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Forensic examiners make important decisions to address legal questions, yet there is now ample evidence that their decisions can be subjective and inconsistent. This commentary suggests that elements of deliberate practice may help in not only having more consistent forensic decisions but also toward expected accuracy. Specifically, four elements of deliberate practice: (1) setting a goal, (2) motivation, (3) feedback, and (4) repetition are outlined with examples for addressing issues of cognitive bias and managing stress at work. If any of these elements are missing, such as delayed or no feedback, then suboptimal or no improvement of examiners' decision-making may result. This tool for deliberately improving decision-making may be applicable to other legal professionals; thus, potentially driving policies that may help enhance the criminal justice system broadly., (© 2024 American Academy of Forensic Sciences.)

The cognitive model of suicide proposes that biased cognitive processes contribute to suicidal thoughts and behaviors, and initial evidence suggests that attentional bias to suicide-congruent cues may predict suicidal behavior beyond established clinical risk factors. To date, much less work has explored the potential role of interpretation biases in the development and prediction of suicide risk. The present study assessed the psychometric properties, including reliability, concurrent validity, and predictive validity, of a novel adaptation of the Word Sentence Association Paradigm (WSAP) to assess suicide-suicide interpretation biases. In a sample of 239 psychiatric inpatients, including patients with no recent suicidal ideation or lifetime attempts (n = 35), those with recent suicide attempts (n = 29), and those with recent suicidal ideation (n = 174), participants completed the modified WSAP as well as self-reported suicidal ideation and attempts for the subsequent 6 months. Although the WSAP demonstrated good reliability, evidence of concurrent and prospective validity (in terms of self-reported suicidal ideation and attempts) was limited. Specifically, the clinical groups did not differ from one another on any measure of interpretation bias, nor did suicide-specific interpretation endorsements predict concurrent or future suicidal ideation when controlling for dysphoric interpretation bias. However, suicide-specific interpretation biases were uniquely associated with a history of a lifetime suicide attempt. Future work should further clarify the extent and specificity of the relationship between suicide-specific interpretation biases and clinical outcomes., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: To review and synthesise research on technological debiasing strategies across domains, present a novel distributed cognition-based classification system, and discuss theoretical implications for the field., Background: Distributed cognition theory is valuable for understanding and mitigating cognitive biases in high-stakes settings where sensemaking and problem-solving are contingent upon information representations and flows in the decision environment. Shifting the focus of debiasing from individuals to systems, technological debiasing strategies involve designing system components to minimise the negative impacts of cognitive bias on performance. To integrate these strategies into real-world practices effectively, it is imperative to clarify the current state of evidence and types of strategies utilised., Methods: We conducted systematic searches across six databases. Following screening and data charting, identified strategies were classified into (i) group composition and structure, (ii) information design and (iii) procedural debiasing, based on distributed cognition principles, and cognitive biases, classified into eight categories., Results: Eighty articles met the inclusion criteria, addressing 100 debiasing investigations and 91 cognitive biases. A majority (80%) of the identified debiasing strategies were reportedly effective, whereas fourteen were ineffective and six were partially effective. Information design strategies were studied most, followed by procedural debiasing, and group structure and composition. Gaps and directions for future work are discussed., Conclusion: Through the lens of distributed cognition theory, technological debiasing represents a reconceptualisation of cognitive bias mitigation, showing promise for real-world application., Application: The study results and debiasing classification presented can inform the design of high-stakes work systems to support cognition and minimise judgement errors., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Yule reports research grants from the National Institutes for Health, Canadian Department of National Defense, National Aeronautics and Space Administration, Melville Trust for Care and Cure of Cancer and Royal College of Surgeons of Edinburgh, outside the submitted work.

Confirmation bias (CB) is a cognitive bias that allows us to fool ourselves by selectively filtering data and distorting analyses to support favored beliefs or hypotheses. In this article, I will briefly review some classic experiments from cognitive psychology that illustrate what a powerful, pernicious, and insidious force CB is. I will then discuss how to recognize CB in our own thinking and behavior and describe specific elements of good experimental design that can mitigate its effects. These elements-such as randomization and blinding-are conceptually straightforward but often difficult in practice and therefore not as widely implemented as they should be., Competing Interests: The author declares no competing financial interests., (Copyright © 2024 Born.)

Background/objectives: The dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been associated with various mental disorders. One of the most commonly described parameters of HPA axis functioning is the cortisol awakening response (CAR). To date, few studies have been conducted on the relationship between personality disorders and CAR. The present study aimed to compare the CAR between individuals with personality disorders and healthy controls. Moreover, the study aimed to assess the association of CAR with cognitive biases and psychopathological symptoms in people with personality disorders., Methods: A total of 43 individuals with personality disorders and 45 healthy controls were enrolled. Participants completed questionnaires measuring the severity of depressive symptoms, anxiety, cognitive biases, and psychotic-like experiences. Cortisol levels were measured in four morning saliva samples: immediately after awakening, and after 15, 30, and 45 min., Results: A significantly lower CAR was found among individuals with personality disorders, even after adjustment for age, sex, and the level of education. However, the receiver operating characteristic (ROC) curve analysis showed a relatively low area under the curve (AUC = 0.362). Furthermore, a significant negative correlation was observed between the CAR and the level of external attribution bias among individuals with personality disorders. No significant associations of the CAR with psychopathological symptoms and other cognitive biases were observed., Conclusions: Findings from this study indicate that the HPA axis activity might be altered in personality disorders. However, the clinical utility of this observation needs further studies in larger samples. External attribution might be related to the HPA axis alterations in this population.

The mental state of terror is a dysphoric emotion, feeling of dread and sudden realisation that the outcomes of one's life events can take an extremely negative turn. The state represents the acute stage of fear, anxiety and trauma and generally occurs in mental disorders, such as trauma- and stress-related disorders, but it can also manifest in healthy individuals as the initial trigger response, the point of mental dysregulation. The mental state of terror can be specified with the following parameters: (1) perceived loss of safety, (2) unpredictability and uncertainty, (3) intense consequent emotional reaction, (4) hypersensitivity to the trigger stimuli, and consequentially, (5) the outcome that can be either negative, such as resulting in developing a mental disorder, or positive, such as developing post-traumatic growth and resilience. Behavioural biases are also a for factor the development of the mental state of terror. The aim of this theoretical contribution is to define the mental state of terror in terms of cognitive factors, such as exposure to traumatic events and uncertainty of the environment for understanding the development of mental disorders within stress and trauma domains; highlight the importance of psychological resilience and social support., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Judgement bias tasks (JBTs) are used to assess the emotional state and welfare of animals in zoos, farms and laboratories, based on the interpretation of an ambiguous or intermediate cue. Animals in positive affective states are more likely to interpret the ambiguous cue positively, whereas animals experiencing negative affect are more likely to interpret ambiguous cues pessimistically. Here, we developed a modified JBT assay for the stumpy-spined cuttlefish, Sepia bandensis , to determine whether cuttlefish exhibit negative affective states resulting from external stressors. Positive and neutral visual cues were presented twice daily until animals learned to associate food with the reinforced visual cue. After training, one treatment group was exposed to combined exposure and handling stress produced by 6 days of impoverished housing and simulated net capture. Our control group received no stress experience. In test trials performed after the stress experience, stressed animals showed higher latencies to approach ambiguous cues, spent significantly less time in rooms with ambiguous cues once they entered, and were less likely to enter first into the ambiguous cue-paired room compared with controls. These behaviours suggest that stress induces pessimistic judgement bias in cuttlefish, the first indication of this capacity in cephalopods.

