DECISIONE TRA EMOZIONE E COGNIZIONE. Meccanismi funzionali e disfunzionali del decision-making

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1 Atti del Convegno DECISIONE TRA EMOZIONE E COGNIZIONE. Meccanismi funzionali e disfunzionali del decision-making 12 APRILE 2014 UNIVERSITÀ CATTOLICA DEL SACRO CUORE Largo Gemelli, Milano PROGRAMMA Iscrizione partecipanti Apertura lavori Albino Claudio Bosio, Michela Balconi Basi emotive, cognitive e neuropsicologiche della decisione Chair: N. Bonini Neuroscienze e decision-making: un approccio integrato - M. Balconi Comunicazione e decisione: tra persuasione e inganno - N. Bonini Strumenti di neuroimmagine nello studio dell effetto di stimoli audiovisivi - G. Vecchiato Coffee break Clinica della decisione Chair: S. Campanella A triadic neurocognitive approach to addiction - X. Noel Alcohol dependence, ERPs and inhibition: is it possible to predict relapse? - S. Campanella Patient engagement in health care: pathways for shared decision-making - G. Graffigna, S. Barello Gambling, reward mechanisms and decision-making - R. Finocchiaro, M. Balconi Lunch Contesti e applicazioni della decisione Chair: F. Babiloni L efficacia di una comunicazione pubblicitaria: quale ruolo per gli strumenti di brain imaging? - P. Cherubino Ragione e sentimento: chi è il miglior personal shopper? - B. Colombo, P. Iannello, A. Antonietti Advertising, brand and neuromarketing or how consumer brain works - B. Stumpo, M. Balconi, F. Leanza Decidere e comunicare nel neuromanagement - C. Scortegagna, M. Balconi Modalità di iscrizione: Dato il numero limitato di posti, si prega di notificare la propria adesione tramite indicando nome, cognome e affiliazione. Sarà riconosciuto un attestato di partecipazione. Quote di partecipazione: 40 (IVA esente) Modalità di pagamento: In loco oppure Bonifico Bancario (IBAN: IT07W Beneficiario: Università Cattolica del Sacro Cuore - Causale: Iscrizione a Decisione tra Emozione e Cognizione, NOMINATIVO PARTECIPANTE ) INFO: Comitato Scientifico: Michela Balconi Fabio Babiloni Nicolao Bonini Segreteria Organizzativa: Maria Elide Vanutelli Davide Crivelli

2 Atti del Convegno DECISIONE TRA EMOZIONE E COGNIZIONE. Meccanismi funzionali e disfunzionali del decision-making 12 APRILE 2014 UNIVERSITÀ CATTOLICA DEL SACRO CUORE Largo Gemelli, Milano SESSIONE Basi emotive, cognitive e neuropsicologiche della decisione Chair: N. Bonini Neuroscienze e decision-making: un approccio integrato M. Balconi Comunicazione e decisione: tra persuasione e inganno N. Bonini Strumenti di neuroimmagine nello studio dell effetto di stimoli audiovisivi G. Vecchiato

3 UNIVERSITA CATTOLICA DEL SACRO CUORE - MILANO Department of Psychology DECISIONE TRA EMOZIONE E COGNIZIONE: MECCANISMI FUNZIONALI E DISFUNZIONALI DEL DECISION-MAKING Michela Balconi Research Unit in Affective and Social Neuroscience Department of Psychology Catholic University of Milan, Italy

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5 Decision between emotion and cognition Three sections to answer about a possible integration 1. Basi emotive, cognitive e neuropsicologiche della decisione 2. Clinica della decisione 3. Contesti e applicazioni della decisione

6 Decision between emotion and cognition Neurophysiological models of decision The neuropsychological measures for decisions; the role of the prefrontal cortex Cognitive models of decision Normative models ; the rational problem; decisional bias (frame effect, euristics); communication and persuasion Emotional attitude and engagement The reward mechanisms and the emotional effects What kind of intra-individual variability? The functional/dysfunctional contexts (addition) The personal attitudes The cognitive styles ; the decisional styles ; purchese processes

7 Decision between emotion and cognition: what about the neurophysiology? More than 1700 scientific papers that talk about the physiology of decisional processes The concept of decision-making is applied to heterogeneous contexts and it is related to different biological systems Some examples To decide what kind of visual pattern: the perceptual decision To select movements and the decision to act: the motor decision To opt for an economic strategy: the economic decision Human vs. apes Drosophyla and different flight paths Action planning in motor tasks Financial investments

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10 Neuroscience and decisonmaking What about decisions? What is a decision? Between neurophysiology, cognition and emotion Cognition Emotion Neurophysiology

11 UNIVERSITA CATTOLICA DEL SACRO CUORE - MILANO Department of Psychology NEUROPHYSIOLOGICAL FRONTAL BRAIN ACTIVITY, REWARD-SENSITIVITY AND SENSE OF EFFICACY IN GAMBLING DECISIONAL BEHAVIOUR Michela Balconi Research Unit in Affective and Social Neuroscience Department of Psychology Catholic University of Milan, Italy

12 The theoretical background Phase 1: Gambler behavior Frontal system: the contribution of PFC (vmpfc; DLPFC) (Bechara et al., 2010) Motivational-Reward mechanisms, OFC (Davidson, 2009) Somatic marker disfunction (Damasio et al., 2008) Multilevel analysis: behavioral task (IOWA), autonomic index, EEG/ERP Phase 2: Dependence-behavior What kind of relationship beween «gambler» and «addiction»?

13 PFC and «gambler behavior» Gambler behavior: unfunctional behavior in decisional-processes with increased risk-seeking, high dependence to reward which produces more risky and unfunctional (loss) strategies Brain correlates = prefrontal cortex vmpfc, DLPFC: executive functions and control of decisional processes (working memory), for action planning; long-term pianification and strategies OFC and its relatioship with amygdala and reward mechanisms Frontal brain unbalance (BIS/BAS system) (Gray, 2001): more sensitivity to reward and less to punishment (Balconi et al., 2013)

14 Reward mechanisms

15 PFC and «gambler»: what effect on behavior? 1) Some neurocognitive hypotheses on gambler behavior: effect on both the emotional/motivational and cognitive level 2) VMPFC unbalance between left (reward) and right (punishment) hemisphere, with increased left activation reward-sensitivity (BIS/BAS) induces a related effect: more attentional bias toward positive (potentially rewarding) than negative (potentially punishing) cues (Balconi et al., 2014; Barry et al., 2008) 3) DLPFC impairment, disfunctional executive system (disexecutive): Cognitive effects: reduced long-term strategies Attentional bias toward risky-choices

16 Iowa Gambling Task (IGT) (Bechara et al., 1997; 2009) Participants have to choose between decks that yield high immediate gain but larger future loss (long-term disadvantageous decks, BAD DECKS), and decks that yield lower immediate gain but a smaller future loss (long-term advantageous decks, GOOD DECKS)

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19 The somatic marker Patients and pathological gambler = «bad decision-makers» Reduction of «biological markers» = unability to manage the decisional process

20 But is it enought to explain the «gambling»? Some integrative measures Autonomic behavior: SCR and somatic marker + Cognitive and metacognitive measures: selfrepresentation of the strategies BIS/BAS measures: as a predictive value of the gambler behavior Neurophysiological EEG/ERPs correlates as attentional/feedback markers: P300/FRN; alpha band analysis

21 Main hypotheses: the multilevel biomarkers of gambling behavior WHAT ABOUT THE PREDICTIVE VALUES OF THESE DIFFERENT MEASURES? REWARD SENSITIVITY (BIS/BAS) : motivational response to external reinforce, with a direct impact on behavioral choices and cognitive strategies MORE RISK-SEEKING CHOICES related to high reward sensitivity AUTONOMIC RESPONSIVENESS: SCR somatic marker as a biological marker of loss PARTIAL INABILITY TO ACTIVATE A FUNCTIONAL SOMATIC SIGNAL in case of bad decks

22 continue EEG/ERP Attentional marker: P300 as a functional correlate of attentional bias, able to inhibit interfering stimulus processing (focal attention) REDUCED DIFFERENCES BETWEEN EXPECTED AND UNEXPECTED STIMULI External feedback: FRN as a functional correlate of feedback bias, generally increased in case of unattended (loss) feedback LESS RESPONSIVE TO NEGATIVE (LOSS) FEEDBACK Alpha Brain activation: alpha band as an index of brain activity (frontal left/right unbalance), alpha decreasing as increased brain activity, with an inter-hemispheric balence INCREASED LEFT (REWARD) HEMISPHERE ACTIVITY

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24 Subjects Phase 1 Sub-clinical sample: 28 high riskseeking (i.e. Risk Attitude Scale; Sensation Seeking Scale) and high reward-sensitivity (high BAS-reward > 18) (HRS); 22 low risk-seeking and low rewardsensititivy (low BAS-reward < 10) (LRS) Phase 2 Clinical sample (cocaine-abusers)

