Coproducing a library of videos to support families caring for children with gastrostomies: A mixed-methods evaluation with family carers and clinicians.

INTRODUCTION: Many families now perform specialist medical procedures at home. Families need appropriate training and support to do this. The aim of this study was to evaluate a library of videos, coproduced with parents and healthcare professionals, to support and educate families caring for a child with a gastrostomy. METHODS: A mixed-methods online survey evaluating the videos was completed by 43 family carers who care for children with gastrostomies and 33 healthcare professionals (community-based nurses [n = 16], paediatricians [n = 6], dieticians [n = 6], hospital-based nurses [n = 4], paediatric surgeon [n = 1]) from the United Kingdom. Participants watched a sample of videos, rated statements on the videos and reflected on how the videos could be best used in practice. RESULTS: Both family carers and healthcare professionals perceived the video library as a valuable resource for parents and strongly supported the use of videos in practice. All healthcare professionals and 98% (n = 42) of family carers agreed they would recommend the videos to other families. Family carers found the videos empowering and easy to follow and valued the mixture of healthcare professionals and families featured in the videos. Participants gave clear recommendations for how different video topics should fit within the existing patient pathway. DISCUSSION: Families and healthcare professionals perceived the videos to be an extremely useful resource for parents, supporting them practically and emotionally. Similar coproduced educational materials are needed to support families who perform other medical procedures at home. PATIENT OR PUBLIC CONTRIBUTION: Two parent representatives attended the research meetings from conception of the project and were involved in the design, conduct and dissemination of the surveys. The videos themselves were coproduced with several different families.

Alpha oscillations and stimulus-evoked activity dissociate metacognitive reports of attention, visibility, and confidence in a rapid visual detection task.

Variability in the detection and discrimination of weak visual stimuli has been linked to oscillatory neural activity. In particular, the amplitude of activity in the alpha-band (8-12 Hz) has been shown to impact the objective likelihood of stimulus detection, as well as measures of subjective visibility, attention, and decision confidence. Here we investigate how preparatory alpha in a cued pretarget interval influences performance and phenomenology, by recording simultaneous subjective measures of attention and confidence (experiment 1) or attention and visibility (experiment 2) on a trial-by-trial basis in a visual detection task. Across both experiments, alpha amplitude was negatively and linearly correlated with the intensity of subjective attention. In contrast with this linear relationship, we observed a quadratic relationship between the strength of alpha oscillations and subjective ratings of confidence and visibility. We find that this same quadratic relationship links alpha amplitude with the strength of stimulus-evoked responses. Visibility and confidence judgments also corresponded with the strength of evoked responses, but confidence, uniquely, incorporated information about attentional state. As such, our findings reveal distinct psychological and neural correlates of metacognitive judgments of attentional state, stimulus visibility, and decision confidence when these judgments are preceded by a cued target interval.

A Postdecisional Neural Marker of Confidence Predicts Information-Seeking in Decision-Making.

Theoretical work predicts that decisions made with low confidence should lead to increased information-seeking. This is an adaptive strategy because it can increase the quality of a decision, and previous behavioral work has shown that decision-makers engage in such confidence-driven information-seeking. The present study aimed to characterize the neural markers that mediate the relationship between confidence and information-seeking. A paradigm was used in which 17 human participants (9 male) made an initial perceptual decision, and then decided whether or not they wanted to sample more evidence before committing to a final decision and confidence judgment. Predecisional and postdecisional event-related potential components were similarly modulated by the level of confidence and by information-seeking choices. Time-resolved multivariate decoding of scalp EEG signals first revealed that both information-seeking choices and decision confidence could be decoded from the time of the initial decision to the time of the subsequent information-seeking choice (within-condition decoding). No above-chance decoding was visible in the preresponse time window. Crucially, a classifier trained to decode high versus low confidence predicted information-seeking choices after the initial perceptual decision (across-condition decoding). This time window corresponds to that of a postdecisional neural marker of confidence. Collectively, our findings demonstrate, for the first time, that neural indices of confidence are functionally involved in information-seeking decisions.SIGNIFICANCE STATEMENT Despite substantial current interest in neural signatures of our sense of confidence, it remains largely unknown how confidence is used to regulate behavior. Here, we devised a task in which human participants could decide whether or not to sample additional decision-relevant information at a small monetary cost. Using neural recordings, we could predict such information-seeking choices based on a neural signature of decision confidence. Our study illuminates a neural link between decision confidence and adaptive behavioral control.

The effects of recursive communication dynamics on belief updating.