Purpose: Previous studies have investigated the role of gender in clinical symptoms, social functioning, and neuropsychological performance in people with first-episode psychosis (FEP). However, the evidence of gender differences for metacognition in subjects with FEP is still limited and controversial. The aim of the present study was to explore gender differences in cognitive insight and cognitive biases in this population., Methods: Cross-sectional study was carried out in a sample of 104 patients with FEP (35 females and 69 males) recruited from mental health services. Symptoms were assessed with the Positive and Negative Syndrome Scale, cognitive insight with the Beck Cognitive Insight Scale, and cognitive bias by the Cognitive Biases Questionnaire for Psychosis. The assessment also included clinical and sociodemographic characteristics., Results: After controlling for potential confounders (level of education, marital status, and duration of psychotic illness) analysis of covariance revealed that males presented greater self-reflectiveness (p = 0.004) when compared to females. However, no significant differences were found in self-certainty and composite index of the cognitive insight scale, as in the cognitive biases assessed., Conclusions: Gender was an independent influence factor for self-reflectiveness, being better for males. Self-reflectiveness, if shown to be relatively lacking in women, could contribute to the design of more gender-sensitive and effective psychotherapeutic treatments, as being able to self-reflect predicts to better treatment response in psychosis., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Episodic future thinking (EFT), the ability to imagine future autobiographical events, is both an everyday and clinically significant cognitive process. With a focus on depression and suicidality, here we discuss evidence connecting EFT with psychopathology. Emotional valence of imagined future events has emerged as the most widely established feature of EFT detected to date, with less positive EFT being associated with depressive symptoms and suicidal thoughts and behaviors. This pattern may not be merely a byproduct of sadness or anhedonia. Promising directions for future research include clarifying the temporal association between EFT and clinical outcomes, investigating the potential benefits and drawbacks of positive EFT, and refining assessments for youth to measure EFT either preceding or soon after onset of psychopathology., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study aimed to determine the causal role of insomnia-consistent interpretation bias within the cognitive model of insomnia, by modifying this bias in students experiencing subclinical levels of insomnia and assessing subsequent effects on sleep parameters. A sample of 128 students underwent randomization to receive either a single session of online Cognitive Bias Modification-Interpretation (CBM-I) or a sham training. Participants then tracked their pre-sleep worry and sleep parameters for seven consecutive days. Interpretation bias was assessed using an encoding-recognition task specifically designed for insomnia-related interpretation bias. The CBM-I manipulation utilized ambiguous scenarios to redirect participants away from making insomnia-related interpretations. Results revealed that CBM-I effectively decreased insomnia-consistent interpretation bias compared to the sham treatment, with interpretation bias being absent post-training in the CBM-I group. This reduction did not lead to improvements in pre-sleep worry or any sleep parameters. This study has been the first to investigate the causal role of interpretation bias on symptoms of insomnia. Although results indicated this bias to be modifiable, its causality within the cognitive model proves to be more complicated. Future research focusing on optimization of cognitive bias modifications could shed more light on the effects of biased cognitions on insomnia symptoms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Interpretation biases in the processing of ambiguous affective information are assumed to play an important role in the onset and maintenance of emotional disorders. Reports of low reliability for experimental measures of cognitive biases have called into question previous findings on the association of these measures with markers of mental health and demonstrated the need to systematically evaluate measurement reliability for measures of cognitive biases. We evaluated reliability and correlations with self-report measures of mental health for interpretation bias scores derived from the Ambiguous Cue Task (ACT), an experimental paradigm for the assessment of approach-avoidance behavior towards ambiguous affective stimuli. For a non-clinical sample, the measurement of an interpretation bias with the ACT showed high internal consistency (r SB = .91 - .96, N = 354) and acceptable 2-week test-retest correlations (r Pearson = .61 - .65, n = 109). Correlations between the ACT interpretation bias scores and mental health-related self-report measures of personality and well-being were generally small (r ≤ |.11|) and statistically not significant when correcting for multiple comparisons. These findings suggest that in non-clinical populations, individual differences in the interpretation of ambiguous affective information as assessed with the ACT do not show a clear association with self-report markers of mental health. However, in allowing for a highly reliable measurement of interpretation bias, the ACT provides a valuable tool for studies considering potentially small effect sizes in non-clinical populations by studying bigger samples as well as for work on clinical populations, for which potentially greater effects can be expected., (© 2024. The Author(s).)

Study Objective: Hindsight bias is the tendency to overestimate the predictability of an event after it has already occurred. We aimed to evaluate whether hindsight bias influences the retrospective interpretation of clinical scenarios in the field of anesthesiology, which relies on clinicians making rapid decisions in the setting of perioperative adverse events., Design: Two clinical scenarios were developed (intraoperative hypotension and intraoperative hypoxia) with 3 potential diagnoses for each. Participants completed a crossover study reviewing one case without being informed of the supposed ultimate diagnosis (i.e., no 'anchor' diagnosis), referred to as their foresight case, and the other as a hindsight case wherein they were informed in the leading sentence of the scenario that 1 of the 3 conditions provided was the ultimate diagnosis (i.e., the diagnosis the participant might 'anchor' to if given this information at the start). Participants were randomly assigned to (1) which scenario (hypotension or hypoxia) was presented as the initial foresight case and (2) which of the 3 potential diagnoses for the second case (the hindsight case, which defaulted to whichever case the participant was not assigned for the first case) was presented as the ultimate diagnosis in the leading sentence in a 2 (scenario order) x 3 (hindsight case anchor) between-subjects factorial design (6 possible randomization assignments)., Setting: Two academic medical centers., Participants: Faculty, fellow, and resident anesthesiologists and certified nurse anesthetists (CRNAs)., Interventions: None., Measurements: After reading each clinical scenario, participants were asked to rate the probability (%) of each of three potential diagnoses to have caused the hypotension or hypoxia. Compositional data analysis (CoDA) was used to compare whether diagnosis probabilities differ between the hindsight and the foresight case., Main Results: 113 participants completed the study. 59 participants (52%) were resident anesthesiologists. Participants randomized to the hypotension scenario as a hindsight case were 2.82 times more likely to assign higher probability to the pulmonary embolus diagnosis if provided as an anchor (95% CI, 1.35-5.90; P = 0.006) and twice as likely to assign higher probability to the myocardial infarction diagnosis if provided as an anchor (95% CI, 1.12-3.58; P = 0.020). Participants randomized to the hypoxia scenario as a hindsight case were 1.78 times more likely to assign higher probability to the mainstem bronchus intubation diagnosis if provided in the anchor statement (95% CI, 1.00-3.14; P = 0.048) and 3.72 times more likely to assign higher probability to the pulmonary edema diagnosis if provided as an anchor (95% CI, 1.88-7.35; P < 0.001)., Conclusions: Hindsight bias influences the clinical diagnosis probabilities assigned by anesthesia providers. Clinicians should be educated on hindsight bias in perioperative medicine and be cognizant of the effect of hindsight bias when interpreting clinical outcomes., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

