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1.
Behav Sci (Basel) ; 13(5)2023 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-37232642

RESUMO

Optimally deciding on the best deal for sport event tickets requires the ability to evaluate risk and make informed decisions in uncertain environments. This study examines how individual trait factors, such as experience, expertise, and involvement, influence consumers' decision-making process when purchasing tickets online for sporting events. To examine and test the study hypotheses, 640 respondents from a Qualtrics survey panel were recruited from geographically confined subjects of New York City sports fans over a ten-day data collection period. The research subjects were surveyed to assess their perception of the expected likelihood of obtaining event tickets at a lower rate (ELR) and the expected likelihood that tickets would remain available (ETA) as the event day approached. MANOVA showed that there was a significant effect of the time period on the participants' ETA and ELR risk assessments [Λ = 0.954, F (18, 1262) = 1.653, p < 0.05]. The ETA was highest ten days before the event and lowest the day before the event, with a similar pattern observed for the ELR. The mediation path analysis showed that fan involvement had a strong positive correlation with confidence (B = 0.496, p < 0.001). Confidence, in turn, was a significant predictor of the ELR (B = 5.729, p < 0.05) but not for the ETA (B = 1.516, p = 0.504). The positive mediation of confidence between fan involvement and the ELR indicates that consumers with higher fan involvement tend to have overconfidence in their ability to evaluate the uncertain purchase environment, which ultimately impacts their risk perception and decision-making. The study highlights the importance of considering both temporal and psychological factors when assessing the likelihood of ticket purchases and provides behavioral insights for sports marketers and ticket distributors.

2.
Psychon Bull Rev ; 30(4): 1294-1322, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36877362

RESUMO

Decades of work have been dedicated to developing and testing models that characterize how people make inter-temporal choices. Although parameter estimates from these models are often interpreted as indices of latent components of the choice process, little work has been done to examine their reliability. This is problematic because estimation error can bias conclusions that are drawn from these parameter estimates. We examine the reliability of parameter estimates from 11 prominent models of inter-temporal choice by (a) fitting each model to data from three previous experiments with designs representative of those typically used to study inter-temporal choice, (b) examining the consistency of parameters estimated for the same person based on different choice sets, and (c) conducting a parameter recovery analysis. We find generally low correlations between parameters estimated for the same person from the different choice sets. Moreover, parameter recovery varies considerably between models and the experimental designs upon which parameter estimates are based. We conclude that many parameter estimates reported in previous research are likely unreliable and provide recommendations on how to enhance the reliability of inter-temporal choice models for measurement purposes.


Assuntos
Comportamento de Escolha , Projetos de Pesquisa , Humanos , Reprodutibilidade dos Testes , Fatores de Tempo
3.
Elife ; 122023 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-36786427

RESUMO

Making optimal decisions in the face of noise requires balancing short-term speed and accuracy. But a theory of optimality should account for the fact that short-term speed can influence long-term accuracy through learning. Here, we demonstrate that long-term learning is an important dynamical dimension of the speed-accuracy trade-off. We study learning trajectories in rats and formally characterize these dynamics in a theory expressed as both a recurrent neural network and an analytical extension of the drift-diffusion model that learns over time. The model reveals that choosing suboptimal response times to learn faster sacrifices immediate reward, but can lead to greater total reward. We empirically verify predictions of the theory, including a relationship between stimulus exposure and learning speed, and a modulation of reaction time by future learning prospects. We find that rats' strategies approximately maximize total reward over the full learning epoch, suggesting cognitive control over the learning process.


Assuntos
Tomada de Decisões , Aprendizagem , Animais , Ratos , Tomada de Decisões/fisiologia , Tempo de Reação/fisiologia , Recompensa , Redes Neurais de Computação
4.
Philos Trans R Soc Lond B Biol Sci ; 377(1866): 20210348, 2022 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-36314150

