM, is a new finding. Medicolegal vulnerability was a unifying theme for other reported barriers to SDM. These included expectations for GPs to follow clinical guidelines, challenges encountered in applying guidelines and in communicating clinical uncertainty, and limited clinician self-efficacy for SDM. Increasing consultation duration and improving continuity were viewed as facilitators.
CONCLUSION
Clinician perceptions of medicolegal vulnerability are recognised by both patients and GPs as a barrier to SDM and should be addressed to optimise delivery of personalised care. Greater awareness of multimorbidity guidelines is needed. Educating clinicians in the communication of uncertainty should be a core component of SDM training. The incorrect perception that most clinicians already effectively facilitate SDM should be addressed to improve the uptake of personalised care interventions.
Topics: Aged; Clinical Decision-Making; Decision Making; Decision Making, Shared; Humans; Multimorbidity; Patient Participation; Qualitative Research; Uncertainty
PubMed: 35379603
DOI: 10.3399/BJGP.2021.0529