To adapt teaching to the prerequisites of students, teachers have various options at their disposal to gather and process information as the basis to form a judgment, such as carrying out tests, talking to and observing the behavior of students, or administering tasks. The complexity of such a judgment arises from the multitude of observations and their different possible explanations. This complexity might be reduced when teachers focus on one hypothesis instead of considering multiple hypotheses, interpret information in a confirmatory way, and not collect diagnostically relevant information. However, in this way, they run the risk of undesirable biased judgments. It therefore seems important to improve diagnostic judgments by selecting and processing information in a more reflective way. Research indicates that if information on a student is not easily available but restricted (e.g., by time pressure, difficult access to the student or high effort), a teacher who wants to make a careful decision is forced to rely on more reflective processes in the selection of tasks and in the interpretation of solutions. The present experimental study therefore investigates how the restricted availability of information in a specific diagnostic situation-when diagnostically inexperienced prospective mathematics teachers determine misconceptions in decimal fractions-influences the underlying cognitive processes. We assume that restricting the availability of information on student behavior augments the attentional focus and therefore reduces cognitive biases. Such more reflective processing can be observed by an increased time spent per piece of information, which should lead to the processing of relevant information and further increase judgment accuracy. To investigate these hypotheses, prospective teachers without prior knowledge in diagnosing misconceptions ( N  = 81) were asked to diagnose misconceptions on decimal fractions of virtual students by collecting information on students' solutions. Data concerning the effects of restricting the availability of information on teachers' cognitive processes were analyzed. The results show that with restricted information, participants indeed select a greater proportion of diagnostically relevant tasks, which positively influences judgment accuracy. These results are discussed with respect to their significance for framing teacher training and for further research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rieu, Loibl and Leuders.)

Objectives: Diagnostic excellence underscores the patient-centered diagnosis and patient engagement in the diagnostic process. In contrast to a patient-centered diagnosis, a doctor-centered diagnosis with a lack of patient engagement may inhibit the diagnostic process due to the lack of responsibility, disrupted information, and increased effect of cognitive biases, particularly in a situation where multiple physicians are involved. In this paper, we suggest a promising idea to enhance patient engagement in the diagnostic process by using written information by a patient about their perspective and experience, which can fill the gaps needed for diagnosis that doctors cannot find alone., Case Presentation: A 38-year-old woman developed chest pain, which gradually worsened during the following two years. For two years, she was evaluated in multiple departments; however, no definitive diagnosis was made, and her condition did not improve. During this evaluation, she searched her symptoms and image findings online. She reached a possible diagnosis of 'esophageal achalasia.' Still, she could not tell her concerns to any physicians because she felt that her concerns were not correctly recognized, although she showed her notes that her symptoms were recorded. She finally consulted the department of internal medicine, where her notes and previous test results were thoroughly reviewed. The final diagnosis of esophageal achalasia was confirmed., Conclusions: Doctors must organize an environment where patients can freely express their thoughts, emotions, and ideas regarding their diagnosis. Cogenerating visit notes using patient input through written communication can be a promising idea to facilitate patient engagement in the diagnostic process., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Unconscious bias of the clinician favors the diagnosis of carpal tunnel syndrome (CTS) in patients with median paresthesia. We hypothesized that more patients in this cohort would be diagnosed with proximal median nerve entrapment (PMNE) by strengthening our cognitive awareness of this alternative diagnosis. We also hypothesized that patients with PMNE may be successfully treated with surgical release of the lacertus fibrosus (LF)., Methods: In this retrospective study, cases of median nerve decompression at the carpal tunnel and in the proximal forearm for the 2-year periods before and after adopting strategies to mitigate cognitive bias for CTS were enumerated. Patients diagnosed with PMNE and treated by LF release under local anesthesia were evaluated to determine surgical outcome at minimum 2-year follow-up. Primary outcome measures were changes in preoperative median paresthesia and proximal median-innervated muscle strength., Results: There was a statistically significant increase in PMNE cases identified after our heightened surveillance was initiated ( z = 3.433, P < .001). In 10 of 12 cases, the patient had previous ipsilateral open carpal tunnel release (CTR) but experienced recurrent median paresthesia. In 8 cases evaluated an average of 5 years after LF release, there was improvement in median paresthesia and resolution of median-innervated muscle weakness., Conclusions: Owing to cognitive bias, some patients with PMNE may be misdiagnosed with CTS. All patients with median paresthesia, particularly those with persistent or recurrent symptoms after CTR, should be assessed for PMNE. Surgical release limited to the LF may be an effective treatment for PMNE., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: We aimed to explore gender-related differences in the associations of insight impairment with clinical symptoms, metacognition, and social cognition in psychosis., Methods: Regression analysis of several clinical insight dimensions was conducted on the data from 116 men and 56 women with first-episode psychosis. Various clinical symptoms and measures of metacognition and social cognition were entered as predictors., Results: In both men and women, delusions emerged as a strong predictor of all insight dimensions, and verbal hallucinations as a strong predictor of symptom relabelling. In men, certain negative symptoms as well as self-certainty, lack of self-reflectiveness, impaired theory of mind, attributional biases, and a jumping-to-conclusions bias were additional predictors of poor insight, while good insight was associated with depression, anxiety, avolition, blunted affect, and impaired emotional recognition. In women, poor insight was associated with a self-serving/externalising bias, impaired emotional recognition, and attention disorders., Conclusions: Poor insight in first-episode psychosis is strongly linked to deficits in metacognition and social cognition, with marked differences between men and women with respect to the specific skills involved in the impairment. Meanwhile, good insight is linked to a variety of affective manifestations in men. These findings suggest new avenues for more targeted cognitive interventions to improve clinical insight in psychosis., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Forensic examiners have come under scrutiny due to high-profile exonerations, highlighting the consequences that contextual bias can have on investigations. Researchers have proposed solutions to reduce the effects of bias including blind testing and redacting task-irrelevant information. Practitioners have concerns over the limitations of some of this research that uses untrained students to examine complex pieces of forensic evidence (e.g., fingerprints) (1; but see 2 for studies including trained experts and/or actual casework). This study sought to (a) examine the effect of contextual bias on examiners' evaluation of forensic evidence by varying the amount of pre-comparison information available to participants, (b) compare student and expert examiners' performance and their vulnerability to contextual bias, and (c) examine the effects of contextual bias on examiners' evaluation of different types of forensic evidence. Expert fingerprint examiners and student participants were presented with varying amounts of pre-comparison case information and compared matching and non-matching fingerprint and footwear impression evidence. Results suggest no effects of blinding examiners from case information or redacting task-irrelevant information. As expected, expert fingerprint examiners were more likely to correctly identify matching fingerprints and correctly exclude non-matching fingerprints than students. However, expert fingerprint examiners were no better than student participants at comparing footwear impression evidence. These findings suggest that sample, stimulus selection, and discipline-specific training matter when investigating bias in forensic decision making. These findings suggest caution when using forensic stimuli with student samples to investigate forensic decision-making and highlight the need for more research on redaction procedures., (© 2024 American Academy of Forensic Sciences.)