RESUMO

Self-control, the ability to resist temptation and wait for better but delayed possibilities, is an important cognitive skill that underpins decision-making and planning. The capacity to exert self-control has been linked to intelligence in humans, chimpanzees and most recently cuttlefish. Here, we presented 10 Eurasian jays, Garrulus glandarius, with a delayed maintenance task, which measured the ability to choose a preferred outcome as well as the ability to sustain the delay prior to that outcome. Jays were able to wait for better possibilities, but maximum wait times varied across the subjects. We also presented them with five cognitive tasks that assessed spatial memory, spatial relationships and learning capacity. These tasks are commonly used as measures of general intelligence within an ecological context. Individual performance was correlated across the cognitive tasks, which suggests that there was a general intelligence factor underlying their performance. Performance in these tasks was correlated significantly with the jays' capacity to wait for better possibilities. This study demonstrates that self-control and intelligence are correlated in jays. The fact that this correlation exists in diverse species suggests that self-control is a fundamental feature of cognition. Our results are discussed in the context of convergent evolution. This article is part of the theme issue 'Thinking about possibilities: mechanisms, ontogeny, functions and phylogeny'.


Assuntos
Passeriformes , Autocontrole , Aves Canoras , Humanos , Animais , Prazer , Pan troglodytes , Cognição
5.
Proc Biol Sci ; 288(1946): 20203161, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33653135

RESUMO

The ability to exert self-control varies within and across taxa. Some species can exert self-control for several seconds whereas others, such as large-brained vertebrates, can tolerate delays of up to several minutes. Advanced self-control has been linked to better performance in cognitive tasks and has been hypothesized to evolve in response to specific socio-ecological pressures. These pressures are difficult to uncouple because previously studied species face similar socio-ecological challenges. Here, we investigate self-control and learning performance in cuttlefish, an invertebrate that is thought to have evolved under partially different pressures to previously studied vertebrates. To test self-control, cuttlefish were presented with a delay maintenance task, which measures an individual's ability to forgo immediate gratification and sustain a delay for a better but delayed reward. Cuttlefish maintained delay durations for up to 50-130 s. To test learning performance, we used a reversal-learning task, whereby cuttlefish were required to learn to associate the reward with one of two stimuli and then subsequently learn to associate the reward with the alternative stimulus. Cuttlefish that delayed gratification for longer had better learning performance. Our results demonstrate that cuttlefish can tolerate delays to obtain food of higher quality comparable to that of some large-brained vertebrates.


Assuntos
Decapodiformes , Autocontrole , Animais , Aprendizagem , Prazer , Recompensa
6.
Brain Struct Funct ; 225(8): 2377-2386, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32815053

RESUMO

Fronto-striatal structural connectivity is associated with choice impulsivity. Yet, to date, whether distinct fronto-striatal functional coupling associates with impulsive choices are largely unknown. Using seed-based resting-state functional MRI (rsfMRI) combined with multivariate pattern analysis (MVPA), the present study aimed to explore the predictions of dissociable frontal-striatal functional connectivity on choice impulsivity in a relatively large sample (N = 429). Adaptive delay-discounting task was utilized to assess choice impulsivity and the striatum was further divided into three subregions including the nucleus accumbens (NAcc), caudate, and putamen. Results revealed that both the functional coupling between the NAcc and the limbic/dorsolateral prefrontal cortex, and between the caudate and the dorsal prefrontal cortex, including the dorsomedial prefrontal cortex (DMPFC), successfully predicted the delay-discounting rate. However, such pattern was not observed in the putamen-prefrontal functional connectivity. These findings suggest fronto-striatal-dependent neural mechanisms of choice impulsivity and further provide a better understanding of the contributions of striatum subregions and their functional connectivities with different areas of prefrontal cortex upon inter-temporal choice.


Assuntos
Comportamento de Escolha/fisiologia , Corpo Estriado/fisiologia , Desvalorização pelo Atraso/fisiologia , Lobo Frontal/fisiologia , Comportamento Impulsivo/fisiologia , Adolescente , Adulto , Corpo Estriado/diagnóstico por imagem , Feminino , Lobo Frontal/diagnóstico por imagem , Neuroimagem Funcional , Humanos , Imageamento por Ressonância Magnética , Masculino , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiologia , Testes Neuropsicológicos , Adulto Jovem
7.
Front Psychol ; 11: 1647, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32849008

RESUMO

This study examines entrepreneurship. It focuses on the effect of tenacity and future self-continuity (FSC) on inter-temporal risky choice in the entrepreneurial context. A total of 129 Chinese undergraduates participated in this survey. The results formulate that tenacity positively correlates with the risky choices and inter-temporal risky choices, in which commitment, endurance, and challenge play a major role. Meanwhile, FSC predicts the risk-return of the subjects. Higher FSC corresponds to higher expected inter-temporal risk-return. Furthermore, the multivariable regression analysis shows that there is a reciprocal effect when tenacity and FSC work together on subjects' inter-temporal risky decision-making. FSC slightly mitigates both the pursuit of risky-return and the tolerance of time delay for the subjects with high tenacity. This implies that their worthwhile goal is to seek smooth income rather than to pursue an extreme high risk-return. These findings extend the research on personality, choice, and entrepreneurship and provide a guiding significance to the start-up.