25 mean selections Behavioral responses to IGT 35,00 30,00 25,00 20,00 15,00 HRS LRS 10,00 5,00 0,00 bed decks good decks * = all comparisons were significant p.01

26 Behavioral responses to IGT Increased bad-deck choices for HRS more heterogeneous strategy (a higher number of changes) inability to report their own overall choice strategy (post-exp debriefing questionnaire) Absence of a metacognitive representation

27 ms/s SCR modulation 0,20 * * 0,15 0,10 HRS LRS 0,05 0,00 bed decks good decks

28 SCR modulation Somatic marker: decreased SCR for punishment (loss) for HRS in comparison with LRS who showed the «classical» increasing pre-loss effect But necessary to be explored the postpunishment/reward somatic response: the preliminary results show no significant differences between HRS and LRS group

29 mvolt P300 modulation 10,00 9,00 8,00 7,00 6,00 5,00 4,00 3,00 2,00 1,00 0,00 reward * * * punishment HRS LRS P300 for reward and loss LRS ( ms) P300 for reward and loss - HRS

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31 eloreta SOURCE ANALYSIS

32 P300 modulation Less significant posterior P300 response in HRS, with significant reduction in case of punishment in comparison with LRS But more posteriorly distributes than previous studies (i.e. Campanella): a P3b effect? Less ability to restore past experience and updating the context in case of unexpected cues

33 mvolt FRN modulation 10,00 9,00 8,00 7,00 6,00 5,00 4,00 3,00 2,00 1,00 0,00 reward * * punishment HRS LRS FRN for reward and loss LRS ( ms) FRN for reward and loss - HRS

34 FRN modulation FRN effect for HRS/LRS as a function of loss and reward: reverse pattern for loss with decreased FRN for HRS than LRS, on the contrary similar profile for reward For HRS less ability to compare internal vs external feedback in case of loss

35 Alpha asymmetry Alpha (8-12 Hz) band Log-trasformed asymmetry for mean power density A negative value indicated more right-side alpha power, i.e greater cortical activity in the left hemisphere for HRS

36 Conclusions: step 1 To summarize Behavior and cognitive strategies: more disfunctional and low selfknowledge on the cognitive strategies for HRS Autonomic (SCR) behavior: in general less responsiveness; absence of clear somatic marker related to losses Less P300 and FRN responsivity to unattended and negative (loss) feedback: it may be explained as an increased bias toward the rewarding cues which «limited» the usual more punishment (unexpectancy) effect Supported also by an hemispheric unbalance as shown by alpha: clear reward preference (left-hemisphere) for HRS than LRS

37 Conclusions: step 1 but also working memory disfunction managed by DLPFC Thus an explanation only reward-based is unable to explain all the cognitive significant effects we found (mainly for metacognitive deficits and FRN effect) Both reward system explanation (as reported by alpha asymmetry and somatic marker impairment) and executive functions (working memory) (as reported by P300/FRN and metacognition) should be considered

38 Conclusions: step 1 What more proficient bio-marker of functional/dysfunctional processes? All together as potential predictors of a «reward bias» But are all results explanable only based on a reward system anomaly and the predominance of lefthemisphere activity? DLPFC contribution and working-memory role to be tested also on drug-dependence

39 Step 2 Drug-dependence behavior Similar profile than higher reward-sensitivity and risk-seeking? See next talk (Finocchiaro, Balconi)

40 A continuum from subclinical «gambler» to other dysfunctional behavior? 1) reward sensitivity (bad strategies) 2) Absence of metacognition 3) Less somatic marker response 4) unbalanced left/right activation

41 More emotion or more cognition in functional/dysfunctional conditions? Some future clinical/application contexts Parkinson desease Alzheimer desease Neuromarketing (Stumpo et al.) NeuroManagement (Scortegagna et al.)

42 Thanks! Roberta Finocchiaro Ylenia Canavesio Salvatore Campanella All the gamblers who worked and will work with us

43 Comunicazione e Decisione: tra persuasione ed inganno Nicolao Bonini Dipartimento di Economia e Management Università di Trento Milano 12 aprile

44 Comunication and informed decision-making Beyond the paradigm of accurate and complete information & the neoclassical notion of sovereign consumer The organization/framing of accurate and complete information might well be misleading

45 The theory of rational choice (e.g. economic rationality) Preferences are: i) Complete ii) Internally consistent iii) Stable iv) Self-referred (selfish) Psychological vs. economic accounts of preference and value. 3

46 The sovereign consumer: Neoclassical notion Consumer sovereignty in terms of satisfaction of coherent preferences Each individual, it is usually claimed, is the best or proper judge of her own well-being, and those judgments of well-being are revealed in her preferences (Sugden, 2004, p. 1016) -emphasis added. Economists usually assume that these revealed preferences are also normative preferences preferences that represent the economic actor s true interests. (Beshears et al., 2008, p. 1787) -emphasis added.

47 The sovereign consumer & Market regulation Corollary of conventional economic rationality: It is sufficient to provide the sovereign consumer with accurate and complete information to allow him/her to make normative preferences (es. la migliore scelta; quella che risponde al meglio ai suoi interessi). Minimalist approach to Market Regulation => Simplified Norms

48 Money, money, money Searching for the best offer (& deceptive communication?)

49 B) Crisi economica e comportamento dei consumatori: USA The top four (by volume of sales) global discount retailers increased their net sales by 38,9% during the period The retail industry witnessed a 0.7 percent increase in sales (February ). However, this positive figure was almost entirely attributed to the positive performance of the discount stores (+2,9%), while department stores sales dropped by 9% Source: KMPG Issues Monitor, June 2009, volume 3.

50 B) Crisi economica e comportamento dei consumatori: ITA Un fenomeno sociale La percentuale di famiglie Italiane che fa regolarmente la spesa agli hard discount è cresciuta dal 21% al 28,4% nel periodo La percentuale di famiglie Italiane che cerca attivamente e regolarmente offerte promozionali e sconti commerciali è cresciuta dal 36% al 42,1% nel periodo [1] Analisi della Camera di Commercio di Monza e Brianza su dati ISTAT

51 On the psychology of choosing the worst offer -Graffeo & Bonini, submitted Exp.1 Percentage vs. Euro-saved comparative formats Product Initial price Euro saved Percentage discount Ski Helmet % [9.60 ] 9

52 .. Choosing the worst offer -Graffeo e Bonini, submitted Exp.1 Product: Ski Helmet NUMERACY Tot. Percentage discount (worst option) LOW HIGH % 29.4% 37.2% Euro-Saved discount % 70.6% 62.8% Chi square (1) = 10,6 p <

53 Choosing the worst offer. -Graffeo e Bonini, submitted, Exp.1 Comparative price formats & Numeracy Prodotti Prezzo iniziale Sconto in Valore Assoluto Sconto in Percentuale e corrispondente valore assoluto Zaino % [11 ] Cuscino in lattice % [ 9,6 ] Casco da sci % [ 9,6 ] 11

54 Proportion dominance out of the lab. Same economic value, but different perceptions..

55 Proportion dominance & Perceived value of a coupon Yin & Dubinsky, 2004 Vendor Coupon: Expires 12/15/04 SAVE $10.00 Off the $50.00 regular price of Product A Vendor Coupon: Expires 12/15/04 SAVE 20% Off the $50.00 regular price of Product A Same economic value, but different perceptions..

56 Offerte commerciali: L informazione è accurata, però. Ecco il consiglio di uno tra i migliori 15 professori di marketing negli Stati Uniti: Advertising Principles (Evidence-based principles): For inexpensive products, state price discounts as percentage saved; for expensive products, state price discounts as dollars saved or present both underlined mine Armstrong, J. S. (2010) Persuasive Advertising, New York: Mac Millan

57 Numeracy or something else? Heuristic Vs. analytic approaches to solve the decision problem.

58 Choosing the worst offer -Graffeo e Bonini, submitted Exp.1 Type of choice (out of three products) Choice strategy Tot. Heuristic Analytic Worst offer (percentage format) % 31.9% 36.5% Best offer (Euro-saved) % 68.1% 63.5% Total choices

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60 more on the psychology of the choice of commercial offers On the impact of low initial prices & impulsivity. (Graffeo, Polonio & Bonini, in progress) Impulsivity as a trait of vulnerable consumers?

61 Stimuli Example

62 Stimuli Example

63 Numeracy Vs. Impulsivity.. Solo i consumatori che hanno scarsa alfabetizzazione numerica, oppure c è dell altro?

64 Quanto costa la pallina? Un set di racchetta e pallina costa in totale 1,10. La racchetta costa 1 euro più della pallina. Quanto costa la pallina?

