Making decisions one drink at a time and the "just one drink" effect: A fuzzy-trace theory model of harmful drinking.

BACKGROUND: Understanding the decision factors that drive harmful alcohol use among young adults is of practical and theoretical importance. We apply fuzzy-trace theory (FTT) to investigate a potential danger that may arise from the arguably correct notion that a single drink carries no meaningful risk. Decisions that are mentally represented as one drink at a time could contribute to excessive drinking. METHODS: College students (N = 351) made a series of decisions to take or decline eight hypothetical drinks presented one at a time. Outcome measures included each decision, recent alcohol consumption (weekly drinks, peak blood alcohol content, and binges), and alcohol-related harms (scores on the Brief Young Adult Alcohol Consequences Questionnaire and Alcohol Use Disorders Identification Test). Linear regression models predicted each outcome from sex, perceived risk of a single drink, perceived risk of heavy drinking, perceived consequences of drinking, and general health-related risk sensitivity. RESULTS: Consistent with FTT, decisions to have a first drink and up to four additional drinks in short succession were each associated with lower perceived risk of one drink-a "just-one drink" effect-independent of perceived risks of heavy drinking, perceived consequences of drinking, and general risk sensitivity. Similarly, all measures of recent alcohol consumption and consequent harms were associated with perceived risk of one drink. Participants reporting "zero risk" of a single drink had worse outcomes on all measures than those reporting at least "low risk." CONCLUSIONS: Results are consistent with the theoretically informed premise that consumption decisions are typically made one drink at a time rather than by deciding the total number of drinks to be consumed in a sitting. When decisions about alcohol use proceed one drink at a time, a perception of zero risk in a single drink may contribute to heavy drinking.

The power of meaningful numbers: Attorney guidance and jury deliberation improve the reliability and gist validity of damage awards.

OBJECTIVE: A mock jury experiment tested the effects of attorney guidance and jury deliberation to mitigate the challenges that civil juries face in assessing damages. HYPOTHESES: We hypothesized that two types of attorney guidance (per diem, per diem + lump sum), theoretically based in the Hans-Reyna model of jury decision making, would improve jury decision making compared with no guidance against five key benchmarks: injury assessment, validity, reliability, verbatim-gist coherence, and metacognitive experience. We expected that deliberation would increase reliability of, confidence in, and polarization of awards compared with predeliberation. METHOD: Community members (N = 317; 61% women; 86.1% White; Mage = 48.68 years) deliberated in 54 mock juries. Participants watched a videotaped trial involving an automobile accident in which two plaintiffs sustained concussions (one mild and one severe). The plaintiffs' attorney's closing arguments varied attorney guidance (no guidance, per diem, per diem + lump sum). Mock jurors provided individual judgments before deliberating as a jury and reaching group verdicts and awards. RESULTS: Juries performed well against benchmarks. Providing gist-based guidance with a meaningful award recommendation increased the validity of jurors' individual damage awards (η²p jurors = .03) and the reliability of jury damage awards (η²p jurors = .04; η²p jurors = .20); gist-based guidance without an award recommendation did not improve performance against benchmarks and increased perceptions of decision-making difficulty (η²p = .13). Deliberation increased reliability of (η²p = .17), confidence in (η²p = .02), and polarization of (d = 2.14) awards compared with predeliberation. CONCLUSION: Juries performed well against objective benchmarks of performance (injury assessment, validity, reliability, and verbatim-gist coherence), and deliberation improved performance compared with predeliberation decisions. Jury decisions were further influenced by attorney closing arguments (the guidance manipulation), especially when the attorney requests a lump sum, which can serve as a powerful influence on jury awards, mainly by setting an upper limit. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Providing the Gist of Medical Expertise in the Context of Laws, Rules, and Guidelines: Fuzzy-Trace Theory's Alternative Approach to Improve Patient Communication.