8.
Physiol Behav ; 221: 112893, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32277987

RESUMO

The prevalence of obesity has driven searches for cognitive or behavioural economic factors related to Body Mass Index (BMI). One candidate is delay discounting: those who prefer smaller sooner rewards over larger but later rewards are hypothesised to have higher BMI. The findings in the literature are mixed however, with meta analyses suggesting only a very small correlation between discounting and BMI. Here we present novel empirical data (N=381) and Bayesian analyses which suggest no such relationship between discounting of either monetary or weight loss rewards and BMI. We also find evidence against our novel proposal that discounting moderates the rate of BMI gain over time. We also present our data in the context of a random effects Bayesian meta-analytical result which does suggest the presence of a small correlation overall. The strength of the correlation is so weak (2.25% shared variance) that its practical significance may be minor to non existent. However because we found decisive evidence for unaccounted for study-level variance, due to study heterogeneity, we argue that we should treat such meta-analytic correlations with extreme caution. While the relationship between discounting and health outcomes such as BMI remain theoretically appealing, our empirical and meta-analytic results suggest we should be cautious in inferring a correlational, let alone a causal, role for discounting processes in driving BMI or moderating BMI gain with age.


Assuntos
Desvalorização pelo Atraso , Teorema de Bayes , Índice de Massa Corporal , Humanos , Obesidade , Recompensa
9.
Cognition ; 198: 104203, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32007801

RESUMO

While parameters are crucial components of cognitive models, relatively little importance has been given to their units. We show that this has lead to some parameters to be contaminated, introducing an artifactual correlation between them. We also show that this has led to the illegal comparison of parameters with different units of measurement - this may invalidate parameter comparisons across participants, conditions, groups, or studies. We demonstrate that this problem affects two related models: Stevens' power law and Rachlin's delay discounting model. We show that it may even affect models which superficially avoid the incompatible units problem, such as hyperbolic discounting. We present simulation results to demonstrate the extent of the issues caused by the muddled units problem. We offer solutions in order to avoid the problem in the future or to aid in re-interpreting existing datasets.


Assuntos
Desvalorização pelo Atraso , Comportamento de Escolha , Simulação por Computador , Humanos , Recompensa
10.
Psychon Bull Rev ; 26(5): 1729-1737, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31520252

RESUMO

How do our valuation systems change to homeostatically correct undesirable psychological or physiological states, such as those caused by hunger? There is evidence that hunger increases discounting for food rewards, biasing choices towards smaller but sooner food reward over larger but later reward. However, it is not understood how hunger modulates delay discounting for non-food items. We outline and quantitatively evaluate six possible models of how our valuation systems modulate discounting of various commodities in the face of the undesirable state of being hungry. With a repeated-measures design, an experimental hunger manipulation, and quantitative modeling, we find strong evidence that hunger causes large increases in delay discounting for food, with an approximately 25% spillover effect to non-food commodities. The results provide evidence that in the face of hunger, our valuation systems increase discounting for commodities, which cannot achieve a desired state change as well as for those commodities that can. Given that strong delay discounting can cause negative outcomes in many non-food (consumer, investment, medical, or inter-personal) domains, the present findings suggest caution may be necessary when making decisions involving non-food outcomes while hungry.