65 Experimental method 39 students (16 males and 23 females), mean age = 24.5 (SD = 3.47). Participants responded to 12 decision problems randomly presented. For each problem the participants decided whether to buy a product (e.g. DVD player) at shop A or B. The two shops, A and B, sold the same identical product but it was on sale with different initial prices and percentage discounts. We will call the two alternatives option with low (high) initial price - for half of the problems the more worthwhile option is the one with low initial price, for the other half the best option is the one with high initial price. 23

66 Areas of interest (AOI) 24

67 Eye Tracking Procedure 25

68 Results Behavior, Preferences: CRT, Numeracy and Choice (1) Dependent Variable: Choice of the option with low/high initial price. Predictors: CRT, Numeracy, Dominant option (D.O.), CRT by D.O., and Numeracy by D.O.. Effect of CRT: Low CRT participants chose the product with low initial price significantly more often than the high CRT participants (low CRT = 6.9 vs. high CRT = 5.3, β = -1.79, SE = 0.43, Z = -4.19, p <.001). Mean number of preferences for the low initial price options, out of 12 problems Low CRT High CRT 26

69 Results Behavior, Preferences: CRT, Numeracy and Choice (2) The interaction CRT * D.O. is significant (β = 1.79, SE = 0.58, Z = 3.07, p =.002). When the D.O. is the product with low initial price, the choices of low and high CRT participants are very similar (low CRT = 4 vs. high CRT = 4.3). On the contrary, when the D.O. is the product with high initial price, the low CRT participants chose more often the product with low initial price (suboptimal option) than high CRT (low CRT = 2.9 vs. high CRT = 1). [out of 6 problems] Mean number of preferences for the low initial price options, out of 6 problems Low CRT High CRT DO Low Price DO High Price 27

70 Results Behavior, Preferences: CRT, Numeracy and Choice (3) The factor Dominant Option (D.O.) is not statistically significant (β = 0.37, SE = 1.16, Z = 0.32, p =.75). The factors Numeracy and the interaction Numeracy by Choice Pair are not significant. Thus, Impulsivity matters more than Numeracy 28

71 Results Process, Eye movements: CRT and Saccades A compact index of the participants' saccades: ratio between vertical and horizontal saccades. Higher values of the index indicate that the participant did a larger proportion of vertical saccades, compared to the number of horizontal saccades. A linear mixed model on the Saccades Index (I.V.: CRT, Choice Pair; CRT by Choice Pair) indicates that the participants with low CRT did a smaller proportion of vertical saccades compared to the high CRT participants (1.8 vs. 2.7, β =.89, SE = 0.23, t = 3.92, p <.001). 29

72 Results Process, Eye movements: CRT and Fixation Times Natural logarithm transformation of the fixation times (Newell & Rosenbloom, 1981). The mean fixation times of the two prices (r(24) =.87, p <.001) and of the two discounts (r(24) =.70, p <.001) are highly correlated. Low CRT participants did significantly shorter Price and Discount Fixations, compared to the high CRT participants (Price Fixations: 5.6 vs. 5.8; β =.20, SE = 0.03, t = 7.7, p <.001. Discount Fixations: 5.36 vs. 5.44; β =.08; SE = 0.02, t = 3.4, p 30 <.001).

73 Results Process, Eye movements: CRT and Eye movements - Conclusions Overall, the results show that participants with different CRT scores used different strategies of information search. Low CRT participants did a greater proportion of horizontal saccades and they gazed for a shorter time the two macroareas of interest, compared to the high CRT participants (the fixation time is considered a proxy of the processing depth). 31

74 Eye movements and Accuracy (Choice Efficiency) Saccades do not affect accuracy (β = 0.13, SE = 0.09, Z = 1.49, p =.14). Longer fixations of the prices are associated with greater accuracy (β = 1.91, SE = 0.58, Z = 3.30 p <.001), while longer fixations of the discounts reduce the accuracy (β = -1.71, SE = 0.65, Z = 0.51, p =.008). 32

75 Conclusion 1 The low CRT participants have a different approach to the evaluation of the choice problems compared to the high CRT participants. - Shorter fixations and less vertical saccades (shallow withinoption search). A first impression evaluation of the option? Strong preference for one kind of option: the low initial price option. Participants with a propensity to choose impulsively (as measured by CRT) tend to use a Heuristic choice strategy (incomplete evaluation of the options, shorter fixations, and shallow information search process), which increases the 33 chance to prefer the more attractive but economically dominated option.

76 Conclusion 2 Price anchors & illusion of advantage Anchoring on initial prices. Reported findings (e.g. the role of initial low price) are congruent with the study of the Office of Fair Trade on drip pricing format (e.g., the role of headline price) However, not for everybody (e.g. not for low impulsive consumers ) 34

77 Conclusion 1 Theory & Experimental evidence Homo sapiens & decision anomalies Failure (descriptive and predictive) of the consumer sovereign principle Is it sufficient to provide the sovereign consumer with accurate and complete information to allow him/her to make normative preferences (es. the best choice; the choice that reflects his/her true interests)? not always -as we just saw!

78 Conclusion 2 Beyond the lab From persuasive to misleading commercial practices? - Drip pricing format - Anchoring on unreasonable cheapest/highest initial low prices - Default prices See the very sophisticated notion of «misleading» used by European Union 36

79 A Sophisticated Notion - Directive 2005/29/CE of May 11, 2005 Section 1. Misleading Commercial Practices: Article 6: Misleading Actions 1. A commercial practice shall be regarded as misleading if it contains false information and is therefore untruthful or in any way, including overall presentation, deceives or is likely to deceive the average consumer, even if the information is factually correct ( ), and in either case causes or is likely to cause him to take a transactional decision that he would not have taken otherwise ( ) See Caterina (2010) on the notion of misleading action & decision error See also Article 7 on Misleading Omissions 37

80 Un passo avanti: le nozioni di azione ingannevole e vantaggio comparativo illusorio Un commento alla lettera d) ( ) proteggere il consumatore dalla macchinaz. perpetrata tramite l utilizzo di sistemi di calcolo della somma dovuta o per mezzo della concessione di sconti, premi fedeltà e simili, i quali persuadono la parte vulnerabile a moltiplicare gli acquisti sull abbrivio della falsa aspettativa di beneficiare di vantaggi che, a ben guardare, sono frutto di mera illusione De Cristofaro e Zaccaria (2010). Commentario breve al Diritto dei consumatori, CEDAM, p. 159 commento 6 38

81 Temporal price framing: the study of OFT, 2010 The drip price frame (or partitioned pricing) was found the most likely misleading frame [survey, experiment and focus groups] Drip pricing = where price increments (e.g., due to taxes, card charges and delivery charges) drip through during the buying process.. E.g.1: Ticket price (10 ), then plus Admin. Fee (5 ), then plus Payment charge (5 ) See also legal cases such as AIR ITALY, Home shopping selections 39

82 Consumer detrimental effects of Drip Pricing The evidence shows that certain pricing techniques when used in a misleading way can result in consumers making purchasing decision they would not have made were prices more clearly advertised, or to spend more than they need to [OFT, Advertising of Prices, Findings and outcomes; See also Annexe I Ranking of pricing practices ] 40

83 Competition detrimental effects of Drip Pricing Consumer purchasing decisions are driven by who has the cheapest headline prices - which in turn disadvantages firms that include all charges in the headline price In general, misleading pricing is not only bad for the consumer, it is also bad for competition (e.g. it creates an uneven playing field between fair vs. unfair dealing businesses). 41

84 AGCM: MY AIR case (PS168) La sentenza è motivata dal fatto che la procedura di acquisto dei biglietti (via internet) è strutturata in maniera tale da generare un vantaggio illusorio. Al momento in cui il consumatore sceglie se acquistare o meno il servizio l indicazione di prezzo non corrisponde al costo effettivo del servizio (che viene reso chiaro nei due successivi passaggi). Dunque, i vari elementi di costo del servizio NON non sono immediati, forniti in maniera contestuale e con pari grado di enfasi espressiva. AGCM: nel consumatore si è già creato il falso convincimento della minore onerosità del servizio! => dunque la leva psicologica è l induzione di falsa credenza?... 42

85 TAR confirmed it Considerate le caratteristiche proprie del mezzo Internet nell offerta di beni/servizi: La completezza informativa del messaggio va effettuata attraverso un attenta analisi della struttura del sito, tenendo conto del fatto che tra i consumatori alcuni si fermano al primo livello informativo (effetto aggancio) (TAR Lazio, 8394/09): le caratteristiche principali devono risultare chiaramente percepibili sin dalla prima pagina del sito web. Si noti, inoltre, come altre informazioni rilevanti possano essere poco accessibili. Ad esempio, assenza di un link oppure un percorso di consultazione solo eventuale (PS3883 Tatuaggifantasy) 43

86 ASA Adjudication on Home Shopping Selections Ltd April 20, 2011 AD: An offer for Snuggle Blankets feature the headline text BUY1 GET1 FREE for just GBP 10 + P&P followed by a picture of a woman lying on a sofa wearing ( ) ISSUE: The compliant challenged whether the ad was misleading, because it failed to provide details of postage and packaging costs (P&P). 44

87 ASA Adjudication on Home Shopping Selections Ltd April 20, 2011 Assessment: Upheld. The ASA noted that postage and packaging costs were available on the checkout page of HSS website but considered that the delivery charge was a significant term likely to affect a consumer s decision to take up the offer and therefore should have been made clear in the ad. Because it was not, we concluded that the ad was misleading. The ad breached CAP Code (Edition 12) rules 3.1, 3.3 and (Misleading advertising) and (Distance selling). 45

88 A&A in the business domain Too expensive referent initial prices See uso di prezzi iniziali esageratamente alti e fuori mercato (e.g. ancore out of range; ancore non credibili, etc.) see codice di autoregolamentazione gruppo aziende coupon online. => pcs via induzione falsa credenza?