Many social interactions are characterized by dynamic interplay, such that individuals exert reciprocal influence over each other's behaviours and beliefs. The present study investigated how the dynamics of reciprocal influence affect individual beliefs in a social context, over and above the information communicated in an interaction. To this end, we developed a simple social decision-making paradigm in which two people are asked to make perceptual judgments while receiving information about each other's decisions. In a Static condition, information about the partner only conveyed their initial, independent judgment. However, in a Dynamic condition, each individual saw the evolving belief of their partner as they learnt about and responded to the individual's own judgment. The results indicated that in both conditions, the majority of confidence adjustments were characterized by an abrupt change followed by smaller adjustments around an equilibrium, and that participants' confidence was used to arbitrate conflict (although deviating from Bayesian norm). Crucially, recursive interaction had systematic effects on belief change relative to the static baseline, magnifying confidence change when partners agreed and reducing confidence change when they disagreed. These findings indicate that during dynamic interactions-often a characteristic of real-life and online social contexts-information is collectively transformed rather than acted upon by individuals in isolation. Consequently, the output of social events is not only influenced by what the dyad knows but also by predictable recursive and self-reinforcing dynamics.

The many characters of visual alpha oscillations.

A central feature of human brain activity is the alpha rhythm: a 7-13 Hz oscillation observed most notably over occipitoparietal brain regions during periods of eyes-closed rest. Alpha oscillations covary with changes in visual processing and have been associated with a broad range of neurocognitive functions. In this article, we review these associations and suggest that alpha oscillations can be thought to exhibit at least five distinct 'characters': those of the inhibitor, perceiver, predictor, communicator and stabiliser. In short, while alpha oscillations are strongly associated with reductions in visual attention, they also appear to play important roles in regulating the timing and temporal resolution of perception. Furthermore, alpha oscillations are strongly associated with top-down control and may facilitate transmission of predictions to visual cortex. This is in addition to promoting communication between frontal and posterior brain regions more generally, as well as maintaining ongoing perceptual states. We discuss why alpha oscillations might associate with such a broad range of cognitive functions and suggest ways in which these diverse associations can be studied experimentally.

Subjective Confidence Predicts Information Seeking in Decision Making.

There is currently little direct evidence regarding the function of subjective confidence in decision making: The tight correlation between objective accuracy and subjective confidence makes it difficult to distinguish each variable's unique contribution. Here, we created conditions in a perceptual decision task that were matched in accuracy but differed in subjective evaluation of accuracy by orthogonally varying the strength versus variability of evidence. Confidence was reduced with variable (vs. weak) evidence, even across conditions matched for difficulty. Building on this dissociation, we constructed a paradigm in which participants ( N = 20) could choose to seek further information before making their decision. The data provided clear support for the hypothesis that subjective confidence predicts information seeking in decision making: Participants were more likely to sample additional information before giving a response in the condition with low confidence, despite matched accuracy. In a preregistered replication ( N = 50), these findings were replicated with increased task difficulty levels.

Adaptive behaviour and feedback processing integrate experience and instruction in reinforcement learning.

In any non-deterministic environment, unexpected events can indicate true changes in the world (and require behavioural adaptation) or reflect chance occurrence (and must be discounted). Adaptive behaviour requires distinguishing these possibilities. We investigated how humans achieve this by integrating high-level information from instruction and experience. In a series of EEG experiments, instructions modulated the perceived informativeness of feedback: Participants performed a novel probabilistic reinforcement learning task, receiving instructions about reliability of feedback or volatility of the environment. Importantly, our designs de-confound informativeness from surprise, which typically co-vary. Behavioural results indicate that participants used instructions to adapt their behaviour faster to changes in the environment when instructions indicated that negative feedback was more informative, even if it was simultaneously less surprising. This study is the first to show that neural markers of feedback anticipation (stimulus-preceding negativity) and of feedback processing (feedback-related negativity; FRN) reflect informativeness of unexpected feedback. Meanwhile, changes in P3 amplitude indicated imminent adjustments in behaviour. Collectively, our findings provide new evidence that high-level information interacts with experience-driven learning in a flexible manner, enabling human learners to make informed decisions about whether to persevere or explore new options, a pivotal ability in our complex environment.

Shared neural markers of decision confidence and error detection.