Current guidelines and regulatory frameworks create a dilemma that threatens the effectiveness of much needed communication between patients and medical providers: How can patients be presented with detailed facts without creating cognitive "overload"? We explain how this is a false dichotomy and illustrate, using three examples, how fuzzy-trace theory offers a third way of informing patients.

Giving information strategically and transparently: A pilot trial of the Oncolo-GIST intervention to promote patients' prognostic understanding.

PURPOSE: Most patients with cancer lack the prognostic understanding necessary to make informed decisions. We tested the feasibility and acceptability of the Oncolo-GIST ("Giving Information Strategically and Transparently, GIST") intervention and explored its associations with patients' improved prognostic understanding. METHODS: The Oncolo-GIST intervention distills prognostic discussions into easy-to-understand talking points. Patients with metastatic cancers that progressed on ≥1 line of chemotherapy and not expected to survive 12 months (n = 31) were recruited from October 2020 through November 2022. We compared patients who discussed their progressive scans with an oncologist trained in the GIST technique or not (i.e., usual care). A primary outcome was prognostic understanding (e.g., patients reporting a life-expectancy of months) assessed within a week of the scan discussion visit. RESULTS: Oncologists (n = 4) appeared receptive to the Oncolo-GIST intervention and scored nearly perfectly on post-training tests of material mastery after a < 2-h tutorial. Post-scan discussion visit, 100% of patients who met with an Oncolo-GIST-trained clinician understood that their cancer was considered incurable (a 31% improvement from pre-visit) compared with 91% of patients meeting with usual care oncologists (an 18% improvement); 33% of patients who met with an Oncolo-GIST-trained oncologist understood that they likely had months, not years, compared to 18% in the usual care group. No statistically significant differences emerged for these changes, nor for therapeutic alliance, anxiety, or depression scores between groups. CONCLUSION: Oncolo-GIST appears to be an easily learned approach to improve prognostic understanding that neither undermines therapeutic alliances nor increases patients' anxiety or depressive symptoms. Efficacy testing in a larger trial is warranted.

Numeracy, gist, literal thinking and the value of nothing in decision making.

The onus on the average person is greater than ever before to make sense of large amounts of readily accessible quantitative information, but the ability and confidence to do so are frequently lacking. Many people lack practical mathematical skills that are essential for evaluating risks, probabilities and numerical outcomes such as survival rates for medical treatments, income from retirement savings plans or monetary damages in civil trials. In this Review, we integrate research on objective and subjective numeracy, focusing on cognitive and metacognitive factors that distort human perceptions and foment systematic biases in judgement and decision making. Paradoxically, an important implication of this research is that a literal focus on objective numbers and mechanical number crunching is misguided. Numbers can be a matter of life and death but a person who uses rote strategies (verbatim representations) cannot take advantage of the information contained in the numbers because 'rote' strategies are, by definition, processing without meaning. Verbatim representations (verbatim is only surface form, not meaning) treat numbers as data as opposed to information. We highlight a contrasting approach of gist extraction: organizing numbers meaningfully, interpreting them qualitatively and making meaningful inferences about them. Efforts to improve numerical cognition and its practical applications can benefit from emphasizing the qualitative meaning of numbers in context - the gist - building on the strengths of humans as intuitive mathematicians. Thus, we conclude by reviewing evidence that gist training facilitates transfer to new contexts and, because it is more durable, longer-lasting improvements in decision making.

Social media: Why sharing interferes with telling true from false.

Sharing on social media decreases true-false discrimination but focusing on accuracy helps people recognize what they already know. Process-oriented research offers hope in combatting misinformation.

Critical tests of fuzzy trace theory in brain and behavior: uncertainty across time, probability, and development.

