Decision-Making, Affect, and Emotion
Recent strategic planning efforts have highlighted the importance of research that elucidates the role of affect, and specifically emotion, in cancer control. Such research may have important theoretical and clinical implications for the reduction of cancer risk and the improvement in cancer outcomes.
Scientific evidence from a variety of domains suggest that affect may be a critical determinant of information processing, sensory perceptions, judgment and decision-making, cancer prevention and health promotion behaviors, and cancer outcomes. However, additional research is needed on the nature of affective phenomena, including the associations among affect and other processes/outcomes, as well as to identify underlying biological and psychological mechanisms. It is critical for us to gain a better understanding of the nature and utility of psychological experiences like stress, emotion, emotion regulation, and resilience.
Ferrer, R., Klein, W., Lerner, J. S., Reyna, V. F., & Keltner, D. (in press). Emotions and Health Decision-Making: Extending the Appraisal Tendency Framework to Improve Health and Healthcare . In C. Roberto & I. Kawachi (Eds.), Behavioral economics and public health. Cambridge, MA: Harvard University Press.
Fundamental Mechanisms of Affective and Decisional Processes in Cancer Control (R01)
This Funding Opportunity (PAR-18-681) will support research to generate new fundamental knowledge of affective processes. Successful basic affective science projects must have downstream consequences for single and multiple event decisions and behaviors in cancer prevention and control. However, projects do not necessarily need to examine these decisions and behaviors directly, as long as future cancer implications are clearly defined. Scientists within disciplines not traditionally focused on cancer research are encouraged to apply. Such disciplines might include (but are not limited to): affective and cognitive science, decision science, consumer science, and neuroscience.
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PAR-18-681 (R01 Clinical Trial Optional).
The Basic Biobehavioral and Psychological Sciences Branch (BBPSB) seeks to fund innovative affective science research that has potential downstream benefits for cancer prevention and control. Basic biobehavioral and psychological science related to cancer-related outcomes may include the following areas of examination:
- Affective states as they relate to judgments and decisions relevant to cancer (e.g., cancer risk behaviors such as poor energy balance and tobacco use; informed consent; clinical cancer care; response to placebo conditions in cancer clinical trials; cancer communication)
- Affective responses to social experiences and potential influences on biological processes associated with cancer progression and outcome
- Affect in cancer survivorship experiences and trajectories
- Affective phenomena (e.g., emotion, stress, mood) and mechanisms by which these may influence cancer outcomes
- Associations among affect and cognition, social cognition, expectancy, hedonics, sensation, and perception
The Basic Biobehavioral and Psychological Sciences Branch (BBPSB) held a series of workshops to inform further strategic investment in affective science.
In the first workshop in this series, we explored how affective science might inform important questions and gaps in knowledge along the cancer continuum. The meeting brought leading experts in affective science together with NCI cancer prevention and control scientists. NCI scientists presented synthesized reviews of important questions in respective domains across the cancer control continuum. These presentations were followed by commentary from an affective scientist discussant, and general discussion among all scientists present. Interesting questions emerged from the workshop deliberations, including, for example:
- In which situations, or for which outcomes, are affective reactions (such as stress or specific emotions) normative vs. maladaptive?
- Do affective states influence the biology of cancer, and vice versa?
- Does recovery from stress or negative affective states mitigate the effects of these affects on biological outcomes? Can positive affect counteract biological effects of stress or other negative affective states?
- What role do affective processes play in perception and memory as they relate to expectation?
- Is affect a source of bias in healthcare and clinical trial contexts?
- Do specific affective states or environments facilitate optimal processing of information, and can these be targeted in intervention or implemented in clinical settings?
- Is it possible to objectively disentangle affective responses from physiological sensations, pleasure, or craving? Which are the best predictors of cancer-related behaviors, and which are easiest to target or influence?
- What are the temporal dynamics of emotional responding?
- How can we best measure affect in various contexts (e.g., survivorship, aging, etc.)?
- How do shared affective states or “emotional contagion” influence cancer-related behaviors and cancer trajectories our outcomes?
- What role do affective complexity, mixed affective states, chronicity, and habituation play in health communication?
- How can we leverage existing theoretical models, methodological rigor, and empirical innovation in affective science to influence tangible cancer outcomes?
- Optimizing Patient-Centered Communication Across the Cancer Control Continuum: The Role of Affective Science?
- Affect and Energy Balance: Implications for Diet and PA across the Cancer Continuum
- The Role of Emotion in Health Communication: Foundational Research and Future Directions
- Affective Science Perspectives on Cancer Control: A Focus on Informed Consent
- Affective Science Perspectives on Cancer Control: The Placebo Effect
- Emotion and Cancer: Treatment and Survivorship
- Affective Science Perspective on Cancer Control: Tobacco
- Can Affective Science Process Influence Cancer Biology?