Empirical evidence indicates that people can provide accurate evaluations of their own thoughts and actions by means of both error detection and confidence judgments. This study investigates the foundations of these metacognitive abilities, specifically focusing on the relationship between confidence and error judgments in human perceptual decision making. Electroencephalography studies have identified the error positivity (Pe)--an event-related component observed following incorrect choices--as a robust neural index of participants' awareness of their errors in simple decision tasks. Here we assessed whether the Pe also varies in a graded way with participants' subjective ratings of decision confidence, as expressed on a 6-point scale after each trial of a dot count perceptual decision task. We observed clear, graded modulation of the Pe by confidence, with monotonic reduction in Pe amplitude associated with increasing confidence in the preceding choice. This effect was independent of objective accuracy. Multivariate decoding analyses indicated that neural markers of error detection were predictive of varying levels of confidence in correct decisions, including subtle shifts in high-confidence trials. These results suggest that shared mechanisms underlie two forms of metacognitive evaluation that are often treated separately, with consequent implications for current theories of their neurocognitive basis.

Reward activates stimulus-specific and task-dependent representations in visual association cortices.

Humans reliably learn which actions lead to rewards. One prominent question is how credit is assigned to environmental stimuli that are acted upon. Recent functional magnetic resonance imaging (fMRI) studies have provided evidence that representations of rewarded stimuli are activated upon reward delivery, providing possible eligibility traces for credit assignment. Our study sought evidence of postreward activation in sensory cortices satisfying two conditions of instrumental learning: postreward activity should reflect the stimulus category that preceded reward (stimulus specificity), and should occur only if the stimulus was acted on to obtain reward (task dependency). Our experiment implemented two tasks in the fMRI scanner. The first was a perceptual decision-making task on degraded face and house stimuli. Stimulus specificity was evident as rewards activated the sensory cortices associated with face versus house perception more strongly after face versus house decisions, respectively, particularly in the fusiform face area. Stimulus specificity was further evident in a psychophysiological interaction analysis wherein face-sensitive areas correlated with nucleus accumbens activity after face-decision rewards, whereas house-sensitive areas correlated with nucleus accumbens activity after house-decision rewards. The second task required participants to make an instructed response. The criterion of task dependency was fulfilled as rewards after face versus house responses activated the respective association cortices to a larger degree when faces and houses were relevant to the performed task. Our study is the first to show that postreward sensory cortex activity meets these two key criteria of credit assignment, and does so independently from bottom-up perceptual processing.

Dissociable neural correlates of intention and action preparation in voluntary task switching.

This electroencephalographic (EEG) study investigated the impact of between-task competition on intentional control in voluntary task switching. Anticipatory preparation for an upcoming task switch is a hallmark of top-down intentional control. Meanwhile, asymmetries in performance and voluntary choice when switching between tasks differing in relative strength reveal the effects of between-task competition, reflected in a surprising bias against switching to an easier task. Here, we assessed the impact of this bias on EEG markers of intentional control during preparation for an upcoming task switch. The results revealed strong and varied effects of between-task competition on EEG markers of global task preparation-a frontal contingent negative variation (CNV), a posterior slow positive wave, and oscillatory activity in the alpha band (8-12 Hz) over posterior scalp sites. In contrast, we observed no between-task differences in motor-specific task preparation, as indexed by the lateralized readiness potential and by motor-related amplitude asymmetries in the mu (9-13 Hz) and beta (18-26 Hz) frequency bands. Collectively, these findings demonstrate that between-task competition directly influences the formation of top-down intentions, not only their expression in overt behavior. Specifically, this influence occurs at the level of global task intention rather than the preparation of specific actions.

Bayesian confidence in optimal decisions.

The optimal way to make decisions in many circumstances is to track the difference in evidence collected in favor of the options. The drift diffusion model (DDM) implements this approach and provides an excellent account of decisions and response times. However, existing DDM-based models of confidence exhibit certain deficits, and many theories of confidence have used alternative, nonoptimal models of decisions. Motivated by the historical success of the DDM, we ask whether simple extensions to this framework might allow it to better account for confidence. Motivated by the idea that the brain will not duplicate representations of evidence, in all model variants decisions and confidence are based on the same evidence accumulation process. We compare the models to benchmark results, and successfully apply four qualitative tests concerning the relationships between confidence, evidence, and time, in a new preregistered study. Using computationally cheap expressions to model confidence on a trial-by-trial basis, we find that a subset of model variants also provide a very good to excellent account of precise quantitative effects observed in confidence data. Specifically, our results favor the hypothesis that confidence reflects the strength of accumulated evidence penalized by the time taken to reach the decision (Bayesian readout), with the penalty applied not perfectly calibrated to the specific task context. These results suggest there is no need to abandon the DDM or single accumulator models to successfully account for confidence reports. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Give it a second try? The influence of feedback and performance in the decision of reattempting.