Uncertainty permeates decisions from the trivial to the profound. Integrating brain and behavioral evidence, we discuss how probabilistic (varied outcomes) and temporal (delayed outcomes) uncertainty differ across age and individuals; how critical tests adjudicate between theories of uncertainty (prospect theory and fuzzy-trace theory); and how these mechanisms might be represented in the brain. The same categorical gist representations of gains and losses account for choices and eye-tracking data in both value-allocation (add money to gambles) and risky-choice tasks, disconfirming prospect theory and confirming predictions of fuzzy-trace theory. The analysis is extended to delay discounting and disambiguated choices, explaining hidden-zero effects that similarly turn on categorical distinctions between some gain and no gain, certain gain and uncertain gain, gain and loss, and now and later. Bold activation implicates dorsolateral prefrontal and posterior parietal cortices in gist strategies that are not just one tool in a grab-bag of cognitive options but rather are general strategies that systematically predict behaviors across many different tasks involving probabilistic and temporal uncertainty. High valuation (e.g., ventral striatum; ventromedial prefrontal cortex) and low executive control (e.g., lateral prefrontal cortex) contribute to risky and impatient choices, especially in youth. However, valuation in ventral striatum supports reward-maximizing and gist strategies in adulthood. Indeed, processing becomes less "rational" in the sense of maximizing gains and more noncompensatory (eye movements indicate fewer tradeoffs) as development progresses from adolescence to adulthood, as predicted. Implications for theoretically predicted "public-health paradoxes" are discussed, including gist versus verbatim thinking in drug experimentation and addiction.

Individual differences in numerical representations of risk in health decision making: A fuzzy-trace theory approach.

Fuzzy-trace theory predicts that decisionmakers process numerical information about risk at multiple levels in parallel: the simplest level, nominal (categorical some-none) gist, and at more fine-grained levels, involving relative comparison (ordinal less-more gist) and exact quantities (verbatim representations). However, little is known about how individual differences in these numerical representations relate to judgments and decisions, especially involving health tradeoffs and relative risks. To investigate these differences, we administered measures of categorical and ordinal gist representations of number, objective numeracy, and intelligence in two studies (Ns = 978 and 956). In both studies, categorical and ordinal gist representations of number predicted risk judgments and decisions beyond objective numeracy and intelligence. Participants with higher scores in categorical gist were more likely to choose options to avoid cancer recurrence risks; those who were higher in ordinal gist of numbers were more likely to discriminate relative risk of skin cancer; and those with higher scores in objective numeracy were more likely to choose options that were numerically superior overall in terms of relative risk of skin cancer and of genetic risks of breast cancer (e.g., lower numerical probability of cancer). Results support parallel-processing models that assume multiple representations of numerical information about risk, which vary in precision, and illustrate how individual differences in numerical representations are relevant to tradeoffs and risk comparisons in health decisions. These representations cannot be reduced to one another and explain psychological variations in risk processing that go beyond low versus high levels of objective numeracy.

Understanding the landscape of web-based medical misinformation about vaccination.

Given the high rates of vaccine hesitancy, web-based medical misinformation about vaccination is a serious issue. We sought to understand the nature of Google searches leading to medical misinformation about vaccination, and guided by fuzzy-trace theory, the characteristics of misinformation pages related to comprehension, inference-making, and medical decision-making. We collected data from web pages presenting vaccination information. We assessed whether web pages presented medical misinformation, had an overarching gist, used narrative, and employed emotional appeals. We used Search Engine Optimization tools to determine the number of backlinks from other web pages, monthly Google traffic, and Google Keywords. We used Coh-Metrix to measure readability and Gist Inference Scores (GIS). For medical misinformation web pages, Google traffic and backlinks were heavily skewed with means of 138.8 visitors/month and 805 backlinks per page. Medical misinformation pages were significantly more likely than other vaccine pages to have backlinks from other pages, and significantly less likely to receive at least one visitor from Google searches per month. The top Google searches leading to medical misinformation were "the truth about vaccinations," "dangers of vaccination," and "pro con vaccines." Most frequently, pages challenged vaccine safety, with 32.7% having an overarching gist, 7.7% presenting narratives, and 17.3% making emotional appeals. Emotional appeals were significantly more common with medical misinformation than other high-traffic vaccination pages. Misinformation pages had a mean readability grade level of 11.5, and a mean GIS of - 0.234. Low GIS scores are a likely barrier to understanding gist, and are the "Achilles' heel" of misinformation pages.