Background and Objectives: Consumption of sugar-sweetened beverages (SSBs) is a global public health issue. Consequently, there is strong interest in advancing understanding of the cognitive mechanisms that underpin excessive SSB consumption. This work proposes that selective interrogation of taste-based characteristics (e.g., flavour), rather than health-based characteristics (e.g., sugar content), of beverages is associated with greater SSB choice and consumption., Methods: To evaluate this novel hypothesis, undergraduate students (n = 210) were recruited to complete self-report measures of SSB consumption, motivation and success in reducing SSB consumption and unhealthy eating more broadly, as well as a novel selective interrogation assessment task. This task provided participants with the opportunity to selectively interrogate taste-based and health-based characteristics of various mystery beverages., Results: Results supported the hypothesis that greater selective interrogation of taste-based characteristics, rather than health-based characteristics, of beverages is associated with greater SSB choice and consumption. Additionally, results revealed that greater selective interrogation of taste-based characteristics was associated with decreased motivation to reduce SSB consumption and decreased motivation and success to reduce unhealthy consumption more broadly., Limitations: The current study did not evaluate whether selective interrogation of taste-based characteristics of beverages predicted actual SSB consumption., Conclusion: These findings provide novel evidence for the potential role of selective interrogation of taste-based characteristics of beverages in SSB choice and consumption. An important implication of these findings is that in order for interventions focusing on front-of-package nutrition labels to be effective in reducing unhealthy consumption, it is necessary that individuals are selectively interrogating this 'health-based' information., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Causal illusions consist of believing that there is a causal relationship between events that are actually unrelated. This bias is associated with pseudoscience, stereotypes and other unjustified beliefs. Thus, it seems important to develop educational interventions to reduce them. To our knowledge, the only debiasing intervention designed to be used at schools was developed by Barberia et al. (Barberia et al. 2013 PLoS One 8 , e71303 (doi:10.1371/journal.pone.0071303)), focusing on base rates, control conditions and confounding variables. Their assessment used an active causal illusion task where participants could manipulate the candidate cause. The intervention reduced causal illusions in adolescents but was only tested in a small experimental project. The present research evaluated it in a large-scale project through a collaboration with the Spanish Foundation for Science and Technology (FECYT), and was conducted in schools to make it ecologically valid. It included a pilot study ( n = 287), a large-scale implementation ( n = 1668; 40 schools) and a six-month follow-up ( n = 353). Results showed medium-to-large and long-lasting effects on the reduction of causal illusions. To our knowledge, this is the first research showing the efficacy and long-term effects of a debiasing intervention against causal illusions that can be used on a large scale through the educational system., Competing Interests: We declare we have no competing interests., (© 2024 The Author(s).)

The present study examined cognitive mechanisms underpinning the increased tendency of individuals with high trait anxiety to experience inflation of negative affect when approaching potential stressors. Specifically, the roles of (1) disproportionately negative relative to positive expectancies (i.e., negative expectancy bias) and (2) disproportionately interrogating negative relative to positive information (i.e., negative interrogation bias), each concerning the potential stressor, were examined. High and low trait anxiety participants (N = 286) completed the experimental session, in which they were informed they may view a potentially stressful film. As participants approached the putative film viewing, participants' negative and positive affect, as well as their negative and positive expectancies were assessed. Additionally, negative interrogation bias was assessed by providing participants the opportunity to selectively interrogate information from a larger pool of negative and positive information concerning the putative film viewing. Our findings provide evidence indirect associations between trait anxiety and inflation of negative affect is serially mediated via negative interrogation bias and, in turn, negative expectancy bias. Findings are discussed with regards to limitations and potential implications for public health campaigns, and cognitive interventions for anxiety, highlighting the utility of further examining negative interrogation bias as an avenue for improving the efficacy of each., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Social information can be used to optimize decision-making. However, the simultaneous presentation of multiple sources of advice can lead to a distinction bias in judging the validity of the information. While the involvement of event-related potential (ERP) components in social information processing has been studied, how they are modulated by (mis)judging an advisor's information validity remains unknown. In two experiments participants performed a decision-making task with highly accurate or inaccurate cues. Each experiment consisted of an initial, learning, and test phase. During the learning phase, three advice cues were simultaneously presented and the validity of them had to be assessed. The effect of different cue constellations on ERPs was investigated. In the subsequent test phase, the willingness to follow or oppose an advice cue was tested. Results demonstrated the distinction bias with participants over or underestimating the accuracy of the most uncertain cues. The P2 amplitude was significantly increased during cue presentation when advisors were in disagreement as compared to when all were in agreement, regardless of cue validity. Further, a larger P3 amplitude during outcome presentation was found when advisors were in disagreement and increased with more informative cues. As such, the most uncertain cues were related to the smallest P3 amplitude. The findings hint at the possible role of P3 in judging and learning the predictability of social cues. This study provides novel insights into the role of P2 and P3 components during the judgment of social information validity., (© 2024 The Authors. Psychophysiology published by Wiley Periodicals LLC on behalf of Society for Psychophysiological Research.)

Left-digit bias is a cognitive bias wherein individuals assess the magnitude of numbers by emphasizing the leftmost digit. For instance, people often perceive the difference between $9.99 and $10.00 larger than that between $10.00 and $10.01, given the distinct left digits in the former two numbers. This study associates self-reported height with this cognitive bias. Taller stature is frequently associated with desirable attributes such as higher earnings and leadership positions; individuals may aspire to be taller and, consequently, report a height greater than their actual measurement. We posit that this inclination is more pronounced when combined with left-digit bias. In other words, individuals whose actual height ends in nine, such as 169 cm, are more likely to report their height as 170 cm than individuals with an actual height of 170 cm who report it as 171 cm. To conduct this analysis, we used data from an annual health survey of adolescents in grades 7-12. Our findings indicate that male adolescents exhibit a left-digit bias in reporting their height, whereas female adolescents do not. We contribute to the literature by providing new evidence of left-digit bias., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Evidence supports a causal role of insomnia in the development and maintenance of depression, yet mechanisms underlying this association in young people are not well established. Attention biases have been implicated separately in the sleep and depression fields and represents an important candidate mechanism. Poor sleep may lead to a negative attention bias (characteristic of depression) by impacting attentional control. This study assessed the hypothesis that attentional control and negative attention bias would sequentially mediate the relationship between insomnia and depressive symptoms in an unselected sample of young people (17-24 years). Concerns have been raised regarding the psychometric properties of tasks used to measure attention bias, and a Dual-Probe Task is emerging as a more reliable measure. Participants (N = 275, Male = 59, M age  = 19.40) completed the Dual-Probe Task, a behavioural measure of attentional control, and self-report measures of insomnia and depression. Participants completed a one-week sleep diary. Results were consistent with negative attention bias, but not attentional control, as a mechanism which partially accounts for the relationship between sleep (i.e., insomnia severity, sleep duration, sleep efficiency, sleep latency) and depression. This study highlights sleep and negative attention bias as potentially modifiable risk factors to reduce depressive symptoms in young people., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Recent work shows that people judge an outcome as less likely when they learn the probabilities of all single pathways that lead to that outcome, a phenomenon termed the Unlikelihood Effect. The initial explanation for this effect is that the low pathway probabilities trigger thoughts that deem the outcome unlikely. We tested the alternative explanation that the effect results from people's erroneous interpretation and processing of the probability information provided in the paradigm. By reanalyzing the original experiments, we discovered that the Unlikelihood Effect had been substantially driven by a small subset of people who give extremely low likelihood judgments. We conducted six preregistered experiments, showing that these people are unaware of the total outcome probability and do formally incorrect calculations with the given probabilities. Controlling for these factors statistically and experimentally reduced the proportion of people giving extremely low likelihood judgments, reducing and sometimes eliminating the Unlikelihood Effect. Our results confirm that the Unlikelihood Effect is overall a robust empirical phenomenon, but suggest that the effect results at least to some degree from a few people's difficulties with encoding, understanding, and integrating probabilities. Our findings align with current research on other psychological effects, showing that empirical effects can be caused by participants engaging in qualitatively different mental processes., (© 2024. The Author(s).)