89 Codice di auto-regolamentazione & Couponing Il Codice di auto-regolamentazione sui prezzi (Consorzio Netcomm che rappresenta 127 aziende del settore) [presentato alla Camera dei Deputati il 6 novembre 2012] [Codice] è relativo alle modalità di comunicazione e pubblicizzazione delle offerte di sconti e risparmi nel settore del commercio elettronico ( ) esso definisce in particolare le regole per la comparazione dei prezzi => prezzi omogenei + prezzo di riferimento oggettivo e verificabile [nel settore dell e-commerce] si perde il rapporto di fiducia personale => è cruciale dunque dare valore alla forza etica delle aziende (e.g., brand ad elevato livello di fiducia) Il Sole 24 Ore, Domenica 4 novembre 2012, p. 48 nòva n. 305

90 Default option & Consumer choice 1) Automobile insurance regulation (in Pennsylvania the higher-cost option was the default 70% of drivers purchased it Vs. 21% drivers in New Jersey. See Johnson et al., 1993) 2) Online buying of railways ticket (with Vs. without the reserved seat option five times more with the default set to price inclusive of reserved seat! See Goldstein et al., 2008) [see also my study on online purchasing of the hotel room inclusive or not of half board] 3) See Fasolo et al. rel. online choosing of a hotel vs. a hospital - presented at Trento on June 2013

91 Default option frame and Deception What about the behaviour of Mr X who purchased the higher-cost railways ticket [insurance policy, room hotel, hotel, etc.] because of the default frame? For example, what s about if we could demonstrate that he would not have purchased it under a different frame such as: i) The Alternative default option frame (e.g., the lower-cost ticket is the default); ii) Active Choice frame (e.g., both options are explicitly presented) See Beshears et al., 2008

92 The EU consumer policy perspective The European Commission has proposed a Directive on consumer rights which includes a clause limiting the use of default options in consumer contracts (European Commission, 2008). Specifically, sellers would be required to obtain express consent from consumers for any payment that is in addiction to the payment for the main contractual obligation, and could not rely on default options that require buyers to reject those options to avoid payment (OECD, 2010 Consumer Policy Toolkit, p. 47)

93 Neuroimaging tools for studying the effect of audiovisual stimuli Dr. Giovanni Vecchiato Dept of Physiology and Pharmacology University of Rome Sapienza

94 Human tissues generate an electrical potentiai measurable on the skin In1849 the german physiologist Emil Heinrich Du Bois-Reymond reported for the first time the gathering of small electric potentials generated by contractions of hands muscles In 1880 the ECG is measured in dogs...and later on humans Neuroimaging and advertisement 15/04/2014 Pagina 2

95 The father of the Electroencephalograhy Neuroimaging and advertisement 15/04/2014 Pagina 3

96 Technologies to study brain functions Measurement of postsynaptic potentials (PSP) in the apical dendrites of the cerebral cortex pyramidal cells Synchronization and desynchronization of PSP generate signals measurable on the scalp surface EEG electric fields Analysis of temporal and frequency signals variations Titolo Presentazione 15/04/2014 Pagina 4

97 Electroencephalograhy EEG EEG measures potentials by means of electrodes located on the scalp surface Neurons spatial properties have to assure the reciprocal amplification of their extracellular electric field Parallel dendric trees Normal to the cortical surface Different kind of sensors can be used Passive: economic, impedence adaptation Active: expensive, high SNR Dry: easy to use, low SNR Titolo Presentazione 15/04/2014 Pagina 5

98 High resolution EEG and the estimation of cortical sources A large number of recording electrodes is not sufficient to detect accurately the cortical activity Neuroimaging and advertisement 15/04/2014 Pagina 6

99 High resolution EEG and the estimation of cortical sources Realistic Insert the Model geometry of of The skull Head and Volume dura mater Conductor in inverse calculation Neuroimaging and advertisement 15/04/2014 Pagina 7

100 The Neuromarketing world The ideas behind Neuroimaging and advertisement 15/04/2014 Pagina 8

101 Neuroeconomy as value-based decision making Nowadays there is a large body of evidences suggesting that neuroimaging tools could return useful information on brain processing mechanism related to the observation of videos (lectures, commercials) and economic decisions Neuroimaging and advertisement 15/04/2014 Pagina 9

102 Neuromarketing Neuromarketing is a discipline that investigates the brain related activity with respect to marketing relevant task such as the purchase of goods or advertising (McClure et al., Neuron 2004; Braeutigam et al., Eur. J. Neurosci 2004) Neuroimaging and advertisement 15/04/2014 Pagina 10

103 Neural predictor of purchases It has been investigated the possibility to detect in advance with neuroimaging tools, such as the fmri, the preference of the subjects for purchasing some goods (Knutson et al., Neuron, 2007) Neuroimaging and advertisement 15/04/2014 Pagina 11

104 Neural responses to TV commercials Cognitive advertisements activate predominately posterior parietal and superior prefrontal cortices, whereas affective material modulates activity in orbitofrontal cortices, the amygdala and the brainstem. Ioannides et al., Brain Topography 2000 Vecchiato et al., Computational Intelligence and Neuroscience 2011 Neuroimaging and advertisement 15/04/2014 Pagina 12

105 Descriptors of memorization and pleasantness Experimental hypothesis Neuroimaging and advertisement 15/04/2014 Pagina 13

106 EEG is able to track cognitive attention and memorization for ads High resolution EEG techniques are able to return accurate information about the cerebral spatiotemporal activity during the observation of sensory percepts in humans (Babiloni et al., 1996; 2003; 2005) Several papers have been demonstrated that there exists a strict link between the EEG activity in a particular set of frequency bands (theta, alpha, beta, gamma) and particular cognitive event such as visual attention and memorization (from minutes to several hours based; Klimesh et al, 1999; Summerfield et al, 2005) It is hence possible to use the EEG technology and the variation of the power spectra in those frequency bands to track time-dependent changes of visual attention and memorization during the sensory perception of commercial ads (De Vico Fallani et al., 2008; Astolfi et al., 2008; Vecchiato et al., 2009) Summerfield, C., Mangels, J.A. Coherent theta-band activity predicts item-context binding during encoding. NeuroImage 24, Neuroimaging and advertisement 15/04/2014 Pagina 14

107 Measurements on EEG, HR and GSR return information on emotive states Variation of Galvanic Skin Responses (GSR) have been then associated to variation of the arousal of the emotive state of the subject (Buchel and others 1998; Morris and others 1998). Variation of the Heart Rate (HR) have also been linked by a variety of psychophysiological studies to the variation of the positive/negative quality of the emotions experienced by the subject Dozen of studies suggested that the vision of sad, or even boring films generated a decrease of the HR when compared to the baseline conditions (Bosch et al., 2001; Ritz, Steptoe et al., 2000; Kreibig et al, 2007). In addition, positive emotions trigger increased HR values. Positive and negative emotions could be also detected with the unbalance of EEG activity (Davidson, 2004) Neuroimaging and advertisement 15/04/2014 Pagina 15

108 Descriptors of memorization and pleasantness of TV commercials We linked significant variation of EEG, GSR and HR measurements with the memory and pleasantness of the stimuli presented, as resulted successively from the subject s verbal interview. Different indices were used to summarize the cerebral and autonomic measurements performed A lifelike experiment! Each commercial break consists of several spots ~3 min ~7 min Commercial Break Break Commercial Break Break Commercial Break Break HR Neutral Documentary (~30 min) GSR In this study we were interested to analyse the brain activity occurring during the naturalistic observation of commercials. To measure both the brain activity and the emotional engagement subjects investigated, we used simultaneous EEG, GSR and HR measurements during the whole experiment. Neuroimaging and advertisement 15/04/2014 Pagina 16