Feedback evaluation can affect behavioural continuation or discontinuation, and is essential for cognitive and motor skill learning. One critical factor that influences feedback evaluation is participants' internal estimation of self-performance. Previous research has shown that two event-related potential components, the Feedback-Related Negativity (FRN) and the P3, are related to feedback evaluation. In the present study, we used a time estimation task and EEG recordings to test the influence of feedback and performance on participants' decisions, and the sensitivity of the FRN and P3 components to those factors. In the experiment, participants were asked to reproduce the total duration of an intermittently presented visual stimulus. Feedback was given after every response, and participants had then to decide whether to retry the same trial and try to earn reward points, or to move on to the next trial. Results showed that both performance and feedback influenced participants' decision on whether to retry the ongoing trial. In line with previous studies, the FRN showed larger amplitude in response to negative than to positive feedback. Moreover, our results were also in agreement with previous works showing the relationship between the amplitude of the FRN and the size of feedback-related prediction error (PE), and provide further insight in how PE size influences participants' decisions on whether or not to retry a task. Specifically, we found that the larger the FRN, the more likely participants were to base their decision on their performance - choosing to retry the current trial after good performance or to move on to the next trial after poor performance, regardless of the feedback received. Conversely, the smaller the FRN, the more likely participants were to base their decision on the feedback received.

Confidence biases in problem gambling.

Background and aims: Subjective confidence plays an important role in guiding behaviour, especially when objective feedback is unavailable. Systematic misjudgements in confidence can foster maladaptive behaviours and have been linked to various psychiatric disorders. In this study, we adopted a transdiagnostic approach to examine confidence biases in problem gamblers across three levels: local decision confidence, global task performance confidence, and overall self-esteem. The importance of taking a transdiagnostic perspective is increasingly recognised, as it captures the dimensional nature of psychiatric symptoms that often cut across diagnostic boundaries. Accordingly, we investigated if any observed confidence biases could be explained by transdiagnostic symptom dimensions of Anxiety-Depression and Compulsive Behaviour and Intrusive Thought. This approach allows us to gain a more comprehensive understanding of the role of metacognitive processes in problem gambling, beyond the constraints of traditional diagnostic categories. Methods: Thirty-eight problem gamblers and 38 demographically matched control participants engaged in a gamified metacognition task and completed self-report questionnaires assessing transdiagnostic symptom dimensions. Results: Compared to controls, problem gamblers displayed significantly elevated confidence at the local decision and global task levels, independent of their actual task performance. This elevated confidence was observed even after controlling for the heightened symptom levels of Anxiety-Depression and Compulsive Behaviour and Intrusive Thought among the problem gamblers. Discussion: The results reveal a notable disparity in confidence levels between problem gamblers and control participants, not fully accounted for by the symptom dimensions Anxiety-Depression and Compulsive Behaviour and Intrusive Thought. This suggests the contribution of other factors, perhaps linked to gambling-specific cognitive distortions, to the observed confidence biases. Conclusion: The findings highlight the intricate link between metacognitive confidence and psychiatric symptoms in the context of problem gambling. It underscores the need for further research into metacognitive biases, which could enhance therapeutic approaches for individuals with psychiatric conditions.

EEG indices of reward motivation and target detectability in a rapid visual detection task.

A large corpus of data has demonstrated the sensitivity of behavioral and neural measures to variation in the availability of reward. The present study aimed to extend this work by exploring reward motivation in an RSVP task using complex satellite imagery. We found that reward motivation significantly influenced neural activity both in the preparatory period and in response to target images. Pre-stimulus alpha activity and, to a lesser degree, P3 and CNV amplitude were found to be significantly predictive of reward condition on single trials. Target-locked P3 amplitude was modulated both by reward condition and by variation in target detectability inherent to our task. We further quantified this exogenous influence, showing that P3 differences reflected single-trial variation in P3 amplitude for different targets. These findings provide theoretical insight into the neural indices of reward in an RSVP task, and have important applications in the field of satellite imagery analysis.

Flexible use of confidence to guide advice requests.

Subjective confidence plays an important role in guiding behavior, for example, people typically commit to decisions immediately if high in confidence and seek additional information if not. The present study examines whether people are flexible in their use of confidence, such that the mapping between confidence and behavior is not fixed but can instead vary depending on the specific context. To investigate this proposal, we tested the hypothesis that the seemingly natural relationship between low confidence and requesting advice varies according to whether people know, or do not know, the quality of the advice. Participants made an initial perceptual judgement and then chose between re-sampling evidence or receiving advice from a virtual advisor, before committing to a final decision. The results indicated that, when objective information about advisor reliability was not available, participants selected advice more often when their confidence was high rather than when it was low. This pattern reflects the use of confidence as a feedback proxy to learn about advisor quality: Participants were able to learn about the reliability of advice even in the absence of feedback and subsequently requested more advice from better advisors. In contrast, when participants had prior knowledge about the reliability of advisors, they requested advice more often when their confidence was low, reflecting the use of confidence as a self-monitoring tool signaling that help should be solicited. These findings indicate that people use confidence in a way that is context-dependent and directed towards achieving their current goals.

