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Learning to wait for more likely or just more: greater tolerance to delays of reward with increasingly longer delays.

ABSTRACT: Little research has focused on training greater tolerance to delays of rewards in the context of delayed gratification. In delayed gratification, waiting for a delayed outcome necessitates the ability to resist defection for a continuously available smaller, immediate outcome. The present research explored the use of a fading procedure for producing greater waiting in a video-game based, delayed gratification task. Participants were assigned to conditions in which either the reward magnitude, or the probability of receiving a reward, was a function of time waited and the delay to the maximum reward was gradually increased throughout this training. Waiting increased for all participants but less for those waiting for a greater reward magnitude than a greater reward probability. All participants showed a tendency to wait in a final testing phase, but training with probabilistic outcomes produced a significantly greater likelihood of waiting during testing. The behavioral requirements of delay discounting versus delay gratification are discussed, as well as the benefits of training greater self-control in a variety of contexts.

SUBMITTER: Rung JM

PROVIDER: S-EPMC9211002 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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Learning to wait for more likely or just more: greater tolerance to delays of reward with increasingly longer delays.

Rung Jillian M JM Young Michael E ME

Journal of the experimental analysis of behavior 20150101 1

Little research has focused on training greater tolerance to delays of rewards in the context of delayed gratification. In delayed gratification, waiting for a delayed outcome necessitates the ability to resist defection for a continuously available smaller, immediate outcome. The present research explored the use of a fading procedure for producing greater waiting in a video-game based, delayed gratification task. Participants were assigned to conditions in which either the reward magnitude, or ...[more]

PMID: 25641081

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Project description:Objective: Community addiction treatment agencies have utilized Network for the Improvement of Addiction Treatment (NIATx), a proven implementation strategy, to reduce appointment wait-times. However, its effectiveness at reducing medication access wait-times has not been explored. Thus, we conducted an exploratory analysis to evaluate the impact of the NIATx implementation strategies on reduced wait-times to addiction, psychotropic or both medications for individuals with co-occurring disorders (COD). Methods: In a cluster-randomized waitlist control group design, community addiction treatment agencies (n = 49) were randomized to receive the NIATx strategy (Cohort 1, n = 25) or to a Waitlist control (Cohort 2, n = 24). All agencies had a 12-month active intervention period. The primary outcome was the medication encounter wait-time. A univariate general linear model analysis utilizing a logarithmic (log10) transformation examined medication wait-times improvements. Results: The intent-to-treat analysis for psychotropic medications and both medications (reflecting integrated treatment) showed significant main effects for intervention and time, especially comparing Baseline and Year 1 to Year 2. Conversely, only the main effect for time was significant for addiction medications. Wait-time reductions in Cohort 1 agencies was delayed and occurred in the sustainment phase. Wait-times to a psychotropic, addiction, or both medications encounter declined by 3 days, 4.9 days, and 6.8 days, respectively. For Cohort 2 agencies, reduced wait-times were seen for psychotropic (3.4 days), addiction (6 days), and both medications (4.9 days) during their active implementation period. Same- or next-day medication access also improved. Conclusions: NIATx implementation strategies reduced medication encounter wait-times but timing of agency improvements varied. Despite a significant improvement, a three-week wait-time to receive integrated pharmacological interventions is clinically suboptimal for individuals with a COD in need of immediate intervention. Community addiction treatment agencies should identify barriers and implement changes to improve medication access so that their patients "wait no longer" to receive integrated treatment and medications for their COD.

Project description:BackgroundResearch consistently documents no correlation between the duration of a musculoskeletal specialty care visit and patient experience (perceived empathy of the specialist and satisfaction with care). Based on a combination of clinical experience and other lines of research, we speculate that longer visits are often related to discordance between specialist and patient interpretation of symptoms and weighting of available test and treatment options. If this is true, then the specific duration of time discussing the specialist's interpretations and options with the patient (expertise transfer) might correlate with satisfaction with care and perceived empathy of the clinician even if the total visit time does not.Questions/purposes(1) What demographic or mental health factors are associated with the duration of expertise transfer? (2) What factors, including the duration of expertise transfer, are associated with the patient's satisfaction with the visit and perceived clinician empathy?MethodsIn a cross-sectional study, 128 new and returning English-speaking adult outpatients seeking care from one of three orthopaedic specialists in two urban practices between September and November 2019 were enrolled and agreed to audio recording of the visit. A total of 92% (118) of patients completed the questionnaire and had a usable recording. Participants completed a sociodemographic survey, the Patient-Reported Outcome Measure Information System Depression computer adaptive test (PROMIS Depression CAT; a measure of symptoms of depression), the Short Health Anxiety Index (SHAI-5; a measure of symptoms of hypochondriasis, a form of symptoms misinterpretation), the Pain Catastrophizing Scale (PCS-4; a measure of misinterpretation of symptoms), an ordinal measure of patient satisfaction (dichotomized into satisfied or not because of strong ceiling effects), and the Jefferson Scale of Patient Perception of Physician Empathy (JSPPPE; a measure of perceived clinician empathy). The duration of expertise transfer and the total duration of the visit were measured by two raters with acceptable reliability using software that facilitates segmentation of the visit audio recording. To determine factors associated with the duration of expertise transfer, satisfaction, and empathy, we planned a multivariable analysis controlling for potential confounding variables identified in exploratory bivariable analysis. However, there were insufficient associations to merit multivariable analysis.ResultsA longer duration of expertise transfer had a modest correlation with catastrophic thinking (r = 0.24; p = 0.01). Complete satisfaction with the visit was associated with less health anxiety (6 [interquartile range 5 to 7] for complete satisfaction versus 7 [5 to 7] for less than complete satisfaction; p = 0.02) and catastrophic thinking (4 [1 to 7] versus 5 [3 to 11]; p = 0.02), but not with the duration of expertise transfer. Greater perceived clinician empathy had a slight correlation with less health anxiety (r = -0.19; p = 0.04).ConclusionPatients with greater misinterpretation of symptoms experience a slightly less satisfying visit and less empathetic relationship with a musculoskeletal specialist despite a longer duration of expertise transfer. This supports the concept that directive strategies (such as teaching healthy interpretation of symptoms) may be less effective then guiding strategies (such as nurturing openness to alternative, healthier interpretation of symptoms using motivational interviewing tactics, often over more than one visit or point of contact).Level of evidenceLevel II, therapeutic study.

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Learning to wait for more likely or just more: greater tolerance to delays of reward with increasingly longer delays.

Publications

Learning to wait for more likely or just more: greater tolerance to delays of reward with increasingly longer delays.

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