109 Experimental Design The subjects after 2 hours the observation of the whole video (documentary + commercials) were interviewed Methodology Four groups of cerebral and autonomic data were generated Data related to the spots remembered RMB group Data related to the spots forgotten FRG group Data related to the spots liked by the subjects LIKE group Data related to the spots did not liked by the subjects DISLIKE group LIKE RMB DISLIKE FRG Neuroimaging and advertisement 15/04/2014 Pagina 17

110 Patterns of cortical Power Spectral Density An estimation of the cortical activity by means of the high resolution EEG Neuroimaging and advertisement 15/04/2014 Pagina 18

111 Statistical cortical maps A frequency analysis During the observation of the memorized TV commercials the population analyzed have increased power spectral activity in the theta-alpha band, left frontal cortex. These results are congruent with: Previous results on memorization of complex items (Summerfield et al., 2005, NeuroImage) The HERA model (Tulving et al., 1994, PNAS) RMB Vecchiato et al. (2010), Brain Topography Neuroimaging and advertisement 15/04/2014 Pagina 19

112 Cognitive Indices From the EEG measurements we derived two cognitive indices related to Memorization and Attention The Memorization Index is linearly correlated with the probability of spontaneous recall The increase of the Attention Index enhances the probability of recall Vecchiato et al., IEEE Pulse 2012 Neuroimaging and advertisement 15/04/2014 Pagina 20

113 Statistical cortical maps A frequency analysis The brain activity during the observation of TV commercials that was rated as pleasant by the subjects has an enhancement in the theta, alpha frontal left frontal activity. The results here obtained for the LIKE condition are also congruent with other observations performed with EEG in a group of 20 subjects during the observation of pictures from the International Affective Picture System (IAPS) LIKE Aftanas et al. (2004), Neuroscience and Behavioral Physiology Balconi et al. (2009), Brain Res, Brain Res Bull Vecchiato et al. (2010), Brain Topography Neuroimaging and advertisement 15/04/2014 Pagina 21

114 EEG asymmetry and pleasantness EEG frontal asymmetry: the most of activity in the left frontal hemisphere relates to the observation of commercials that have been judged pleasant by the analyzed population. On the other hand, the right frontal sites highlighted neuroelectrical activations concerning the observation of advertisements that have been judged less pleasant this imbalance in the activations was linearly correlated with the degree of pleasantness the subjects expressed The left PFC is an important brain area in a Z IM = Z like dx - Z sx dislike widespread circuit that mediates appetitive approach, while the right PFC appears to form a major component of a neural circuit that instantiates defensive withdrawal (Davidson, 2004) Vecchiato et al., MBEC 2011 Neuroimaging and advertisement 15/04/2014 Pagina 22

115 Autonomic nervous system s variability Heart rate: The HR increase in a significant way (p<0.023) as well as the increment of the LF/HF ratio (p<0.01) during the observation of the TV commercials remembered and judged pleasant, respectively Galvanic Skin Response: The level the GSR did not change across the different TV spots irrespective of the RMB, FRG, LIKE or DISLIKE conditions (p<0.3) * x RMB LIKE The HR and LF/HF are variables able to track the occurrence of memorization and pleasantness of the commercial videos while there are no changes in the GSR Vecchiato et al., (2010) Brain Topography Neuroimaging and advertisement 15/04/2014 Pagina 23

116 Statistical cortical maps A temporal analysis Through advanced techniques of brain imaging we can see the most activated cortical areas during the observation of the ad and of the percept frame by frame. Brand e Logo We can asses the scenes which engage and those that does not, with respect to the cerebral state elicited by the observation of a documentary. Astolfi et al., Computational Intelligence and Neuroscience 2009 Neuroimaging and advertisement 15/04/2014 Pagina 24

117 Statistical cortical maps A temporal analysis Drinkers Non Drinkers Neuroimaging and advertisement 15/04/2014 Pagina 25

118 Cultural differences in the fruition of advertisements Neuroimaging and advertisement 15/04/2014 Pagina 26

119 Advertisements employed in the experiment 27 Spot europeo Spot cinese

120 Results from the Chinese population Same levels of memorization and attention The memorization index is slightly higher for the ad with Chinese actors, except for the segments in which the brand is presented and the one where mum and doughter are seen through the smartphone; There is more attention in the spot with european actors Vecchiato et al., IFMBE

121 but the Chinese population does not like the European ad Chinese seem to reject European actors; The rejection regards charachters since in the brand exposition there is no difference between the two ads Vecchiato et al., IFMBE

122 Ethical Issues Coerce consumers into buying products that they neither need nor want Help companies to identify new and exciting products that people wants and find useful Ad PreTest Neuroimaging and advertisement 15/04/2014 Pagina 30

123 Acknowledgment Prof. Fabio Babiloni Dr. Arianna Trettel Dr. Anton Giulio Maglione Dr. Patrizia Cherubino Dr. Ilenia Graziani Dr. Donatella Mattia Dr. Febo Cincotti Dr. Laura Astolfi Dr. Jlenia Toppi Dr. Gianluca Borghini Thank you for your attention! Neuroimaging and advertisement 15/04/2014 Pagina 31

124 Atti del Convegno DECISIONE TRA EMOZIONE E COGNIZIONE. Meccanismi funzionali e disfunzionali del decision-making 12 APRILE 2014 UNIVERSITÀ CATTOLICA DEL SACRO CUORE Largo Gemelli, Milano SESSIONE Clinica della decisione Chair: S. Campanella A triadic neurocognitive approach to addiction X. Noel Alcohol dependence, ERPs and inhibition: is it possible to predict relapse? S. Campanella Patient engagement in health care: pathways for shared decision-making G. Graffigna, S. Barello Gambling, reward mechanisms and decision-making R. Finocchiaro, M. Balconi

125 A triadic neurocognitive approach to addiction X. Noël

126 Addiction as a relapsing disorder characterized by compulsivity Positive reinforcement (impulsivity) Negative reinforcement (impulsivity) Incentive habit (compulsivity) Perseveration in responding in the face of adverse consequences (e. g., degraded reinforcer)

127 Similar to humans, after a prolonged period of drug intake, and despite an equal amount of drug taken, a restricted number of rodents develop addiction-like behaviors Animal studies of compulsivity

128 Addiction may reflect a number of within- and between-system neuroadaptations to excessive activation of the reward system at the neurocircuitry level Key systems: incentive salience mesolimbic dopamine system (reward craving) and dorso-striatum system (habit); spinothalamocortical system (pain); extended amygdala system (negative craving); HPA axis system (stress); prefrontal cortex system (decision-making) But, note the heterogeneity of processes Triadic model states interactions between three neural and cognitive systems promoting: automatic, habitual and salient behaviors amygdala-striatum reflective decision-making forecasting the future consequences of a behavior and inhibitory control PFC the integration of interoception states into conscious feelings and into decision making - Insula

129 HYPERACTIVE AUTOMATIC PROCESSING OF DRUG CUES AT THE LEVEL OF ATTENTION, MEMORY AND ACTION TENDENCIES ADDICTION CUES ADDICTION DECISIONS AND/OR ACTIONS HYPERACTIVE PROPRIOCEPTIVE PROCESSING (CRAVING, STRESS) WEAKENED SUPERVISORY SYSTEM (PREPOTENT RESPONSE INHIBITON) 5

130 I. Enhanced habitual response Attentional bias towards addiction-related cues Implicit memory associations Action tendencies

131 Activity-dependent long-term depression (LTD) and long-term potentiation (LTP) are key forms of synaptic plasticity that permit strenghening (LTP) or weakening (LTD) of synapses in an interplay that allows the refinement of neuronal circuits necessary to adapt behavior to an ever-changing environment Whereas LTD is progressivly recovered in nonaddicted rates maintaining a controlled drug intake, addicted animals have permanently impaired LTD Lack of behavioral flexibility due to impaired (basic) learning processes

132 HYPERACTIVE AUTOMATIC PROCESSING OF DRUG CUES AT THE LEVEL OF ATTENTION, MEMORY AND ACTION TENDENCIES ADDICTION CUES ADDICTION DECISIONS AND/OR ACTIONS HYPERACTIVE PROPRIOCEPTIVE PROCESSING (CRAVING, STRESS) WEAKENED SUPERVISORY SYSTEM (PREPOTENT RESPONSE INHIBITON) 8

133 II. Disrupted executive control Salience detection Executive attention Motor control Conflict detection Conflict monitoring Conflict resolution

134

135 In vivo optogenetic stimulation of prelimbic cortex suppresses compulsive cocaine seeking

136 HYPERACTIVE AUTOMATIC PROCESSING OF DRUG CUES AT THE LEVEL OF ATTENTION, MEMORY AND ACTION TENDENCIES ADDICTION CUES ADDICTION DECISIONS AND/OR ACTIONS HYPERACTIVE PROPRIOCEPTIVE PROCESSING (CRAVING, STRESS) WEAKENED SUPERVISORY SYSTEM (PREPOTENT RESPONSE INHIBITON) 12

137 III. Poor integration of feeling into decision-making Insula hyperactivation while processing addiction cues in addicts, which correlates positively to craving intensity Craving states make approach tendances stronger and the inhibition of the motivational response less efficient Using smoking as a form of addiction, evidence shows that insula damage wipes out smoking addiction, by completely erasing the urge to smoke (Naqvi,, & Bechara, 2007, in Science) Damage to insula abolishes cognitive distortions during simulated gambling (Clark,, & Bechara, 2014, in PNAS)

138 To address the role of the insula in addiction to smoking, patients with insula damage were examined Quitting can be of 2 kinds: 1. Quitting because of being scared. 2. Quitting with complete ease, like a switch being turned off, i.e., disruption of smoking addiction. Patients who quit smoking after lesion onset were designated as having a disruption of smoking addiction if they fulfilled all 4 of the following criteria:

139 They reported that they quit smoking less than 1 day after lesion onset They rated the difficulty of quitting as less than 3 on a scale of 1-7 They reported that they quit in one attempt They reported that they felt no urges to smoke since quitting.