Assuntos
Desvalorização pelo Atraso/fisiologia , Alimentos , Fome/fisiologia , Recompensa , Adulto , Feminino , Humanos , Masculino
11.
Psychon Bull Rev ; 25(2): 785-792, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-28600719

RESUMO

There is growing interest in modelling how people make choices that involve both risks and delays, i.e., risky inter-temporal choices. We investigated an untested assumption underlying several proposed risky inter-temporal choice models: that pure risky choices and pure inter-temporal choices are special cases of risky inter-temporal choice. We tested this assumption by presenting a single group of participants with risky choices and inter-temporal choices. We then compared the performance of a model that is fit to both choice types simultaneously, with the performance of separate models fit to the risky choice and inter-temporal choice data. We find, using Bayesian model comparison, that the majority of participants are best fit by a single model that incorporates both risky and inter-temporal choices. This result supports the assumption that risky choices and inter-temporal choices may be special cases of risky inter-temporal choice. Our results also suggest that, under the conditions of our experiment, interpretation of monetary value is very similar in risky choices and inter-temporal choices.


Assuntos
Comportamento de Escolha/fisiologia , Modelos Psicológicos , Assunção de Riscos , Adulto , Desvalorização pelo Atraso/fisiologia , Feminino , Humanos , Masculino , Adulto Jovem
12.
Front Psychol ; 7: 1421, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27703440

RESUMO

Previous correlational imaging studies have implicated the dorsolateral prefrontal cortex (DLPFC) in decision making. Using High-Definition Transcranial Direct Current Stimulation (HD-tDCS), the present study directly investigated the causal role of the DLPFC in performing the Iowa Gambling Task (IGT) and the Inter-Temporal Choice (ITC) task. Three experiments were conducted: Experiment 1 (N = 41) to study the left DLPFC, Experiment 2 (N = 49) to study the right DLPFC, and Experiment 3 (N = 20, a subset of those in Experiment 1) to switch the experimental and control conditions. All participants were healthy male college students. For Experiments 1 and 2, participants were randomly assigned to either the HD-tDCS or the sham stimulation condition. For Experiment 3, participants were assigned to the condition they were not in during Experiment 1. Results showed that HD-tDCS over the left DLPFC increased IGT score, decreased the recency parameter in IGT, and lowered delay discounting rate (k) in the ITC task. We discussed the potential roles of impulse control and time perception in mediating the effect of tDCS stimulation of left DLPFC on decision making. Our results have clinical implications for the treatment of disorders involving poor decision-making, such as addictions.

13.
Behav Res Methods ; 48(4): 1608-1620, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-26542975

RESUMO

A state-of-the-art data analysis procedure is presented to conduct hierarchical Bayesian inference and hypothesis testing on delay discounting data. The delay discounting task is a key experimental paradigm used across a wide range of disciplines from economics, cognitive science, and neuroscience, all of which seek to understand how humans or animals trade off the immediacy verses the magnitude of a reward. Bayesian estimation allows rich inferences to be drawn, along with measures of confidence, based upon limited and noisy behavioural data. Hierarchical modelling allows more precise inferences to be made, thus using sometimes expensive or difficult to obtain data in the most efficient way. The proposed probabilistic generative model describes how participants compare the present subjective value of reward choices on a trial-to-trial basis, estimates participant- and group-level parameters. We infer discount rate as a function of reward size, allowing the magnitude effect to be measured. Demonstrations are provided to show how this analysis approach can aid hypothesis testing. The analysis is demonstrated on data from the popular 27-item monetary choice questionnaire (Kirby, Psychonomic Bulletin & Review, 16(3), 457-462 2009), but will accept data from a range of protocols, including adaptive procedures. The software is made freely available to researchers.


Assuntos
Teorema de Bayes , Desvalorização pelo Atraso , Testes Neuropsicológicos/estatística & dados numéricos , Algoritmos , Interpretação Estatística de Dados , Feminino , Humanos , Modelos Estatísticos
14.
J Exp Anal Behav ; 104(1): 20-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26080901

RESUMO

Whereas intertemporal choice procedures are a common method for examining impulsive choice in nonhuman subjects, the apparatus used to implement this procedure varies across studies. The purpose of the present study was to compare impulsive choice between a two-lever chamber and a T-maze. In Experiment 1, rats chose between a smaller, immediate reinforcer and a larger, delayed reinforcer, first in a two-lever chamber and then in a T-maze. Delay to the larger reinforcer changed in an ascending and descending order (0-32 s) across sessions. Experiment 2 examined the same between-apparatus comparison but under steady-state conditions with the delay fixed at 32 s. In Experiment 1, choice for the larger, delayed reinforcer was generally higher in the T-maze than in the two-lever chamber. Similarly in Experiment 2, steady-state choice for the larger, delayed reinforcer was higher in the T-maze. Choice for the 32-s delayed reinforcer was also greater in Experiment 2 than in Experiment 1, suggesting that extended exposure to the delay is required for the T-maze to yield reliable impulsive choice data. While the reasons for the between-apparatus discrepancies are at present unknown, results from both experiments clearly demonstrate that the apparatus matters when assessing overall level and reliability of impulsive choice data.