Clinical reasoning is fundamental for effective clinical practice. Traditional consultation models for teaching clinical reasoning or conventional approaches for teaching students how to make a diagnosis or management plan that rely on learning through observation only, are increasingly recognised as insufficient. There are also many challenges to supporting learners in developing clinical reasoning over time as well as across different clinical presentations and contexts. These challenges are compounded by the differences in how experts and novices make sense of clinical information, and the different cognitive processes each use when processing and communicating this information using precise medical language. Diagnostic errors may be due to cognitive biases but also, in a majority of cases, due to a lack of clinical knowledge. Therefore, effective educational strategies to develop clinical reasoning include identifying learners' knowledge gaps, using worked examples to prevent cognitive overload, promoting the use of key features and practising the construction of accurate problem representations. Deliberate reflection on diagnostic justification is also recommended, and overall, contributes to a growing number of evidence-based and theory-driven educational interventions for reducing diagnostic errors and improving patient care.

Background: In the bestseller book "Why Zebras Don't Get Ulcers", Robert Sapolsky argues that animals do not suffer from stress-related diseases like humans because for them, stress is episodic, while humans in contrast suffer from chronic psychological stress. In particular, the idea that fish cannot experience psychological stress is still prevalent, partly due to the lack of a homologous brain area to the neocortex. However, emerging evidence suggests that teleosts can undergo psychological stress, defined as a subjective and perceptual experience of the stressor, and in recent years, the underlying mechanisms started to be unveiled., Summary: The occurrence of cognitive appraisal in the assessment of stressors has been demonstrated in fish, indicating that the subjective evaluation of stimulus valence and salience, rather than absolute intrinsic characteristics of the stimulus itself, play a key role in the activation of the stress response. Moreover, individual biases (i.e., cognitive bias) in the cognitive appraisal of stimuli have also been described in fish, with some individuals consistently evaluating ambiguous stimuli as positive (aka optimists) whereas other individuals (aka pessimists) appraise them as negative. As a result, optimists and pessimists show consistent differences in stress reactivity and susceptibility/resilience to disease. Finally, social context has also been shown to modulate the response to aversive stimuli with the behavior of conspecifics either buffering or enhancing the response (i.e., social buffering vs. social contagion)., Key Messages: Cognitive appraisal of stressors occurs in fish, implying that the stress response is modulated by a subjective and perceptual experience of the stressor. Moreover, interindividual consistent cognitive biases in the appraisal of stressors are also present in fish making some individuals more susceptible to stress-related diseases. Therefore, psychological stress has a health toll in fish, and psychologically stressed fish can potentially have ulcers., (© 2024 S. Karger AG, Basel.)

Objectives: In the cognitive process of establishing a diagnosis, the performance of a diagnostician can be characterized in terms of sensitivity and specificity. The aims of the present study are to analyze in quantitative terms how cognitive bias affects the performance of a diagnostician, and how a diagnostician's biased decision making is further influenced by personal cost-benefit considerations., Methods: The test matrices of two sequential diagnostic tests are manipulated according to the rules of linear algebra, using multiplication of the second with the first test matrix to calculate their joint test characteristics. The decision tree and receiver operating characteristic (ROC) of a biased and unbiased diagnostician are used to calculate which combination of test characteristics maximizes the expected utility value., Results: Biased diagnosticians cannot establish a diagnosis beyond their own limited or distorted level of understanding. An unbiased and a biased diagnostician alike adjust their choice of test characteristics according to their different cost-benefit estimation of the various test outcomes. From the perspective of an unbiased diagnostician, the choices made by a biased diagnostician appear to invert reality. However, the same appearance of inverted reality is perceived by the biased diagnostician, judging the choices made by the unbiased diagnostician., Conclusions: As a general principle, human testers cannot test beyond their own level of understanding. They only see what they know. As they base their judgment on preconceived notions about the utilities associated with different test outcomes, human testers also tend to only know what they want to know., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Major depressive disorder (MDD) is characterized by strong emotional dysregulation. Mechanisms driving the negative affect in depression may be fast processes existing on an unconscious level., Methods: A priming task was conducted using simultaneous electroencephalography-functional magnetic resonance imaging measurement involving presentation of facial expressions (happy, sad, and neutral) to examine the neurophysiological pathway of biased unconscious emotion processing in MDD. Priming prior to a target emotion created unconscious (16.7-ms primer) and conscious (150-ms primer) trials. A large sample (N = 126) was recruited, containing healthy control participants (n = 66; 37 women) and participants with MDD (n = 60; 31 women)., Results: The healthy control group showed a shorter reaction time in happy but not in sad or neutral trials compared with the MDD group. N170 amplitudes were lower in trials with unconscious than conscious primer presentation. N170 amplitudes correlated with cortical (right fusiform gyrus, right middle temporal gyrus, right inferior temporal gyrus, left supplementary motor area, right middle frontal gyrus) and subcortical brain regions (right amygdala). The strength of N170 and brain activity correlation increased when the stimulus was consciously presented. Presented emotions did not affect the correlation of N170 values and brain activity., Conclusions: Our findings show that MDD may exhibit biased emotion regulation abilities at a behavioral and neurophysiological level. Face-sensitive event-related potentials demonstrate a correlation with heightened brain activity in regions associated with both face recognition (fusiform gyrus) and emotion processing (amygdala). These findings are evident in both MDD and healthy control groups, with lower effect sizes in the MDD group indicating reduced emotion recognition and processing abilities., (Copyright © 2024 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

The impact of contextual bias has been demonstrated repeatedly across forensic domains; however, research on this topic in forensic toxicology is very limited. In our previous study, experimental data from only one context version were compared with the actual forensic biasing casework. As a follow-up, this controlled experiment with 159 forensic toxicology practitioners was conducted, to test whether knowledge of different contextual information influenced their forensic decision-making. Participants in different context groups were tasked to identify testing strategies for carbon monoxide and opiate drugs. The results of chi-squared tests for their selections and two context groups exhibited statistically significant differences (p < 0.05 or p < 0.01). These findings show contextual information can bias forensic toxicology decisions about testing strategies, despite it is a relatively objective domain in forensic science., (© 2024 American Academy of Forensic Sciences.)