140 The Specific Hypothesis: Smokers with insula lesions are more likely to have a disruption of smoking addiction after lesion onset, as defined by these criteria, compared to smokers with non-insula lesions.

141 Number of subjects with lesions in the different brain regions identified in this study. ALL (N=69) INSULA (N=19) NON- INSULA (N=50) 0 N 12

142 69 smoked at lesion onset 37 non-quitters 32 quitters 16 quitters not meeting criteria 16 quitters meeting criteria 53 no disruption of smoking addiction 16 disruption of smoking addiction

143 1 Case (5%)

144 By combining the patients with right or left insula lesions: the odds of quitting with a disruption of smoking addiction were about 136 times greater after a lesion that affected either the right or left insula than after a lesion that did not affect the insula (adjusted odds ratio=136.49, c2=15.48, p= ). Two neural processes relate to drug craving One relates to abnormal activity in the insula, which intensifies the awareness of drug craving; damage to this system tends to wipe out the urge to take drug. The other relates to abnormalities in the prefrontal cortex, which is associated with decreased awareness (lack of insight) of the acquired addictive behavior and lack of concern about the potential long term consequences of cigarette smoking.

145 To sum up Craving for drugs (or for gambling) may be powerful on decision making and behaviour because of its action on some automatic and non-automatic motivational-related processes For instance, deregulated stress system is strongly involved in alcohol relapse (see recent Sinha s prospective studies). But how does it work? Based on the triadic model to addiction, it could be best explained by the way the stress moderates the relationship between impulsive and reflective systems The relationship between this lack of awareness and cognition, especially executive control functions, and the incapacity of drug addicts to control their drug seeking behavior, cope with daily stress and demands, and avoid relapse should be an area for future research

146 Alcohol dependence, ERPs and inhibition: is it possible to predict relapse? Salvatore Campanella University of Brussels, Belgium Laboratory of Psychological Medicine and Addiction Milano, 12/10/2014

147 Addiction can be operationally defined as the continuation of choices leading to terrible consequences despite of the explicitly stated desire to make a different choice

148

149 A major problem: the relapse rate There is an urgent need to identify neurocognitive mechanisms that may help to identify people at «high risk» to relapse..

150 Why to focus on the inhibition process?

151 Amplitude = Intensity of processing Latency = Speed of processing

152 (1) Why do we need ERPs?

153 (2) Why do we need ERPs?

154 A Contextual Go-NoGo Task 80% of Go trials: M 20% of NoGo trials: W 3 contexts

155

156 Illustration

157 M

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159 M

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161 M

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163 M

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165 W

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167 M

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169 M

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172 Drinker typology based on AUDIT scores Possible Dependence Heavy Drinkers (mean 16.9) Light Drinkers (mean 6.5)

173 Follow-up at 3 months

174

175 BUT THE ERROR RATE IS SIMILAR BETWEEN Relapsers and Non Relapsers!

176 However, when we look at ERPs Relapsers vs Controls: p =.026 Non Relap vs Controls: p =1

177 Discussion

178 Patients made more commissions errors than controls; No more errors in alcohol context; The error rate did not predict relapse; Flaudias et al., 2013 However, at the ERP level, the NoGo P3 of Relapsers disclosed higher amplitude than the one of Non Relapsers = Controls : patients who need higher neural resources to perform correct inhibition are more prone to relapse?..!

179 Conclusions

180 Is the NoGo P3 a biological marker of relapse? Clinical impact: increase cognitive control through neuropsychological retraining? Is the alcohol attentional bias really modulated by detoxification cure? What is the impact of anti-craving medications on these processes???

181 Thank you for your attention!

182 Guendalina Graffigna, Serena Barello Faculty of Psychology Università Cattolica del Sacro Cuore (Italy) A. Claudio Bosio* *Scuola di Dottorato in Psicologia Università Cattolica di Milano Patient Engagement in health care: pathways for shared decision-making. DECISIONE TRA EMOZIONE E COGNIZIONE Meccanismi funzionali e disfunzionali del decision-making 12 aprile 2014, Università Cattolica del Sacro Cuore 1

183 1 Shared decision making: a primacy for the 21 century healthcare Questioning about how to talk with patients and how to make them engaged in healthcare decision making is currently a policy imperative for Western healthcare systems (WHO, 2008; Zuger, 2013)....Shared Decision Making (SDM) is increasingly advocated by the patient centered care as an ideal model of clinical decision-making (Richards, 1998; Coulter et al., 1999 Coulter et al., 2013 ; Elwyn et al., 2000) as far as it has the potential to deliver better health outcomes and a more efficient use of resources by also retaining patients autonomy and selfdetermination (Tinetti & Basch, 2013). Graffigna G., Barello S., Riva G., (2013) Response to: Potential benefits of well engaged patients are akin to those from a blockbuster drug, say experts, BMJ. 2

184 2 Shared decision making: is this a matter of patients health literacy? According to a «health literate care model» (Koh et al., 2013), the majority of interventions aimed at fostering a SDM in the medical course, are primarily oriented to improve the patients ability to obtain and understand basic health information thus narrowing the process of SDM on the patients cognitive activation toward the disease management (Graffigna et al., 2013) Graffigna G., Barello S., Riva G., (2013) Response to: Potential benefits of well engaged patients are akin to those from a blockbuster drug, say experts, BMJ. Koh, H. K., Brach, C., Harris, L. M., & Parchman, M. L. (2013). A proposed health literate care model would constitute a systems approach to improving patients engagement in care. Health Affairs, 32(2),

185 The model of SDM risks to be a fashionable claim and produce side effects instead of being a real guide for effective medical practice. 3 No decision about me, without me (?) Despite the ackowledged benefits of this practice, the literature about the patients desired role and involvement expectations in the SDM process is still controversial and doesn t offer shared guidelines for practice.

186 Graffigna, G., Barello, S., Wiederhold, B. K., Bosio, A. C., & Riva, G. (2013). Positive Technology as a Driver for Health Engagement. Annual Review of Cybertherapy and Telemedicine 2013, 9. Barello S., Graffigna G., Vegni E., Savarese M., Lombardi F., Bosio AC (2014) Patient-doctor relational patterns in heart failure patient engagement: A Qualitative Study (submitted) 4 Patient engagement in healthcare: a framework proposal to cast light on SDM Patient engagement in health care is highly recommended in order to make them leaders of their care process (Hibbard et al., 2008, Gruman et al., 2009, Graffigna et al., 2013). The patient engagement model (Graffigna et al., 2013, 2014) may allow to better understand the features of the patient-doctor relational dynamics occurring along the care process. thus illuminating the preferable decision making style that is attuned with the patient s care needs and expectations.

187 5 Potential regulatory pathways in patient engagement process: four subsequent phases THE PROCESS OF PATIENT ENGAGEMENT DISENGAGEMENT I am in a blackout AROUSAL I am a ill body ADHESION I am a patient EUDAIMONIC PROJECT I am a person THINK COGNITIVE BLINDNESS SUPERFICIAL KNOWLEDGE COGNITIVE ADHESION SENSE-MAKING FEEL DENY ALERT ACCEPTANCE ELABORATION ACT FREEZING BEHAVIORAL DISORGANIZATION FORMAL ADHERENCE SITUATED PRACTICES A wide qualitative study was conducted on the chroninc patient engagement experience involving 99 patients across different clinical population (diabetes, cancer, CVD, neurological impairments, BPCO). This study allowed to build a patient engagement modeling basing on the patient perspective. (see Graffigna et al., 2013) Graffigna, G., Barello, S., Wiederhold, B. K., Bosio, A. C., & Riva, G. (2013). Positive Technology as a Driver for Health Engagement. Annual Review of Cybertherapy and Telemedicine 2013, 9. Barello S., Graffigna G., Vegni E., Savarese M., Lombardi F., Bosio AC (2014) Patient-doctor relational patterns in heart failure patient engagement: A Qualitative Study (submitted) 6

188 6 The patient-doctor relationship along the engagement process: implication for decision making strategies The patient engagement modeling highlights specificities in the roles enacted respectively by patients and doctors along the care process

189 6.1 DELEGATED DECISION MAKING THE PROCESS OF PATIENT ENGAGEMENT DISENGAGEMENT I am in a blackout DEPENDENCE ZONE : DELEGATED DECISION MAKING Patients rely completely on clinicians for health advice and treatments they delegate to the doctor decisions regarding treatment and disease management This model legitimates the patient in a passive, dependent role vis-a-vis the physician positive health outcomes are assumed to be the responsibility of the clinician. DOCTOR AS A LEADER At the beginning of the journey [with the disease] the doctor has to make you feel safe and should hang around with you and giving the key to understand what happened before understanding what will be (54 year-old male patient with NYHA Class III HF). I needed to be reassured...and to understand that what I was feeling was not strange or wrong... I only wanted doctor told me that it was normal (60 year-old female patient with diabetes).