Adapting a Theoretically-Based intervention for underserved clinical populations at increased risk for hereditary Cancer: Lessons learned from the BRCA-Gist experience.

Background: Minorities at increased risk for Hereditary Breast and Ovarian Cancer (HBOC) frequently have low awareness and use of genetic counseling and testing (GCT). Making sure that evidence-based interventions (EBIs) reach minorities is key to reduce disparities. BRCA-Gist is a theory-informed EBI that has been proven to be efficacious in mostly non-Hispanic White non-clinical populations. We conducted formative work to inform adaptations of BRCA-Gist for use in clinical settings with at-risk diverse women. Methods: Genetic counselors (n = 20) were recruited nationally; at-risk Latinas and Blacks (n = 21) were recruited in Washington DC and Virginia. They completed the BRCA-Gist EBI between April 2018 - September 2019. Participants completed an acceptability scale and an interview to provide suggestions about implementation adaptations. T-tests for independent samples compared acceptability between at-risk women and genetic counselors. The Consensual Qualitative Research Framework was used to code adaptation suggestions. Suggested adaptations were discussed by a multidisciplinary team to integrate fidelity and adaptation considerations. Results: At-risk women had a significantly higher acceptability (M = 4.17, SD = 0.47 vs. M = 3.24, SD = 0.64; p = 0.000; scale 1-5) and satisfaction scores (M = 8.3, SD = 1.3 vs. M = 4.2, SD = 2.0; p = 0.000; scale 1-10) than genetic counselors. Genetic counselors and at-risk women suggested contextual (e.g. format) and content (e.g. shortening) adaptations to enhance the fit of BRCA-Gist for diverse clinical populations. Conclusions: Findings illustrate the process of integrating fidelity and adaptation considerations to ensure that EBIs retain their core components while enhancing the fit to minoritized clinical populations. Future studies will test the efficacy of the adapted BRCA-Gist in a Randomized Controlled Trial.

Supporting Health and Medical Decision Making: Findings and Insights from Fuzzy-Trace Theory.

HIGHLIGHTS: Fuzzy-trace theory (FTT) supports practical approaches to improving health and medicine.FTT differs in important respects from other theories of decision making, which has implications for how to help patients, providers, and health communicators.Gist mental representations emphasize categorical distinctions, reflect understanding in context, and help cue values relevant to health and patient care.Understanding the science behind theory is crucial for evidence-based medicine.

The influence of verbatim versus gist formatting on younger and older adults' information acquisition and decision-making.

Fuzzy-Trace Theory suggests that decision makers encode gist representations (bottom-line meaning) and verbatim representations (details) of information but rely more on gist, a tendency that increases with age. The present study examined implications for age differences in information seeking and decision-making by presenting gist and verbatim formatted choice scenarios. Participants comprised 68 younger and 66 older adults. Predecisional information seeking, indices of decision outcomes and recall, and relevant covariates were assessed. In line with theory, older adults self-reported and demonstrated stronger preferences for gist-based processing than younger adults did. Consistent with hypotheses, the total number of reviewed grid cells (including repeat views) was higher for gist than verbatim conditions, and this effect was stronger among older adults. Also, the proportion of unique cells reviewed and the accuracy of decision attribute recall were higher in the verbatim than gist condition and these effects were stronger among younger versus older adults. Further, gist formatting was associated with stronger use of option-wise information search, more value-concordant decisions (i.e., choices aligning with self-reported choice preferences), and decreased choice satisfaction, but these effects did not vary by age. Covariates, including information-processing preferences, partially accounted for these effects. Consistent with Fuzzy-Trace Theory, this suggests that information formatting and preferences modulate age differences in predecisional information acquisition: Depending on age, using either verbatim or gist formatting to communicate information can offer different benefits. Across age groups, however, gist formatting may facilitate value-concordant (and arguably higher-quality) decision-making. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Enhancing Patient Understanding of Medication Risks and Benefits.