Cognitive biases reveal underlying affective state by indicating optimism and pessimism. This methodology may permit assessment of positive welfare in animals that have few validated positive welfare indicators, such as bears. Our goal was to validate a judgment bias test for assessing optimism in brown bears, using a touchscreen. After training the bears on a conditional discrimination, we compared responses to an ambiguous stimulus in a 2 × 2 nested design involving four experimental conditions representing presence or absence of a behind-the-scenes tour and presence or absence of a keeper training session with food reinforcement. We recorded bears' behavior during the conditions as a measure of convergent validity. Testing revealed the possibility of pessimism in the absence of reinforcement in one bear. More frustration behaviors were also observed during the no food reinforcement conditions. This is the first experimental demonstration of brown bears using a touchscreen and one of only three reports in which bears have been reported to perform a conditional discrimination. This method of assessing underlying affective state shows promise for the future.

It is now well established that decision making can be susceptible to cognitive bias in a broad range of fields, with forensic science being no exception. Previously published research has revealed a bias blind spot in forensic science where examiners do not recognise bias within their own domain. A survey of 101 forensic anthropology practitioners (n = 52) and students (n = 38) was undertaken to assess their level of awareness of cognitive bias and investigate their attitudes towards cognitive bias within forensic anthropology. The results revealed that the forensic anthropology community (∼90%) had a high level of awareness of cognitive bias. Overall ∼89% expressed concerns about cognitive bias in the broad discipline of forensic science, their own domain of forensic anthropology, and in the evaluative judgments they made in reconstruction activities, identifying a significant reduction in the bias blind spot. However, more than half of the participants believed that bias can be reduced by sheer force of will, and there was a lack of consensus about implementing blinding procedures or context management. These findings highlight the need to investigate empirically the feasibility of proposed mitigating strategies within the workflow of forensic anthropologists and their capabilities for increasing the transparency in decision making., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Diagnostic errors impact patient health and healthcare costs. Artificial Intelligence (AI) shows promise in mitigating this burden by supporting Medical Doctors in decision-making. However, the mere display of excellent or even superhuman performance by AI in specific tasks does not guarantee a positive impact on medical practice. Effective AI assistance should target the primary causes of human errors and foster effective collaborative decision-making with human experts who remain the ultimate decision-makers. In this narrative review, we apply these principles to the specific scenario of AI assistance during colonoscopy. By unraveling the neurocognitive foundations of the colonoscopy procedure, we identify multiple bottlenecks in perception, attention, and decision-making that contribute to diagnostic errors, shedding light on potential interventions to mitigate them. Furthermore, we explored how existing AI devices fare in clinical practice and whether they achieved an optimal integration with the human decision-maker. We argue that to foster optimal Human-AI collaboration, future research should expand our knowledge of factors influencing AI's impact, establish evidence-based cognitive models, and develop training programs based on them. These efforts will enhance human-AI collaboration, ultimately improving diagnostic accuracy and patient outcomes. The principles illuminated in this review hold more general value, extending their relevance to a wide array of medical procedures and beyond., Competing Interests: Conflict of interest C.R. is offering paid advice to Linkverse. The remaining authors have no conflicts of interest to disclose., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of Competing Interest Rebecca Carson reports no financial interests or conflicts of interest. John Lyles reports no financial interests or conflicts of interest. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests.

Educational Challenge: Each year, adverse events are reported in healthcare, of which many relate to healthcare workforce cognitive bias. The active involvement of workforce and consumers in the review and co-design of effective training for the healthcare workforce to recognise, monitor, and manage unconscious bias is required., Proposed Solution: We used participatory action research to co-design an innovative, interprofessional simulation based on 'real world' clinical incidents and lived experiences to improve the delivery of safe, high quality, consumer-focused healthcare. Following ethics approval, content analysis of serious adverse patient safety events involving cognitive bias was conducted. These data informed audio-recorded interviews with the healthcare workforce and consumers to explore their experiences of cognitive bias. Following thematic analysis, key themes of communication, stigma, diagnostic overshadowing, and fragmented systems were uncovered. Guided by consumers, these themes were interwoven into a simulation scenario that included real places, stories, and verbatim quotes delivered through mixed media artefacts. This heightened the immersive and experiential learning that aimed to uncover unconscious bias and help learners recognise its impact on clinical decisions and practice., Potential Benefits and Next Steps: To our knowledge, this is the first interprofessional, co-designed simulation to specifically address cognitive bias in current and future healthcare workforce. Plans to translate this research into a practical framework on how to work with key stakeholders (including consumers) to identify 'real-world' health service risks and co-design targeted simulations to address these gaps are described, including lessons learned.

The ability to interpret face-emotion displays is critical for the development of adaptive social interactions. Using a novel variant of a computational model and fMRI data, we examined behavioral and neural associations between two metrics of face-emotion labeling (sensitivity and bias) and age in youth. Youth and adults (n = 44, M age = 20.02, s.d. = 7.44, range = 8-36) completed an explicit face-emotion labeling fMRI task including happy to angry morphed face emotions. A drift-diffusion model was applied to choice and reaction time distributions to examine sensitivity and bias in interpreting face emotions. Model fit and reliability of parameters were assessed on adult data (n = 42). Linear and quadratic slopes modeled brain activity associated with dimensions of face-emotion valence and ambiguity during interpretation. Behaviorally, age was associated with sensitivity. The bilateral anterior insula exhibited a more pronounced neural response to ambiguity with older age. Associations between sensitivity and bias metrics and activation patterns indicated that systems encoding face-emotion valence and ambiguity both contribute to the ability to discriminate face emotions. The current study provides evidence for age-related improvement in perceptual sensitivity to facial affect across adolescence and young adulthood., (Published by Oxford University Press 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system. Patient complexity, illness severity, and the urgency in initiating proper treatment all contribute to decision-making errors. Clinician-related factors such as fatigue, cognitive overload, and inexperience further interfere with effective decision-making. Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error. This evidence-based review discusses ten common misconceptions regarding critical care decision-making. By understanding how practitioners make clinical decisions and examining how errors occur, strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes., Competing Interests: Conflict-of-interest statement: All authors have no conflicts of interest to disclose., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Do large language models (LLMs) display rational reasoning? LLMs have been shown to contain human biases due to the data they have been trained on; whether this is reflected in rational reasoning remains less clear. In this paper, we answer this question by evaluating seven language models using tasks from the cognitive psychology literature. We find that, like humans, LLMs display irrationality in these tasks. However, the way this irrationality is displayed does not reflect that shown by humans. When incorrect answers are given by LLMs to these tasks, they are often incorrect in ways that differ from human-like biases. On top of this, the LLMs reveal an additional layer of irrationality in the significant inconsistency of the responses. Aside from the experimental results, this paper seeks to make a methodological contribution by showing how we can assess and compare different capabilities of these types of models, in this case with respect to rational reasoning., Competing Interests: We declare we have no competing interests., (© 2024 The Authors.)