190 6.2 INFORMED DECISION MAKING THE PROCESS OF PATIENT ENGAGEMENT AROUSAL I am a ill body NURTURING ZONE : INFORMED DECISION MAKING Patients totally rely on the expertise of clinicians to address their condition. and health providers are asked help patients to work upon facts and emotions that are difficult to cope with. This allows the patients to test behavioural caring patterns and learn to manage emotional response to cope with the new health condition DOCTOR AS A VICARIUS I met a doctor really careful in explaining me everything I asked her. Once, I experienced a stab and I right away thought of death. Fortunately I took courage and I told her my worries, She told me that it was not an alarming symptom even if she understood my concerns. This made me immediately feel well. (54 year-old female patient with NYHA Class III HF)

191 6.3 DELIBERATIVE DECISION MAKING THE PROCESS OF PATIENT ENGAGEMENT ADHESION I am a patient EMPOWERMENT ZONE : DELIBERATIVE DECISION MAKING the physician is perceived as a reliable and authoritative expert and this allows patients to feel confident and not alone in managing their disease The patient still strongly relies of the doctor s judgment to make decisions about the disease management DOCTOR AS AN AUTHORITATIVE EXPERT I always follow what the doctor tells me. Everyone is good at something different and I am not a health specialist. I know it is modern to have something to say about everything, even something I am not good at, but, in this moment I can t and this is not my case. (70 year-old male patient with BPCO)

192 6.4 SHARED DECISION MAKING THE PROCESS OF PATIENT ENGAGEMENT EUDAIMONIC PROJECT I am a person SELF-DETERMINATION ZONE : SHARED DECISION MAKING Patients can directly take proactive action according with the healthcare provider. Positive health outcomes are perceived by patients to be their own responsibility. The physician is required to support the patients in finding personalized solutions to situated problems The doctor is a trusted ally to whom they asked counselling on demand. DOCTOR AS A TRUSTED ALLY Yes, I do help the doctor because I live with my medical condition and I am experienced. I have had it for years. I know my problem, I know myself and I know my body, so I would report anything new or different that would help the doctor. (54 year-old female patient with NYHA Class III HF)

193 7 Towards an engagement sensitive» clinical decision making Shared decision making is not an on-off status but it should be developed according to the phase of engagement the patient is experiencing. The patients attitude to be engaged in SDM doesn t merely depend on the patient s health literacy but also on the emotional elaboration of the disease condition and on the acquired behavioral skills to manage the disease We thus advocate for the development of an engagement sensitive decision making in order to orient guidelines for a medical practice really finetuned with the patients needs at each phase of the engagement process. 12

194 8 What is next? Future research lines Further research is needed to deepen the value of engaging patient in SDM by: Deepening the physicians perspective and barriers toward a shared decision making model Considering not only dyadic exchanges (e.g. patient-doctor) occurring when decision making processes are enacted along the care process. but also taking in consideration triadic exchanges (e.g. patient-doctor-caregivers) Finally, context-based studies are needed to discover the features of DM across different medical cultures and health systems

195

196 Conference Decision between emotion and cognition Functional and dysfunctional mechanisms in decision-making 12 April 2014 University Catholic of Sacred Heart, Milan Gambling Reward Mechanisms and Decisional-Making Roberta Finocchiaro Michela Balconi Unit of Research in Affective and Social Neuroscience University Catholic of Sacred Heart, Milan

197 Gambling The player has to put in wagering a stake of money or anything of value The bet can not be withdrawn The result of the game should be based on case Caravaggio, I bari, oil on canvas, 1594

198

199 Gambling Behavior: epidemiology Italian Population Never Gambling 46% Gambling (At least once in the last 12 months) 54% 1,3% - 3,8% Problematic Gambling 0,5% - 2,2% Pathological Gambling Estimated Italian population affected by gambling. Serpelloni (age 18-74) Italian Journal on Addiction, Volume 3, Number 3, July Department of drugs policy. Presidency of the the Council of Ministers

200 Gambling behavior Creative play is a physiological behavior, risk awareness, social gaming and competition, not often Problematical voluntary behavior at risk, increasing of play frequency, increasing time and work for gambling Pathological gambling, daily use, with negative consequences in terms of mental, physical and social (Substancerelated and Addictive disorders in DSM- V)

201 Gambling Addiction Craving Abstinence Tolerance Some evidences show the similarity of reward-related neurocircuitry and behavior patterns to those of substance related-addictions

202 Gambling Addiction pathological gambling occurs frequently in people with impulsive marked by excessive attention to the potential reward and the desire of immediate reinforcement the tendency to respond immediately without taking into account the negative consequences of the excessive sensitivity to the threat of punishment (not reward) deficit in inhibitory control that leads to action despite the risk of negative consequences

203 A similar profile in Subestance Use Addictive? Compulsive drug use can be described as a condition associated with dysfunctional brain mechanisms that subvert the ability to make decisions (Barry & Petry, 2008 ) Substance abuse could arise from poor decisionmaking skills that lead individuals with substance use disorders (SUD) to ignore long-term negative consequences in the interest of immediate gratification or relief of uncomfortable states. Impaired metacognitive representation (selfknowledge; strategic planning; flexibility; efficacy) of the decisional behavior ( Balconi M, Campanella S, Finocchiaro R. 2013)

204 Addictive Behavior: Brain Correlates vmpfc, DLPFC: executive functions and control of decisional processes (working memory), for action planning; organizing, payn attention to; managing time and space long-term pianification and strategies OFC and its relatioship with ACC, Amygdala, Insula (Noël X. et al. 2013) and Reward Mechanisms

205 Reward Mechanisms Dysfunctions in the dopaminergic mesolimbic Reward System, driving attention to Dependence- Associated Stimuli, rendering them specifically salient Dennis S., Charney MD., Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. Am J Psychiatry 2004;161:

206 Addictive behavior like. unfunctional behavior in decisional-processes with increased risk-seeking, high dependence to reward which produces more risky and unfunctional (loss) strategies Frontal brain unbalance (BIS/BAS system, Gray 2001): more sensitivity to reward and less to punishment (Schutter et al., 2004)

207 Our study... DYSFUNCTI ONAL BEHAVIOR (IGT) MOTIVATION (BIS/BAS) HEMISPHERIC LATERALIZATION EFFECT (ALPHA BAND)

208 Iowa Gambling Task ( IGT) (Bechara et al. 1994) Behavioral Inhibition System withdrawal behavior (right PFC) Behavioral Activation System approach behavior (left PFC) BIS and BAS measures represent a usable tool to test subjective reward-sensitivity based on neurophysiological correlates ( Balconi et al. 2012;Davidson et al. 2004; Carver & White 1994, Gray 1981) A strong relationship was shown between impulsivity, drugdependence and BAS (Dawe & Loxton, 2004). A direct association between the BAS and BAS subscale ( BAS Drive, Fun Seeking, Reward responsiveness) to substance abuse ( Franken et al.,2006)

209 Electroencephalography (EEG) Modulation of brain oscillations is a valid measure of brain activation, and it has been applied often to find distinct responsiveness in the two hemispheres for different cognitive or emotional task (Balconi & Mazza,2009; Sutton & Davidson,1997, Balconi, Finocchiaro, & Canavesio 2014) Alpha Power ( Increased activity) Left Frontal System Money gains and Reward Trials Alpha Power (Reduction activity) Right Frontal System (Buss et al.,2003) Punishment Conditions S.J Van Albada & P.A. Robinson. Relationships between electroencephalographic spectral peaks across frequency bands. Front. Hum. Neurosci 2013; 7-56

210 Hypothesis In association with riskier choices, SUD ( Substance Use Disorder) subjects in comparison to controls should show higher BAS ratings, mainly for BAS- Reward subscale. SUD subjects should show a consistent alpha activity increasing within the left hemisphere in the case of an immediate reward (disadvantageous decks, DD) in comparison with a delayed reward (advantageous decks, AD)