OBJECTIVE: To evaluate the effectiveness of 2 interventions, including the DrugFactsBox format for presenting written medication information and the SMART (Strategic Memory Advanced Reasoning Training) program designed to enhance gist (i.e., "bottom-line" meaning) reasoning ability. METHODS: We used a 2 × 2 factorial research design. A total of 286 patients with rheumatoid arthritis were randomly assigned to 1 of 4 groups, including DrugFactsBox with the SMART program, DrugFactsBox without the SMART program, other consumer medication information (CMI) with the SMART program, and other CMI without the SMART program. Data were collected via telephone interviews and online questionnaires at 4 time points, including baseline and 6-week, 3-month, and 6-month time points following baseline. The primary outcome variable was informed decision-making, which was defined as making a value-consistent decision concerning use of disease-modifying antirheumatic drugs based on adequate knowledge. RESULTS: We found no main effects for the 2 interventions, either alone or in combination. However, there was a significant interaction between assignment to the SMART/no SMART groups and informed decision-making at baseline. Among participants in the SMART groups who did not meet the criteria for informed decision-making at baseline, 42.5% met the criteria at the 6-month follow-up, compared to 23.6% of participants in the no SMART groups (mean difference 18.9 [95% confidence interval 5.6, 32.2]; P = 0.007). This difference was driven by increased knowledge in the SMART groups. Among participants who met the criteria for informed decision-making at baseline, the difference between the SMART and no SMART groups was not statistically significant. CONCLUSION: Participation in a theory-driven program to enhance gist reasoning may have a beneficial effect on informed decision-making among patients with inadequate knowledge concerning therapeutic options.

Viruses, Vaccines, and COVID-19: Explaining and Improving Risky Decision-making.

Risky decision-making lies at the center of the COVID-19 pandemic and will determine future viral outbreaks. Therefore, a critical evaluation of major explanations of such decision-making is of acute practical importance. We review the underlying mechanisms and predictions offered by expectancy-value and dual-process theories. We then highlight how fuzzy-trace theory builds on these approaches and provides further insight into how knowledge, emotions, values, and metacognitive inhibition influence risky decision-making through its unique mental representational architecture (i.e., parallel verbatim and gist representations of information). We discuss how social values relate to decision-making according to fuzzy-trace theory, including how categorical gist representations cue core values. Although gist often supports health-promoting behaviors such as vaccination, social distancing, and mask-wearing, why this is not always the case as with status-quo gist is explained, and suggestions are offered for how to overcome the "battle for the gist" as it plays out in social media.

Compliance with mass marketing solicitation: The role of verbatim and gist processing.

INTRODUCTION: Mass marketing scams threaten financial and personal well-being. Grounded in fuzzy-trace theory, we examined whether verbatim and gist-based risk processing predicts susceptibility to scams and whether such processing can be altered. METHODS: Seven hundred and one participants read a solicitation letter online and indicated willingness to call an "activation number" to claim an alleged $500,000 sweepstakes prize. Participants focused on the solicitation's verbatim details (hypothesized to increase risk-taking) or its broad gist (hypothesized to decrease risk-taking). RESULTS: As expected, measures of verbatim-based processing positively predicted contact intentions, whereas measures of gist-based processing negatively predicted contact intentions. Contrary to hypotheses, experimental conditions did not influence intentions (43% across conditions). Contact intentions were associated with perceptions of low risk, high benefit, and the offer's apparent genuineness, as well as self-reported decision regret, subjective vulnerability to scams, and prior experience falling for scams. CONCLUSIONS: Overall, message perceptions and prior susceptibility, rather than experimental manipulations, mattered in predicting scam susceptibility.

Explaining risky choices with judgments: Framing, the zero effect, and the contextual relativity of gist.