Cognitive bias is defined as the influence of emotions on cognitive processes. The concept of the cognitive judgement bias has its origins in human psychology but has been applied to animals over the past 2 decades. In this study we were interested in determining if laterality and personality traits, which are known to influence learning style, might also be correlated with a cognitive bias in the three-spined sticklebacks (Gasterosteus aculeatus). We used the judgement bias test with the go/no-go procedure where fish were first trained to discriminate between a black and white card and, after reaching a minimum learning criterion, tested their response to an ambiguous card (grey). Optimistic subjects were expected to have a high expectation of reward associated with an ambiguous stimulus, whereas pessimistic subjects a high expectation of non-reward. We used an emergence and a mirror test to quantify boldness and laterality, respectively. We hypothesised that male, bolder and more strongly lateralized fish would be more optimistic than female, shy and less strongly lateralised fish. We found that males and more strongly lateralized fish were more optimistic than females and less strongly lateralized fish. In addition, bold males were more optimistic than shy males as we predicted, but females showed the opposite pattern. Finally, fish trained on the black colour card learned the training task faster than those trained on a white card. Our results indicate that both laterality and personality traits are linked to animals' internal states (pessimistic or optimistic outlooks) which likely has broad implications for understanding animal behaviour particularly in a welfare context., (© 2024. The Author(s).)

The Affective Bias Test (ABT) quantifies acute changes in affective state based on the affective biases they generate in an associative reward learning task. The Reward Learning Assay (RLA) provides a control assay for the ABT and reward-induced biases generated in this model are sensitive to changes in core affective state. Both tasks involve training animals to associate a specific digging substrate with a food reward. Animals learn to discriminate between two digging substrates placed in ceramic bowls, one rewarded and one unrewarded. In the ABT, the animal learns two independent substrate-reward associations with a fixed reward value following either an affective state or drug manipulation, or under control conditions. Affective biases generated are quantified in a choice test where the animals exhibit a bias (make more choices) for one of the substrates which is specifically related to affective state at the time of learning. The ABT is used to investigate biases generated during learning as well as modulation of biases associated with past experiences. The RLA follows a similar protocol, but the animal remains in the same affective state throughout and a reward-induced bias is generated by pairing one substrate with a higher value reward. The RLA provides a control to determine if drug treatments affect memory retrieval more generally. Studies in depression models and following environmental enrichment suggest that reward-induced biases are sensitive to core changes in affective state. Each task offers different insights into affective processing mechanisms and may help improve the translational validity of animal studies and benefit pre-clinical drug development. © 2024 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Bowl digging and discrimination training Basic Protocol 2: The reward learning assay Basic Protocol 3: The affective bias test - new learning Basic Protocol 4: The affective bias test - modulation of affective biases associated with past experiences., (© 2024 The Authors. Current Protocols published by Wiley Periodicals LLC.)

Introduction: A unique feature of workplace investigations is the familiarity that investigators and witnesses have with the factors involved in the adverse incident. Familiarity creates expectations that can shape investigators' and witnesses' assumptions and opinions. The current research examined the biasing effect of non-factual witness claims on investigators' judgments. These claims, which we call 'uncheckable,' included opinions about factors involved in the event and the future. We also examined how participants' a priori knowledge of an employee's history influenced their judgments., Method: This experiment used a 2 (background information: control or unsafe) × 2 (uncheckable content: neutral or unsafe) between-subjects design. Participants were provided with background information about a worker (control or unsafe history) and a witness statement about a workplace event that contained uncheckable claims (neutral or worker as unsafe). We tested how our manipulations biased participants' judgments of: (i) the cause of the event, (ii) the witness's confidence and credibility, and (iii) the diagnosticity of the witness's account. We also tested if biasing background information affected how factual participants found the witness's statement., Results: Biasing uncheckable information (i.e., opinions) affected participants' judgments of event cause (ηp2 = 0.033) and increased their ratings of witness confidence (ηp2 = 0.074). Biasing background information about a worker affected participants' judgments of the cause of the event (ηp2 = 0.088), the diagnostic value of the witness statement (ηp2 = 0.054), and the number of factual claims in the witness statement, resulting in more uncheckable claims being misclassified as potential facts (ηp2 = 0.18)., Conclusion: This experiment demonstrated the significant effect that non-factual witness statements and irrelevant background information can have on the interpretation of evidence and judgments about the cause of events., Practical Application: Understanding how contextual information can bias investigative judgment helps workplace investigators manage its influence in their judgment practices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 National Safety Council and Elsevier Ltd. All rights reserved.)

Chronic pain and insomnia symptoms are highly comorbid; however, the psychological mechanisms driving this comorbidity are not well understood. The aim of the present study was to assess whether 2 cognitive biases that occur separately in chronic pain and insomnia, that is, interpretation bias and attentional bias, are heightened in people with comorbid chronic pain and elevated insomnia symptoms. A final sample of N = 109 people with chronic pain and N = 79 people without pain who varied in insomnia symptoms were recruited through Prolific Academic to complete this cross-sectional study. Participants completed measures of sleep and pain-related interpretation bias (ambiguous sentences task) and attentional bias (dot-probe task), as well as questionnaires assessing insomnia symptoms, pain symptoms, and general psychological symptoms. We found an interaction between pain status and insomnia symptoms for sleep-related interpretation bias. That is, people with chronic pain showed greater sleep-related interpretation bias than those without pain, but only when insomnia symptoms were also elevated. This interaction did not extend to pain interpretation bias or attentional bias, although we did find an elevated pain interpretation bias in people with chronic pain compared to pain-free individuals. We also found that both pain and sleep-related interpretation bias were associated with depression symptoms, suggesting that interpretation bias could potentially drive a trimorbidity of chronic pain, insomnia, and depression. Taken together, these findings suggest promise for the role of interpretation bias in the mutual maintenance of chronic pain and insomnia symptoms and the importance of also considering depression. PERSPECTIVE: This article presents data on the cognitive biases that are present in chronic pain, and that are associated with increased insomnia symptoms. Identifying such cognitive biases could help in explaining the high comorbidity between chronic pain and insomnia, leading to more effective and targeted treatments., (Copyright © 2024 United States Association for the Study of Pain, Inc. Published by Elsevier Inc. All rights reserved.)

Caregiver-client communication is a process influenced by many specific elements arising from the context, the content and the form of the message, but also from the inner life of the patient and the caregiver. All these specific factors have an impact on the transmission and reception of the message., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

The central thesis of this article is that by anchoring bioethics' core conceptual armamentarium in a four-principled theory emphasizing autonomy and treating justice as a principle of allocation, theorists inadvertently biased 20th-century bioethical scholarship against addressing such subjects as ableism, anti-Black racism, classism, and other forms of discrimination, placing them outside of the scope of bioethics research and scholarship. It is also claimed that these scope limitations can be traced to the displacement of the nascent concept of respect for persons-a concept designed to address classist and racist discrimination-with the morally solipsistic concept of autonomy., (© 2023 John Wiley & Sons Ltd.)