Expressions for Bayesian confidence of drift diffusion observers in fluctuating stimuli tasks.

We introduce a new approach to modelling decision confidence, with the aim of enabling computationally cheap predictions while taking into account, and thereby exploiting, trial-by-trial variability in stochastically fluctuating stimuli. Using the framework of the drift diffusion model of decision making, along with time-dependent thresholds and the idea of a Bayesian confidence readout, we derive expressions for the probability distribution over confidence reports. In line with current models of confidence, the derivations allow for the accumulation of "pipeline" evidence that has been received but not processed by the time of response, the effect of drift rate variability, and metacognitive noise. The expressions are valid for stimuli that change over the course of a trial with normally-distributed fluctuations in the evidence they provide. A number of approximations are made to arrive at the final expressions, and we test all approximations via simulation. The derived expressions contain only a small number of standard functions, and require evaluating only once per trial, making trial-by-trial modelling of confidence data in stochastically fluctuating stimuli tasks more feasible. We conclude by using the expressions to gain insight into the confidence of optimal observers, and empirically observed patterns.

Memory and cognitive control in task switching.

Cognitive control and memory are fundamentally intertwined, but interactions between the two have only recently received sustained research interest. In the study reported here, we used a novel paradigm to investigate how control influences memory encoding and, conversely, how memory measures can provide new insight into flexible cognitive control. Participants switched between classifying objects and words, then were tested for their recognition memory of items presented in this task-switching phase. Task switching impaired memory for task-relevant information but actually improved memory for task-irrelevant information, which indicates that control demands reduced the selectivity of memory encoding rather than causing a general memory decline. Recognition memory strength provided a robust trial-by-trial measure of the effectiveness of cognitive control that "predicted" earlier task-switching performance. It also revealed a substantial influence of bottom-up factors on between-task competition, but only on trials in which participants had to switch from one type of classification to the other. Collectively, our findings illustrate how cognitive control and bottom-up factors interact to simultaneously influence both current performance and future memory.

Decision processes in human performance monitoring.

The ability to detect and compensate for errors is crucial in producing effective, goal-directed behavior. Human error processing is reflected in two event-related brain potential components, the error-related negativity (Ne/ERN) and error positivity (Pe), but the functional significance of both components remains unclear. Our approach was to consider error detection as a decision process involving an evaluation of available evidence that an error has occurred against an internal criterion. This framework distinguishes two fundamental stages of error detection--accumulating evidence (input), and reaching a decision (output)--that should be differentially affected by changes in internal criterion. Predictions from this model were tested in a brightness discrimination task that required human participants to signal their errors, with incentives varied to encourage participants to adopt a high or low criterion for signaling their errors. Whereas the Ne/ERN was unaffected by this manipulation, the Pe varied consistently with criterion: A higher criterion was associated with larger Pe amplitude for signaled errors, suggesting that the Pe reflects the strength of accumulated evidence. Across participants, Pe amplitude was predictive of changes in behavioral criterion as estimated through signal detection theory analysis. Within participants, Pe amplitude could be estimated robustly with multivariate machine learning techniques and used to predict error signaling behavior both at the level of error signaling frequencies and at the level of individual signaling responses. These results suggest that the Pe, rather than the Ne/ERN, is closely related to error detection, and specifically reflects the accumulated evidence that an error has been committed.

Error-related brain activity and adjustments of selective attention following errors.

The present study investigated adjustments of selective attention following errors and their relation to the error-related negativity (Ne/ERN), a correlate of errors in event-related potentials. We hypothesized that, if post-error adjustments reflect an adaptive mechanism that should prevent the occurrence of further errors, then adjustments of attentional selectivity should be observed only following errors due to insufficient selective attention. To test this, a four-choice flanker task was used in which errors due to insufficient selective attention (flanker errors) and other errors (nonflanker errors) could be distinguished. We found strong adjustments of selective attention following flanker errors but not following nonflanker errors. Moreover, the Ne/ERN amplitude was correlated with adjustments of selective attention on a trial-by-trial basis. The results provide support for the notion that the Ne/ERN is a correlate of adaptive adjustments following errors.