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

Reducing concussion risks in athletes depends on self-reporting. Often, athletes decide whether to report concussions or continue playing and risk serious health consequences. Fuzzy-trace theory (FTT) predicts that reliance on gisty, categorical representations of risky decisions, not amounts of risk/reward, encourages risk avoidance and application of bottom-line values, or gist principles, thus promoting healthy decisions. Applying FTT, we test whether intentions to report are predicted by gist-based thinking about risks and values. High school and college students (N = 1,366) were assessed for concussion knowledge, social pressures to not report (by coaches/parents/teammates), categorical gist-based thinking, endorsement of gist principles expressing values, and intentions to report. As expected, the older group scored higher on gist measures. For young adults, categorical thinking, and gist principles predicted intentions, controlling for sex, knowledge, and social pressures. For adolescents, categorical thinking again predicted intentions. For both age groups, adding FTT's predictors accounted for significantly more variance than baseline models.

This project employs an experimental design to test theoretical predictions regarding how numeracy can assist jurors in determining damage awards to compensate a plaintiff for pain and suffering and how the use of meaningful numerical anchors may produce similar benefits. Mock jurors (N = 345) reviewed a legal case and were asked to give a dollar award to compensate the plaintiff for pain and suffering. The presence and nature of a numerical anchor and the duration of pain and suffering were manipulated. Participants' numeracy was measured. Results provided support for predictions. Jurors higher in numeracy gave awards that more appropriately reflected the duration of pain and suffering and showed less variability in awards. Similar benefits were obtained by exposing jurors to meaningful numerical anchors to help them contextualize dollar amounts. Thus, introducing meaningful anchors to jurors may provide similar benefits to numeracy, without the drawbacks associated with selecting only numerate jurors.

Reducing inappropriate prescribing is key to mitigating antibiotic resistance, particularly in acute care settings. Clinicians' prescribing decisions are influenced by their judgments and actual or perceived patient expectations. Fuzzy trace theory predicts that patients and clinicians base such decisions on categorical gist representations that reflect the bottom-line understanding of information about antibiotics. However, due to clinicians' specialized training, the categorical gists driving clinicians' and patients' decisions might differ, which could result in mismatched expectations and inefficiencies in targeting interventions. We surveyed clinicians and patients from 2 large urban academic hospital emergency departments (EDs) and a sample of nonpatient subjects regarding their gist representations of antibiotic decisions, as well as relevant knowledge and expectations. Results were analyzed using exploratory factor analysis (EFA) and multifactor regression. In total, 149 clinicians (47% female; 74% white), 519 online subjects (45% female; 78% white), and 225 ED patients (61% female; 56% black) completed the survey. While clinicians demonstrated greater knowledge of antibiotics and concern about side effects than patients, the predominant categorical gist for both patients and clinicians was "why not take a risk," which compares the status quo of remaining sick to the possibility of benefit from antibiotics. This gist also predicted expectations and prior prescribing in the nonpatient sample. Other representations reflected the gist that "germs are germs" conflating bacteria and viruses, as well as perceptions of side effects and efficacy. Although individually rational, reliance on the "why not take a risk" representation can lead to socially suboptimal results, including antibiotic resistance and individual patient harm due to adverse events. Changing this representation could alter clinicians' and patients' expectations, suggesting opportunities to reduce overprescribing.

BackgroundAdherence to evidence-based antibiotic therapy guidelines for treatment of upper respiratory tract infections (URIs) varies widely among clinicians. Understanding this variability is key for reducing inappropriate prescribing.ObjectiveTo measure how emergency department (ED) clinicians' perceptions of antibiotic prescribing risks affect their decision-making.DesignClinician survey based on fuzzy-trace theory, a theory of medical decision-making, combined with retrospective data on prescribing outcomes for URI/pneumonia visits in two EDs. The survey predicts the categorical meanings, or gists, that individuals derive from given information.ParticipantsED physicians, residents, and physician assistants (PAs) who completed surveys and treated patients with URI/pneumonia diagnoses between August 2014 and December 2015.Main measuresGists derived from survey responses and their association with rates of antibiotic prescribing per visit.Key resultsOf 4474 URI/pneumonia visits, 2874 (64.2%) had an antibiotic prescription. However, prescribing rates varied from 7% to 91% for the 69 clinicians surveyed (65.2% response rate). Clinicians who framed therapy-prescribing decisions as a categorical choice between continued illness and possibly beneficial treatment ("why not take a risk?" gist, which assumes antibiotic therapy is essentially harmless) had higher rates of prescribing (OR 1.28 [95% CI, 1.06-1.54]). Greater agreement with the "antibiotics may be harmful" gist was associated with lower prescribing rates (OR 0.81 [95% CI, 0.67-0.98]).ConclusionsOur results indicate that clinicians who perceive prescribing as a categorical choice between patients remaining ill or possibly improving from therapy are more likely to prescribe antibiotics. However, this strategy assumes that antibiotics are essentially harmless. Clinicians who framed decision-making as a choice between potential harms from therapy and continued patient illness (e.g., increased appreciation of potential harms) had lower prescribing rates. These results suggest that interventions to reduce inappropriate prescribing should emphasize the non-negligible possibility of serious side effects.