Background: Zoledronate, a bisphosphonate, is a potent first-line treatment for osteoporosis. It is also a preferred treatment for hypercalcemia especially when unresponsive to intravenous fluids. Bisphosphonates can cause acute phase reactions that mimic opioid withdrawal symptoms, which can confound provider decision-making. Our case highlights cognitive bias involving a patient with opioid use disorder who received zoledronate for hypercalcemia secondary to immobilization and significant bone infection., Case Presentation: A 41-year-old male is admitted with a past medical history of active intravenous opioid use complicated by group A streptococcal bacteremia with L5-S1 discitis and osteomyelitis, L2-L3 osteomyelitis, and left ankle abscess/septic arthritis status post left ankle washout. His pain was well-controlled by acute pain service with ketamine infusion (discontinued earlier), opioids, acetaminophen, buprenorphine-naloxone, cyclobenzaprine, gabapentin, and naproxen. Intravenous opioids were discontinued, slightly decreasing the opioid regimen. A day later, the patient reported tachycardia, diaphoresis, myalgias, and chills, which the primary team reconsulted acute pain service for opioid withdrawal. However, the patient received a zoledronate infusion for hypercalcemia, on the same day intravenous opioids were discontinued. He had no other medications known to cause withdrawal-like symptoms per chart review. Therefore, it was suspected that an acute phase reaction occurred, commonly seen within a few days of bisphosphonate use., Conclusion: Zoledronate, well known for causing acute phase reactions, was likely the cause of withdrawal-like symptoms. Acute phase reactions with bisphosphonates mostly occur in the first infusion, and the incidence decreases with subsequent infusions. Symptoms typically occur 24-72 h post-infusion, and last at most for 72 h. Cognitive bias led the primary team to be concerned with opioid withdrawal rather than investigating other causes for the patient's presentation. Therefore, providers should thoroughly investigate potential etiologies and rule them out accordingly to provide the best care. Health care providers should also be aware of the implicit biases that potentially impact the quality of care they provide to patients., (© 2024. The Author(s).)

Objectives: Adherence to palivizumab prophylaxis programmes is crucial to protect infants with CHD against respiratory syncytial virus infections. We analysed the effectiveness of two nudge interventions in increasing adherence., Methods: Our study included 229 infants, and their caregivers, from five centers in Turkey in the 2020-2021 respiratory syncytial virus season. We randomly allocated caregivers to a control and two intervention groups. Caregivers in all groups were informed about the prophylaxis programme and provided a schedule. Additionally, caregivers in Intervention 1 were called two days before appointments (default bias) and were asked to plan the appointment day (implementation intention), whereas caregivers in Intervention 2 received biweekly text messages informing them about the programme's benefits (availability bias) and current adherence rate (social norm)., Results: Caregivers in Intervention 1 had a significantly higher adherence rate than Control (97.3% versus 90.9%) (p = 0.014). Both interventions had a significant effect on participants in their first prophylaxis season (p = 0.031, p = 0.037). Families where the father was employed had a 14.2% higher adherence rate (p = 0.001). Every additional child was associated with a 2.2% decrease in adherence rate (p = 0.02). In control, ICU admission history was associated with an 18.8% lower adherence rate (p = 0.0001), but this association disappeared in intervention groups., Conclusion: This is the first prospective interventional study which, in the context of palivizumab prophylaxis, analyses the effectiveness of nudge interventions based on established cognitive biases by comparing randomly generated intervention and control groups. We found that default bias and implementation intention have significant effects on adherence.Clinical trial, in the name and number "Adherence of palivizumab prophylaxis, NCT05778240" registered retrospectively. https://clinicaltrials.gov/ct2/show/NCT05778240.

Cognitive bias may lead to medical error, and awareness of cognitive pitfalls is a potential first step to addressing the negative consequences of cognitive bias (see Part 1). For decision-making processes that occur under uncertainty, which encompass most physician decisions, a so-called "adaptive toolbox" is beneficial for good decisions. The adaptive toolbox is inclusive of broad strategies like cultural humility, emotional intelligence, and self-care that help combat implicit bias, negative consequences of affective bias, and optimize cognition. Additionally, the adaptive toolbox includes situational-specific tools such as heuristics, narratives, cognitive forcing functions, and fast and frugal trees. Such tools may mitigate against errors due to cultural, affective, and cognitive bias. Part 2 of this two-part series covers metacognition and cognitive bias in relation to broad and specific strategies aimed at better decision-making., (Copyright © 2024. Published by Elsevier Inc.)

Cognitive bias may lead to diagnostic error in the patient encounter. There are hundreds of different cognitive biases, but certain biases are more likely to affect patient diagnosis and management. As during morbidity and mortality rounds, retrospective evaluation of a given case, with comparison to an optimal diagnosis, can pinpoint errors in judgment and decision-making. The study of cognitive bias also illuminates how we might improve the diagnostic process. In Part 1 of this series, cognitive bias is defined and placed within the background of dual process theory, emotion, heuristics, and the more neutral term judgment and decision-making bias., (Copyright © 2024. Published by Elsevier Inc.)

Previous research has suggested that individuals who smoke demonstrate a behavioral tendency to approach rather than avoid smoking-related stimuli (i.e., approach bias). This study assessed whether 149 undergraduates with varying levels of e-cigarette use demonstrated an approach bias for vaping-related stimuli on an Approach-Avoidance Task (AAT). In contrast to our hypotheses, participants with e-cigarette use demonstrated a significant avoidance bias to vaping-related stimuli, and this effect appeared to be primarily driven by female e-cigarette users. Further, we found that more severe e-cigarette use was associated with numerous adverse outcomes, including reduced quality of life and increased vaping cravings, depressive symptoms, perceived stress, and cannabis use severity. Overall, our findings elucidate various negative impacts of e-cigarette use and suggest a potential role for sex differences in approach-avoidance tendencies toward vaping-related stimuli among young adults., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

The onset of the COVID-19 pandemic resulted in a dramatic increase in the salience and importance of information relating to both the risk of infection, and factors that could mitigate against such risk. This is likely to have contributed to elevated contamination fear concerns in the general population. Biased attention for contamination-related information has been proposed as a potential mechanism underlying contamination fear, though evidence regarding the presence of such biased attention has been inconsistent. A possible reason for this is that contamination fear may be characterised by variability in attention bias that has not yet been examined. The current study examined the potential association between attention bias variability for both contamination-related and mitigation-related stimuli, and contamination fear during the early stages of the COVID-19 pandemic. A final sample of 315 participants completed measures of attention bias and contamination fear. The measure of average attention bias for contamination-related stimuli and mitigation-related stimuli was not associated with contamination fear (r = 0.055 and r = 0.051, p > 0.10), though both attention bias variability measures did show a small but statistically significant relationship with contamination fear (r = 0.133, p < 0.05; r = 0.147, p < 0.01). These attention bias variability measures also accounted for significant additional variance in contamination fear above the average attention bias measure (and controlling for response time variability). These findings provide initial evidence for the association between attention bias variability and contamination fear, underscoring a potential target for cognitive bias interventions for clinical contamination fear., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)