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Objectives Both pre-hospital decision delay - the time patients wait before seeking medical attention after symptoms have started - and high psychological distress after the cardiac episode predict poor prognosis of patients with acute coronary syndromes (ACS). We aimed to identify psychosocial markers of these prognostic factors. Design A cross-sectional study of 102 consecutive, clinically stable ACS survivors. Methods Participants completed a questionnaire measuring pre-hospital decision delay, psychological distress, and several known psychosocial factors related to cardiovascular health: type D personality, resilience, social support, and concerns during the cardiac event. Multiple linear regression and mediation analyses were conducted. Results Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress post-ACS, and these relationships were mediated by longer pre-hospital decision delay. In contrast, resilience was related to lower psychological distress. Social support and social concerns about help-seeking were not related to the outcome variables. Conclusions Type D personality may be a risk factor for more delayed help-seeking for an ACS and higher psychological distress after the cardiac event. Resilience, in contrast, emerged as a potential protective factor of patients' mental health after the cardiac event. Pre-hospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one's family) but not about social concerns (e.g., wasting other people's time) during the cardiac episode. Statement of Contribution What is already known on this subject? Longer pre-hospital decision delay, that is waiting longer to seek medical attention after symptoms have started, predicts poor prognosis of acute coronary syndrome patients. High psychological distress post-ACS, such as the development of anxiety and/or depression, also predicts poor prognosis of these patients. What does this study adds? This study identifies several psychosocial markers of longer prehospital decision delay and high psychological distress post-ACS. Prehospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one's family) but not about social concerns (e.g., wasting other people's time) during the cardiac episode. Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress, and these relationships were mediated by longer prehospital decision delay. Resilience was related to lower psychological distress post-ACS., (© 2020 The British Psychological Society.)

The main aim of this research was to study the effects of response feedback on risk behavior and the neural and cognitive mechanisms involved, as a function of the feedback contingency. Sixty drivers were randomly assigned to one of three feedback groups: contingent, non-contingent and no feedback. The participants' task consisted of braking or not when confronted with a set of risky driving situations, while their electroencephalographic activity was continuously recorded. We observed that contingent feedback, as opposed to non-contingent feedback, promoted changes in the response bias towards safer decisions. This behavioral modification implied a higher demand on cognitive control, reflected in a larger amplitude of the N400 component. Moreover, the contingent feedback, being predictable and entailing more informative value, gave rise to smaller SPN and larger FRN scores when compared with non-contingent feedback. Taken together, these findings provide a new and complex insight into the neurophysiological basis of the influence of feedback contingency on the processing of decision-making under risk. We suggest that response feedback, when contingent upon the risky behavior, appears to improve the functionality of the brain mechanisms involved in decision-making and can be a powerful tool for reducing the tendency to choose risky options in risk-prone individuals., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Many patients delay seeking medical attention during acute coronary syndromes (ACS), profoundly increasing their risk for death and major disability. Although research has identified several risk factors, efforts to improve patient decision making have generally been unsuccessful, prompting a call for more research into psychological factors., Purpose: The purpose of this study is to estimate the relationship between ACS decision delay and numeracy, a factor closely related to general decision making skill and risk literacy., Methods: About 5 days after experiencing ACS, 102 survivors (mean age = 58, 32-74) completed a questionnaire including measures of numeracy, decision delay, and other relevant factors (e.g., anxiety, depression, symptom severity, knowledge, demographics)., Results: Low patient numeracy was related to longer decision delay, OR = 0.64 [95 % confidence interval (CI) 0.44, 0.92], which was in turn related to higher odds of positive troponin on arrival at the hospital, OR = 1.37 [95 % CI 1.01, 2.01]. Independent of the influence of all other assessed factors, a patient with high (vs. low) numeracy was about four times more likely to seek medical attention within the critical first hour after symptom onset (i.e., OR high-low  = 3.84 [1.127, 11.65])., Conclusions: Numeracy may be one of the largest decision delay risk factors identified to date. Results accord with theories emphasizing potentially pivotal roles of patient deliberation, denial, and outcome understanding during decision making. Findings suggest that brief numeracy assessments may predict which patients are at greater risk for life-threatening decision delay and may also facilitate the design of risk communications that are appropriate for diverse patients who vary in risk literacy.

The main aim of this research was to investigate the decision making process in risky situations. We studied how different types of feedback on risky driving behaviors modulate risk evaluation and risk-taking. For a set of risky traffic situations, participants had to make evaluative judgments (judge the situation as risky or not) and urgent decisions (brake or not). In Experiment 1, participants received feedback with and without negative emotional content when they made risky behaviors. In Experiment 2 we investigated the independent effects of feedback and negative emotional stimuli. The results showed three important findings: First, urgent decisions were faster [F(1, 92) = 6.76, p = .01] and more cautious [F(1, 92) = 17.16, p < .001] than evaluative judgments. These results suggest that evaluative judgments of risk and actual risk-taking may not always coincide, and that they seem to be controlled by two different processing systems as proposed by dual process theories. Second, feedback made participants' responses even faster [F(1, 111) = 71.53, p < .001], allowing greater risk sensitivity [F(1, 111) = 22.12, p < .001] and skewing towards more cautious responses [F(1, 111) = 14.09, p < .001]. Finally, emotional stimuli had an effect only when they were presented as feedback. The results of this research increase our understanding of the processes involved in risky driving behavior and suggest efficient ways to control risk taking through the use of feedback.