Contemporary theories of decision-making are compared with respect to their predictions about the judgments that are hypothesized to underlie risky choice framing effects. Specifically, we compare predictions of psychophysical models, such as prospect theory, to the cognitive representational approach of fuzzy-trace theory in which the presence or absence of zero is key to framing effects. Three experiments implemented a high-power design in which many framing problems were administered to participants, who rated the attractiveness of either the certain or risky options. Experiments also varied whether truncation manipulations were within-subjects or between-subjects and whether both options were present. Violations of both strong and weak rationality were clearly observed in attractiveness ratings of options. However, truncation effects showed that these violations were conditional on the form of the decision problem. Truncation effects that involved adding or subtracting zero-that should not matter in almost all decision theories-showed that such rationality violations were attenuated when zero was deleted, but were amplified when zero was emphasized, per predictions of fuzzy-trace theory. This is the first such demonstration using attractiveness ratings of certain and risky options. Ratings also revealed that framing effects are inherently comparative: The attractiveness of a given option is a function of zero versus nonzero contrasts both within and between options. Indeed, we observed a losing-nothing-is-better effect that violates attribute framing and prospect theory such that a probability of losing nothing was rated as substantially better than a probability of gaining nothing, in accord with fuzzy-trace theory. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A scientific theory of gist communication and misinformation resistance, with implications for health, education, and policy.

A framework is presented for understanding how misinformation shapes decision-making, which has cognitive representations of gist at its core. I discuss how the framework goes beyond prior work, and how it can be implemented so that valid scientific messages are more likely to be effective, remembered, and shared through social media, while misinformation is resisted. The distinction between mental representations of the rote facts of a message-its verbatim representation-and its gist explains several paradoxes, including the frequent disconnect between knowing facts and, yet, making decisions that seem contrary to those facts. Decision makers can falsely remember the gist as seen or heard even when they remember verbatim facts. Indeed, misinformation can be more compelling than information when it provides an interpretation of reality that makes better sense than the facts. Consequently, for many issues, scientific information and misinformation are in a battle for the gist. A fuzzy-processing preference for simple gist explains expectations for antibiotics, the spread of misinformation about vaccination, and responses to messages about global warming, nuclear proliferation, and natural disasters. The gist, which reflects knowledge and experience, induces emotions and brings to mind social values. However, changing mental representations is not sufficient by itself; gist representations must be connected to values. The policy choice is not simply between constraining behavior or persuasion-there is another option. Science communication needs to shift from an emphasis on disseminating rote facts to achieving insight, retaining its integrity but without shying away from emotions and values.

Development of the Oncolo-GIST ("Giving Information Strategically & Transparently") Intervention Manual for Oncologist Skills Training in Advanced Cancer Prognostic Information Communication.

CONTEXT: Patient prognostic understanding is improved by oncologists' discussions of life expectancy. Most patients deem it important to discuss prognosis with their oncologists, but a minority of cancer patients within months of death report that they had such a discussion with their oncologist. OBJECTIVES: To query stakeholders about their perspectives on the clinical approach and utility of an Oncolo-GIST manualized communication intervention, designed to enhance oncologists' ability to convey the gist of prognostic information simply, clearly, and effectively in the setting of progressing solid tumors and limited life expectancy. METHODS: We obtained and analyzed feedback on the intervention from solid tumor oncology clinicians and bereaved family caregivers, soliciting opinions on the clinical approach taken in the videos, acceptability and likely impact of the instructions, and specific phrases recommended in the manual. RESULTS: Twenty stakeholders (9 clinicians, 11 caregivers) participated. All agreed that oncologists should broach prognosis with patients, balancing honesty and sensitivity. Participants also advocated for oncologists to involve interprofessional team members (e.g., nurses, social workers) when serious mental health concerns arose. After the research team's discussion of the stakeholder feedback, the manual was modified to include or exclude preferred language and approaches. CONCLUSION: The Oncolo-GIST intervention was characterized as simple and potentially effective at conveying prognoses to advanced cancer patients. Future research should determine if this approach to medical communication, which distills the essence of prognostic messages clearly and simply, is associated with improvements in patients' prognostic understanding.