The second workshop examined the associations between emotion and stress, two affective phenomena that might have particular relevance to cancer prevention through their influence on cancer-related behaviors and biological outcomes. Research in emotion and stress uses similar methodology and faces similar theoretical challenges, but the lines of research in each area are often disconnected, and most researchers examine (or believe they examine) one but not the other. The goal for this workshop was to explore the utility of theoretical and methodological integration of emotion and stress, start to develop an integrated approach that would help to solve some of the pressing issues in both fields, and stimulate their study in a cancer context.
During the course of this workshop, it became apparent that similarities between emotion and stress may outweigh differences, and that differences may be due in part to research focus rather than real differences between the two constructs. For example, stress research tends to focus on the architecture of the situation, whereas emotion research often places more emphasis on the subjective experience. Certainly, empirical research is necessary to determine whether emotion and stress can be integrated. Regardless, each field offers theoretical and methodological tools that may be adopted to further the other.
Our third workshop, New Horizons in Emotion Regulation and Resilience, sought to generate new research questions and scientific perspectives in emotion regulation and resilience through scholarly discourse, debate, and reflections. We hoped to encourage basic psychological scientists to consider cancer as an ecologically valid research context and to translate existing knowledge in emotion regulation and resilience to cancer control.
All of the participants actively and enthusiastically challenged each others’ thinking. While some old debates on the nature of psychological phenomena were revisited – such as whether the distinction between affect, cognition, and perception is biological or culturally-based – progress was made in thinking about when such distinctions are useful, and when they obscure scientific progress. Importantly, workshop participants, even those who do not examine emotion regulation and resilience in a cancer context, were able to generate ideas about how cancer could be leveraged to examine basic affective processes, and how knowledge in emotion regulation and resilience can be leveraged to improve cancer outcomes. Our discourse highlighted themes that have emerged across our series of workshops like the importance of expanding our time scale in experimental and natural studies; modeling heterogeneity and complexity in individuals and contexts; emotion/affect as distributed phenomena; and, the need for advances in the science of subjective experiences.
Connections between emotion regulation, resilience, and cancer control were highlighted in the workshop. More basic research on emotion regulation and resilience could certainly lead to more effective efforts to improve cancer patients’ psychological health and well-being. Moreover, a better understanding of emotion regulation could shed light on potentially effective ways to change maladaptive cancer-risk behaviors used to regulate negative affective states (such as smoking, non-homeostatic eating, and alcohol consumption).
Rebecca Ferrer, Ph.D.
Health Scientist/ Program Director
Basic Biobehavioral and Psychological Sciences Branch
Many cancer survivors report cognitive changes — trouble with thinking, memory, and concentration — related to cancer and cancer treatments, particularly chemotherapy. Sometimes referred to as “chemobrain” or “chemofog,” the phenomenon formally referred to as cancer-related cognitive impairment has been an important concern for clinical practitioners and investigators. Overall, research findings have demonstrated changes in several domains of cognition, including working memory, new learning, executive function, and spatial abilities. However, questions remain in the areas of how to measure these changes, how to interpret findings across research studies, and whether neuropsychological test results can be generalized to everyday tasks. Moreover, not all cancer patients and survivors experience cognitive late effects, and determining susceptibility and identifying neural pathways remain important areas of exploration. Also, there are limited validated interventions available for patients suffering from these symptoms, and further work is needed to provide practitioners and patients with advice about accommodation strategies and empirically sound therapies.
The BBPSB focus expands across the cancer control continuum, examining cognition from pre-treatment through end of life, including in long-term survivors. The branch is interested in the problem of cancer-related cognitive changes from the perspectives of cognitive, clinical, and neurodevelopmental psychology and of neuroscience.
Articles and Publications
Horowitz T, Suls J, Trevino M. A call for a neuroscience approach to cancer-related cognitive impairment. Trends Neurosci. 2018 Aug;41(8):493-496. doi: 10.1016/j.tins.2018.05.001. Epub 2018 Jun 12.
Understanding “Chemobrain” and Cognitive Impairment after Cancer Treatment. National Cancer Institute (2017).
Leveraging Cognitive Neuroscience to Improve Assessment of Cancer Treatment-Related Cognitive Impairment (R01 & R21)
This Funding Opportunity Announcement (FOA) encourages transdisciplinary research that will leverage cognitive neuroscience to improve traditional measurement of cognitive impairment following cancer treatment, often referred to as “chemobrain.” A better understanding of the acute- and late-term cognitive changes following exposure to adjuvant chemotherapy and molecularly-targeted treatments, including hormonal therapy, for non-central nervous system tumors can inform clinical assessment protocols with downstream implications for survivorship care plans.
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