Criminal behavior and related disorders have been associated with abnormal neural activity when experiencingor anticipating risks and rewards, as well as when exercising inhibition. However, behavioral and neural substrates of riskpreferences and criminality have received scant attention when unconfounded with experience, anticipation, and inhibition. Wetest predictions of fuzzy-trace theory (FTT) in two experiments using a risky-choice framing task. Behavioral results show thatindividuals with a greater history of criminal behavior are less likely to engage in simple meaning-based processing and areless confident when doing so. These findings are supported by fMRI results showing a greater history of criminal behavioris associated with increased activation in regions associated with cognitive control when engaging in simple meaning-basedprocessing. These results provide insight into the cognitive processes and brain mechanisms that are associated with criminalbehavior.

One factor in reducing the likelihood of sports-related brain injuries is the recognition of risks. However, using colloquial terms may deemphasize the severity of these risks. We hypothesized that using colloquial language to describe sports-related brain injuries will lead to greater willingness to take on the risk. We conducted two experiments, varying the label describing an injury (getting your bell rung, concussion, or brain injury) and assessing willingness of current athletes, former athletes, and nonathletes to accept this risk as part of sports participation. High-school and college athletes were willing to expose themselves to a high probability of risk, compared with nonathletes, when described colloquially. However, risk thresholds were low and indistinguishable across groups when using the term "brain injury." Findings remained significant when controlling for knowledge, age, and sensation seeking. These differences indicate that the term "getting your bell rung" should not be used to describe a brain injury.

ObjectiveTo improve our understanding of patients' treatment preferences for chronic hepatitis C (HCV).MethodsSubjects with HCV were recruited from 2 VA medical centers. Preferences were ascertained using conjoint analysis. We used segmentation analysis to examine whether there were groups of respondents with similar preferences that were systematically different from the preferences of others. We then measured the associations between treatment preference with subjects' characteristics and their gist principles related to living with HCV and the burden of therapy.ResultsA total of 199 subjects participated in this study. The segmentation analysis demonstrated that subjects could be classified into 2 distinct groups. The larger group [group 1, n=118 (59%)] opted for current treatment and the other [group 2, n=81 (41%)] preferred to defer. Patients with cirrhosis were less likely to belong to group 2 (prefer to defer) compared with those without cirrhosis (40.5% vs. 21.3%), whereas subjects self-identifying as African American were more likely to belong to group 2 than white subjects (51.3% vs. 30.5%). Members of group 1 had a more positive overall gist principles related to HCV compared with members of group 2 [mean (SD) score=28.63 (3.06) vs. 26.46 (2.79), P

Fuzzy-trace theory assumes that decision-makers processqualitative “gist” representations and quantitative “verbatim”representations in parallel. Here, we develop a formal modelof fuzzy-trace theory that explains both processes. The modelalso integrates effects of individual differences in numeracy,metacognitive monitoring and editing, and sensation seeking.Parameters of the model varied in theoretically meaningfulways with differences in numeracy, monitoring, and sensationseeking, accounting for risk preferences at multiple levels.Relations to current theories and potential extensions arediscussed.

We propose a new model of risk preferences that integratestheoretical principles relevant to mental representation,metacognitive monitoring and editing, and individualdifferences in risk-taking propensity. Our model is based onfuzzy-trace theory, a theory of decision-making under risk.The theory posits that decision-makers use fuzzy gistrepresentations of the meaning of decision information, inparallel with precise verbatim representations of the exactwording of that information. We account for core phenomenain decision theory, such as shifts in risk preference whenlogically equivalent gambles are described in terms of gainsrather than losses—framing effects—and also extend fuzzytracetheory beyond these phenomena to encompass researchon affect and personality

We tested predictions of fuzzy-trace theory that qualitative health status and gist representations (ordinal and categorical) of risks contribute to willingness to start medications, beyond effects of objective risk, emotion (worry), and numeracy. Adults in two experiments were given hypothetical scenarios based on actual medications, varying health status quo (acceptable or unacceptable), adverse event (pneumonia or cancer), and four levels of quantitative risk (from 1/100,000 to 1/100) between subjects. In both experiments, cancer and higher quantitative risk elicited greater worry and risk perceptions and reduced willingness to start a new medication. Willingness to start was also influenced by health status quo. After controlling for other variables, only status quo and gist representations consistently predicted willingness to start in both experiments. Results support an integrated approach to understanding and predicting perceptions of the risks of medications that encompasses numerical cognition, emotions (such as worry), and qualitative gist representations of medical information.

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

Theoretical accounts of risky choice framing effects assume that decision makers interpret framing options as extensionally equivalent, such that if 600 lives are at stake, saving 200 implies that 400 die. However, many scholars have argued that framing effects are caused, instead, by filling in pragmatically implied information. This linguistic ambiguity hypothesis is grounded in neo-Gricean pragmatics, information leakage, and schema theory. In 2 experiments, we conducted critical tests of the linguistic ambiguity hypothesis and its relation to framing. We controlled for this crucial implied information by disambiguating it using instructions and detailed examples, followed by multiple quizzes. After disambiguating missing information, we presented standard framing problems plus truncated versions, varying types of missing information. Truncations were also critical tests of prospect theory and fuzzy trace theory. Participants were not only college students, but also middle-age adults (who showed similar results). Contrary to the ambiguity hypothesis, participants who interpreted missing information as complementary to stated information nonetheless showed robust framing effects. Although adding words like "at least" can change interpretations of framing information, this form of linguistic ambiguity is not necessary to observe risky choice framing effects.