Contrary to people's intuitions, many screenings can have both benefits (e.g., lives saved) and harms (e.g., unnecessary treatments). Statistical information is often provided to ensure informed decision making. However, few theoretical models have addressed the role of comprehension of such information in screening decisions. In an experiment, we studied how cognitive skills, emotions, and a priori beliefs about screening affect comprehension of the evidence of benefits and harms from screening and intentions to get screened. Young adults (N = 347) received information about a disease for which a screening test was available and numerical information about the benefits and harms from screening. Results showed that comprehension and perceptions of benefits are central to decisions; however, lay perceptions of harms along the screening cascade require further study. Numeracy, science literacy, and emotions can promote informed decision making by facilitating comprehension of the evidence. At the same time emotions and beliefs resulting from persuasive campaigns can have strong effects on screening intentions beyond the available evidence. To apply to screening procedures where informed decision making is recommended, theoretical models of screening decisions need to include comprehension of benefits and harms, and account for how cognitive skills, emotions, and beliefs influence comprehension and decisions. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Recent research has proposed that altered reward and punishment sensitivity, heightened impulsivity, and faulty dynamic decision-making are at the core of disordered gambling. However, each of these traits and cognitive aspects dimensionally vary in the normal population, such that the link between individual differences in these dimensions and gambling use can be ultimately informative to explain disordered gambling. The main aim of the present study was to investigate the contribution of such decision-making-related indices to gambling use parameters in a community sample of college students. Assessment included punishment and reward sensitivity (as measured by the shortened Sensitivity to Punishment and Sensitivity to Reward Questionnaire), impulsivity (as measured by the UPPS-P model and a motor inhibition Go/No-go task), and dynamic decision-making [as measured by the probabilistic reversal learning task (PRLT)]. A structured interview was conducted to explore quantitative aspects of the participants gambling habits (gambling presence, gambling frequency, and average amount of money spent in gambling per unit of time). Our results showed the existence of a decision-making profile of gambling, as it naturally occurs in college students, in which sensation seeking is directly and specifically related to gambling presence (gambling, or not gambling at all), punishment sensitivity is inversely related to gambling frequency, and inflexibility in the PRLT specifically predicts the losses accrued because of gambling. These results are compatible with the idea that sensation seeking and punishment insensitivity could increase exposure to gambling activities, whereas reversal learning inflexibility, in people who already gamble, could boost the risk to accumulate losses.

Dual-process theories have dominated the study of risk perception and risk-taking over the last two decades. However, there is a lack of objective brain-level evidence supporting the two systems of processing in every-day risky behavior. To address this issue, we propose the dissociation between evaluative and urgent behaviors as evidence of dual processing in risky driving situations. Our findings show a dissociation of evaluative and urgent behavior both at the behavioral and neural level. fMRI data showed an increase of activation in areas implicated in motor programming, emotional processing, and visuomotor integration in urgent behavior compared to evaluative behavior. These results support a more automatic processing of risk in urgent tasks, relying mainly on heuristics and experiential appraisal. The urgent task, which is characterized by strong time pressure and the possibility for negative consequences among others factors, creates a suitable context for the experiential-affective system to guide the decision-making process. Moreover, we observed greater frontal activation in the urgent task, suggesting the participation of cognitive control in safe behaviors. The findings of this research are relevant for the study of the neural mechanisms underlying dual process models in risky perception and decision-making, especially because of their proximity to everyday activities., (© 2015 Wiley Periodicals, Inc.)

Emotional interference on behavior is commonly observed when task-irrelevant negative stimuli appear before behavioral targets. One explanation postulates that affect-laden stimuli readily capture attention, interfering with the processing of the upcoming target. Emotional stimuli might also preactivate motor programs incompatible with the demanded response. Using a cued go/no-go procedure we showed that task-irrelevant unpleasant stimuli cause interference or facilitation depending on their onset asynchrony relative to the target. We observed interference with short (200 ms) stimulus-target asynchronies and facilitation for longer ones (600 ms), both for key press (Experiment 1) and key release (Experiment 2) responses. The interference effect is compatible with an attentional explanation, but the behavioral facilitation is hard to accommodate within either attentional or motor accounts. This interference-facilitation pattern can be explained assuming that once the attentional effect subsides, emotional processing may enhance the perceptual processing of the stimuli, or lower the decision threshold, thereby facilitating the response selection process. [ABSTRACT FROM AUTHOR]