Assuntos
Comportamento de Escolha , Comportamento Impulsivo , Animais , Condicionamento Operante , Masculino , Aprendizagem em Labirinto , Psicologia Experimental/instrumentação , Ratos , Ratos Sprague-Dawley , Reforço Psicológico
15.
Front Psychol ; 6: 468, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25941508

RESUMO

Previous studies have obtained inconsistent findings about emotional influence on inter-temporal choice (IC). In the present study, we first examined the effect of temporary emotional priming induced by affective pictures in a trial-to-trial paradigm on IC. The results showed that negative priming resulted in much higher percentages of trials during which smaller-but-sooner reward (SS%) were chosen compared with positive and neutral priming. Next, we attempted to explore the possible mechanisms underlying such emotional effects. When participants performed a time reproduction task, mean reaction times in negative priming condition were significantly shorter than those in the other two emotional contexts, which indicated that negative emotional priming led to overestimation of time. Moreover, such overestimation was negatively correlated with performance in the IC task. In contrast, temporary changes of emotional contexts did not alter performances in a Go/NoGo task (including commission errors and omission errors). In sum, our present findings suggested that myopic decisions under negative emotions were associated with altered time perception but not response inhibition.

16.
Horm Behav ; 69: 50-8, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25530487

RESUMO

Humans often prefer a small immediate reward to large reward in the future. This myopic tendency in inter-temporal choice is termed delay discounting, and has been the focus of intensive research in the past decades. Recent studies indicate that the neural regions underlying delay discounting are influenced by the gonadal steroids. However, the specific relationship between the testosterone levels and delay discounting is unclear at this point, especially in females. The present study investigated the relationship between salivary testosterone concentrations and discounting rates in delay- and probability-discounting tasks with healthy males and females. The results revealed a positive correlation between testosterone concentrations and delay-discounting rates in females and a negative correlation in males. Testosterone concentrations were unrelated to probability-discounting rates. Although causal effects of testosterone cannot be certain in this correlational study, if testosterone directly influenced this behavior, observed sex differences in delay discounting may be evidence of a curvilinear effect of testosterone. Alternatively, the findings may reflect inverse pattern of responsiveness to testosterone between male and female neural systems, or basic sex-difference in the neural mechanism underlying delay-discounting independent of testosterone itself.


Assuntos
Comportamento de Escolha/fisiologia , Saliva/metabolismo , Caracteres Sexuais , Testosterona/metabolismo , Adulto , Tomada de Decisões/fisiologia , Feminino , Humanos , Masculino , Recompensa , Fatores de Tempo , Adulto Jovem
17.
Neural Netw ; 62: 83-90, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24856247

RESUMO

Animals including human often prefer immediate returns to larger delayed returns. It holds true in the human communications. Standard interpretation of the immediate return preference is that an animal might subjectively discount the value of a delayed reward, and that might choose the larger valued one. The interpretation has been successfully applied to explain behavior of many species including human. However, the description is not necessarily sufficient to apply for interactions of individuals. This study adopts a different approach to seek a possibility that immediate return preference may be reproduced by learning rule to maximize objective outcomes. We show that a synaptic learning rule to achieve the temporal difference (TD) learning for outcome maximization fails the maximization and exhibits immediate return preference if the context is not properly represented as a internal state.


