Cognitive effort avoidance in veterans with suicide attempt histories.

Suicide attempts (SA) are increasing in the United States, especially in veterans. Discovering individual cognitive features of the subset of suicide ideators who attempt suicide is critical. Cognitive theories attribute SA to facile schema-based negative interpretations of environmental events. Over-general autobiographical memory and facile solutions in problem solving tasks in SA survivors suggest that aversion to expending cognitive effort may be a neurobehavioral marker of SA risk. In veterans receiving care for mood disorder, we compared cognitive effort discounting and evidence-gathering in a beads task between veterans with (SAHx+; n = 26) versus without (SAHx-; n = 22) a history of SA. Groups did not differ in depressed mood or in a proxy metric of premorbid intelligence. Compared to SAHx- participants, SAHx+ participants self-reported significantly more severe cognitive problems in most domains, and also eschewed choice to earn higher monetary reward if earning it required a slightly increased working memory (WM) demand relative to an easy WM task. There was no group difference, however, in extent of evidence-gathering before declaring a conclusion in a beads task. These preliminary data suggest that aversion to expenditure of cognitive effort, potentially as a component of cognitive difficulties, may be a marker for SA risk.

Impulsivity and Reflective Thinking in Veterans Seeking Care for Substance Use Disorder.

Objective: Substance use disorder (SUD) is a major public health crisis, with increased overdose deaths in the past decade. This has coincided with a tremendous amount of research on those who misuse substances. However, extensive research on SUD vulnerability characteristics such as impulsivity may be complemented by research on theoretically relevant aspects of cognition. The Cognitive Reflection Test (CRT) was designed to measure a person's ability to subdue quick, intuitive decisions to reflect or deliberate. To some decision making theorists, this measure may help explain why some people are better able to inhibit "gut reactions" than others. Methods: We recruited 140 veterans from a Veterans Affairs medical center; 91 of whom were receiving SUD treatment. Participants completed the CRT and a measure of trait impulsivity (the UPPS-P). We ran planned ANCOVAs assessing differences in the number of correct answers on the CRT and the proportion of errors that were intuitive. Results: Participants who were receiving treatment gave significantly fewer correct, reflective answers on the CRT compared to controls. However, there were no significant differences in the proportion of errors that were due to intuitive responses. These findings did not change when controlling for age and/or trait impulsivity. Conclusion: Those suffering from SUD may exhibit cognitive deficits that do not stem from intuitive thinking. These deficits may, in turn, exacerbate issues arising from elevated impulsivity. Additional research which better incorporates decision making theory may be invaluable in providing clinically-relevant results and positive public health outcomes.

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.