The ventromedial prefrontal cortex (VMPFC) have been implied in emotional decision making, because it seems to have a role in affective reversal learning, risk proneness, and impulsive behaviour. The variety of connections of the VMPFC with several cortical and subcortical areas, as the amygdala, make likely that it can play a significant function in the control y regulation of human behaviour. In this work we reviewed studies on the Iowa Gambling task, the affective reversal learning task, lottery tasks designed to measure risk propensity, and reward delayed tasks designed to measure impulsivity. These tasks have been applied to VMPFC patients, patients with damages in other prefrontal areas, and controls. The patterns of behavioural y brain activity data can be best accounted for assuming that the VMPFC build up a representation of the expectation of reinforcement. Reinforcement amount, delay, and variance are integral parts of the representation of an expected reinforcement. [ABSTRACT FROM AUTHOR]

Abstract: The present study is aimed at identifying how prior causal beliefs and covariation information contribute to belief updating when evidence, either compatible or contradictory with those beliefs, is provided. Participants were presented with a cover story with which it was intended to activate or generate a causal belief. Variables related to the prior belief (the type of information, the strength of the cause–effect causal link, and how confident the participant was that the link existed) were assessed. Subsequently, participants were presented with covariational information and were asked to update their beliefs in light of the new evidence. Information reliability, prior belief’s causal influence magnitude, and the cause–effect level of contingency portrayed by the new information – but not the type of the prior belief – are shown to directly determine belief updating. [Copyright &y& Elsevier]

The main aim of this study was to look into the effect of feedback contingency on decision making in complex risky situations, using a driving context. Participants had to decide braking or not in a set of risky traffic situations. After the response, a negative non-contingent or contingent feedback was used. The results highlight the importance of feedback contingency upon safer decision making in risky contexts, as they showed how a contingent feedback led to faster and safer responses than a control group without any feedback; whereas a non-contingent one gives rise to slower responses and, more importantly, an enhanced risk-taking behavior that could be the cause of undesirable effects on road safety. The feedback effect was even more evident in the appearance of an opposite response bias as a function of contingency and enhanced by learning. These results accord with the theoretical accounts based upon the feedback influence on the threshold level of decision making. Moreover, the effects of feedback may be explained by new proposals focusing on the importance of attentional factors as well as of the mental models people build to react in complex risky scenarios, as a product of feedback and learning. Finally, this research may increase our understanding of the role of feedback in the process of learning safer behavior in complex risky situations. [ABSTRACT FROM AUTHOR]

Abstract: In road safety literature the effects of emotional content and salience of advertising billboards have been scarcely investigated. The main aim of this work was to uncover how affect-laden roadside advertisements can affect attention – eye-movements – and subsequent risky decisions – braking – on the Honda Riding Trainer motorcycle simulator. Results indicated that the number of fixations and total fixation time elicited by the negative and positive emotional advertisements were larger than the neutral ones. At the same time, negative pictures got later gaze disengagement than positive and neutral ones. This attentional capture results in less eye fixation times on the road relevant region, where the important driving events happen. Finally, the negative emotional valence advertisements sped up braking on subsequent risky situations. Overall results demonstrated how advertisements with emotional content modulate attention allocation and driving decisions in risky situations and might be helpful for designing roadside advertisements regulations and risk prevention programs. [Copyright &y& Elsevier]

Abstract: In two experiments, we investigated the relative impact of causal beliefs and empirical evidence on both decision making and causal judgments, and whether this relative impact could be altered by previous experience. Participants had to decide which of two alternatives would attain a higher outcome on the basis of four cues. After completing the decision task, they were asked to estimate to what extent each cue was a reliable cause of the outcome. Participants were provided with instructions that causally related two of the cues to the outcome, whereas they received neutral information about the other two cues. Two of the four cues—a causal and a neutral cue—had high validity and were both generative. The remaining two cues had low validity, and were generative in Experiment 1, but almost not related to the outcome in Experiment 2. Selected groups of participants in both experiments received pre-training with either causal or neutral cues, or no pre-training was provided. Results revealed that the impact of causal beliefs and empirical evidence depends on both the experienced pre-training and cue validity. When all cues were generative and participants received pre-training with causal cues, they mostly relied on their causal beliefs, whereas they relied on empirical evidence when they received pre-training with neutral cues. In contrast, when some of the cues were almost not related to the outcome, participants’ responses were primarily influenced by validity and—to a lesser extent—by causal beliefs. In either case, however, the influence of causal beliefs was higher in causal judgments than in decision making. While current theoretical approaches in causal learning focus either on the effect of causal beliefs or empirical evidence, the present research shows that both factors are required to explain the flexibility involved in human inferences. [Copyright &y& Elsevier]

Abstract: This study demonstrated that task features are important factors for the understanding of risk behavior under emotional conditions in driving scenarios. We introduce a distinction between urgent and evaluative behaviors. Urgent behaviors are performed under high time-pressure and, when successful, they will help to avoid high negative outcomes. According to some social psychologists, evaluation is considered a type of value categorization (for example, risk or no risk). Emotional cues in the urgency task make participants slower and less able to discriminate risk from no risk, and prone to positive responses. However, negative emotional pictures speed up the evaluation of risk without affecting the ability to discriminate risk from no risk in a driving scenario. [Copyright &y& Elsevier]