Assuntos
Aprendizagem/fisiologia , Sinapses/fisiologia , Algoritmos , Animais , Columbidae , Humanos , Ratos , Recompensa
18.
J Gambl Stud ; 31(4): 1617-32, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25348253

RESUMO

Previous studies by questionnaires have demonstrated that lottery gamblers who have not meet the criteria of pathological gambler show greater gambling acceptability. However, few empirical evidence of whether such nonpathological lottery gamblers (NPLGs) display the same impairments of decision making with pathological gamblers has been found so far. In present study, NPLGs and matched controls (MCs) were asked to perform the Iowa Gambling Task (IGT) and inter-temporal choice task (ICT). We found that compared to MCs, NPLGs displayed much lower IGT scores, net gains and proportions of advantageous decks in the IGT task and much higher percentages of trials during which smaller-but-sooner rewards were chosen in the ICT. These findings indicate that NPLGs display much more risky and impulsive decision makings, just like pathological gamblers in the previous studies. Next, the Go/NoGo task was employed to explore the role of response inhibition in the impairment of decision making in NPLGs. We found that NPLGs did show much higher commission errors compared to MCs. Moreover, IGT scores, net gain and proportions of advantageous decks were significantly negatively correlated with commission errors, which indicates that poor response inhibition might be involved in the impairments of decision making in NPLGs. To our knowledge, we provided the first empirical evidence of impairment of decision making and its cognitive mechanisms in NPLGs.


Assuntos
Comportamento Aditivo/psicologia , Comportamento de Escolha , Jogo de Azar/psicologia , Inibição Psicológica , Recompensa , Adulto , Tomada de Decisões , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Assunção de Riscos
19.
Psychoneuroendocrinology ; 38(10): 2300-8, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23768971

RESUMO

Organisms prefer to receive rewards sooner rather than later because they excessively discount the subjective value of future rewards, a phenomenon called delay discounting. Recent studies have reported an association between cortisol-which is secreted by the hypothalamic-pituitary-adrenal (HPA) axis-and delay discounting. However, no study has examined whether acutely induced psychosocial stress modulates delay discounting. Thus, the present study examined the effect of acute psychosocial stress and its hormonal and inflammatory correlates on the rate of delay discounting. To accomplish this purpose, we assessed the participants' discounting rates using the questionnaire version with inter-temporal choice before and after an acute psychosocial stress task (the Trier Social Stress Test; TSST). The results demonstrated that TSST increased rates of delay discounting in only cortisol responders (not in non-responders), indicating the possible influence of the pathway from the HPA axis to the dopaminergic systems under acute stress. Furthermore, the findings of correlation analysis indicated a U-shaped relationship between baseline level of C-reactive protein and delay discounting rate, suggesting a complex relationship between inflammatory markers and delay discounting rate.


Assuntos
Tomada de Decisões/fisiologia , Recompensa , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia , Adolescente , Adulto , Proteína C-Reativa/metabolismo , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hidrocortisona/análise , Hidrocortisona/metabolismo , Masculino , Saliva/química , Saliva/metabolismo , Estresse Psicológico/metabolismo , Fatores de Tempo , Adulto Jovem
20.
Patient Prefer Adherence ; 2: 7-19, 2008 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-19920939

RESUMO

The World Health Organization claimed recently that improving patient adherence to long term therapies would be more beneficial than any biomedical progress. First, however, we must understand its mechanisms. In this paper I propose a novel approach using concepts elaborated in a field rarely explored in medicine, the philosophy of mind. While conventional psychological models (eg, the Health Belief Model) provide explanations and predictions which have only a statistical value, the philosophical assumption that mental states (eg, beliefs) are causally efficient (mental causation) can provide the basis for a causal theory of health behaviors. This paper shows that nonadherence to long term therapies can be described as the medical expression of a philosophical concept, that is, weakness of will. I use philosophical explanations of this concept to suggest a mechanistic explanation of nonadherence. I propose that it results from the failure of two principles of rationality. First, a principle of continence, described by the philosopher Donald Davidson in his explanation of weakness of will. This principle exhorts us to act after having considered all available arguments and according to which option we consider best. However, patients conforming to this principle of continence should rationally be nonadherent. Indeed, when patients face a choice between adherence and nonadherence, they must decide, in general, between a large, but delayed reward (eg, health) and a small, but immediate reward (eg, smoking a cigarette). According to concepts elaborated by George Ainslie and Jon Elster, the force of our desires is strongly influenced by the proximity of reward. This inter-temporal choice theory on one hand, and the mere principle of continence on the other, should therefore lead to nonadherence. Nevertheless, adherence to long term therapies is possible, as a result of the intervention of an additional principle, the principle of foresight, which tells us to give priority to mental states oriented towards the future.

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