211 Methods The SUD Group N=40 Control Group N=42 ( SerT 1 Milano- SerT 2 Monza) Inclusion criteria: lifetime history of dependence (Structural Clinical Interview, DSM IV) minimum abstinence duration of 15 days before testing. Evaluation of severity of drug use Intensity ( average dosing) Frequency (consuption episodes by month) Duration ( years of duration) Exclusion criteria for both SUD and CG Suicidal ideation and psychosis Absence of documented co-morbid mood or personality disorders

212 Methods Experimental Phase BIS and BAS scores were calculated for each subject. It included 24 item. BAS also includes three subscales (Reward, 5 items, Drive, 4 items, and Fun Seeking, 4 items) All participants received standard instructions for the IGT Briefly, they were told that the object of the task was to win as much as possible and avoid losses by drawing cards, one at a time, from the four decks. They were informed that each card drawn would indicate how much they had won and whether there was a penalty as well. EEG recordings were performed with a 32-channel DC amplifier (SYNAMPS system) and acquisition software (NEUROSCAN 4.2) during task execution

213 Results BEHAVIOURAL IGT PERFORMANCE As revealed by post-hoc analysis, increased II( Iowa Index) was found for CG compared to SUD within all the five blocks

214 Results BEHAVIOURAL IGT PERFORMANCE As revealed by post-hoc analysis, increased II( Iowa Index) was found for CG compared to SUD within all the five blocks

215 Results BIS/BAS MEASURE Group differences were found for BAS, and BAS-D Increased scores were found for SUD compared with CG

216 Results BIS/BAS MEASURE Group differences were found for BAS, and BAS-D Increased scores were found for SUD compared with CG

217 Results ALPHA BAND ANALYSIS A significant increased LTA (log-transformed asymetry) in response to DD ( Deck Disadvantageous) than AD (Deck Advantageous) was found. SUD showed an increased LTA compared with CG.

218 Results ALPHA BAND ANALYSIS Response to risky and unrisky choices in DD: a clear «left hemisphere effect» for risky choice risky unrisky

219 Results Regression analysis A decreased II ( Iowa Index) was correlated with an increased BAS-Reward. A significant effect was also found for LTA which explained the II decreasing for SUD. On the contrary, BIS di d not significantly account for the variance of II.

220 Discussion 1. Results were consistent with the hypotheses that chronic use of psychoactive substances produces significant deficits in decisional processes based on reward bias. The two groups, SUD and CG, showed different behavioral options and opposite strategies in performing IGT II. Relationship between BAS measure and IGT performance in SUD. A significant substantial increased BAS and BAS- Reward component was registered for SUD in comparison with CG III. A significant higher left frontal activation for SUD was observed when they opted for DD than AD. This result was supported by the supposition that the most rewarding conditions implicate a higher left activation, orienting their choices toward an immediate reward

221 Comparing high BAS Healthy Subjects and Cocaine Dependence.. 40,00 35,00 30,00 25,00 20,00 15,00 10,00 Similar bad-deck choices, no metacognitive selfmonitoring No pre-loss SCR( Skin Conductance Response) increasing, moreover in DD less general SCR in any condition Unbalanced left/right activation 5,00 0,00 bed decks good decks HRS DD 0,16 0,14 0,12 0,10 0,08 0,06 0,04 0,02 0,00 bed decks good decks Balconi, Finocchiaro Canavesio, 2014 HRS DD

222 Conclusion Reward bias seems to be the most relevant variable to explain the current results : long-term strategy is inhibited by the apparent present reward outcomes. Frontal motivational mechanisms (BAS) act as regulators of the strategic behavior

223 Conclusion

224 About the future. Successive research is require to better understand the role of the neural correlates (PFC) underlying the reward system by taking into account the left/right lateralization based on other brain oscillations (high-frequency bands) Finally, other important variable is the direct comparison between drug-addiction and other addiction-categories (such as alcoholdependence) or neurological patients (VMPFC) to verify similar behavioral deficits in decisions.

225 Special thanks to Michela Balconi Salvatore Campanella Ylenia Canavesio THANKS FOR YOUR ATTENTION

226 Atti del Convegno DECISIONE TRA EMOZIONE E COGNIZIONE. Meccanismi funzionali e disfunzionali del decision-making 12 APRILE 2014 UNIVERSITÀ CATTOLICA DEL SACRO CUORE Largo Gemelli, Milano SESSIONE Contesti e applicazioni della decisione Chair: F. Babiloni Ragione e sentimento: chi è il miglior personal shopper? B. Colombo, P. Iannello, A. Antonietti Advertising, brand and neuromarketing or how consumer brain works B. Stumpo, M. Balconi, F. Leanza Decidere e comunicare nel neuromanagement C. Scortegagna, M. Balconi

227 Are Emotions a Better Personal Shopper Than Cognition? Barbara Colombo, Paola Iannello & Alessandro Antonietti Psychology Department Catholic University of the Sacred Heart Milano

228 Decision making processes activates two thinking systems: Rational Emotional/Intuitive

229 The two systems 1 Experiential System 1 Tacit Analytic System 2 Deliberative (Epstein, 2002; Slovic, 2002) (Kahneman, 2003) (Hogharth, 2001) Intuitive Fast Emotional Automatic Implicit Analytic Slow Rational Controlled Explicit 2

230 (Hammond, Hamm, Grassia & Pearson, 1987; McMackin & Slovic, 2000) Which is the best? Neither one is the very best Joint effect of task s properties and thinking modality

231 Focusing on the joint effect, we find ourselves with TWO personal shoppers. Do they know exactly what they are doing? Is their cooperation always productive?

232 And, equally important, what about a map for the researcher? Which are possible methodologies to investigate the role of emotions vs.(&) cognition in DM tasks?

233 ROUTE 1 enhancing differences Use of brain stimulation to enhance or inhibit the activation of the DLPFC Colombo & Mazzucchelli, in press

234 Aim: In relation to to investigate Emotionaldesign products Non-emotional design products attentional behavior decision-making processes

235 DLPFC emotional regulation Damasio, 1999; 2003; Stuss and Levine, 2002; Rushworth et al., 2004 decision making Modulating DLPFC activity transcranial direct current stimulation (tdcs) To explore differences due to different patterns of activation, effective method to explore effect of emotions on decision-making processes

236 Emotional-design products are able to elicit an emotional response The intuitive system plays a role in the evaluation of these stimuli. To purchased, an object has to be perceived also useful and easy to use otherwise, it will be described as appealing but consumers will not buy it based on generally quick/impulsive evaluation of the visual aspects of the stimuli (Norman, 2004). People should rely on intuition to evaluate those stimuli (Bruner, 1986; Chaiken and Trope, 1999; Evans and Over, 1996; 2003; Sloman, 1996; Sun, Slusarz and Terry, 2005) (Norman, 1990; Norman, 2004; I.E.A, International Ergonomics Association, 2003; Giannini, Tessa and Viaggiano, 2011). So these objects also activate the second system

237 Aim1 Detect changes in participants behaviors, depending on different stimulation conditions. We hypothesize that anodal stimulation will decrease participants response time during the decision-making task, since they should be more impulsive. Aim 2 Explore consumers attentional behavior, when emotional and/or functional objects are evaluated, We recorded participants eye-movements to highlight different explorations paths according to the stimulation condition Aim 3 Explore the actual purchasing choices

238 Thirty volunteers (20 females and 10 males, age range: 21-33, Mean: 24.57; SD: 2.75 Anodal Cathodal Sham On F3

239 Effects of tdcs on Decision Making response time General condition effect (F32;26= 1.96; p<.05; 2 =.71). Participants in sham condition had lower response times than participants in cathodal condition and higher than participants in anodal condition R e s p o n s e T i m e

240 Attentional behavior Influence of transcranial stimulation on individuals attentional behavior while examining different design products and evaluating them (before the purchase choice) The index Fixations before was the only one that showed significant differences: we found a significant condition effect (F8;50= 2.38; p<.05; 2 =.26). Participants in the cathodal condition ignored the pictures for a longer time during their visual exploration, focusing first on the captions

241 Influence of brain stimulation on purchasing choices We found a main effect of condition (F32;524= 2.02; p<.05; 2 =.75). The between-subjects effects tests showed that the corrected model was significant for four objects) two functional and two emotional Individuals tend to make different purchase choices after anodal and cathodal stimulation, but the difference is not due the emotional vs. functional characteristics of the object. All participants tend to prefer functional products, even if they tend to make their decision with different timing and considering different elements after an opposite stimulation.

242 ROUTE 2 relying on built-in natural differences Measuring the influence of fluctuations of hormonal levels in women on DM tasks Iannello, Nelli & Zugno (in prep)

243 Hormones Decision making & Evaluation/ judging Partner selection (sensitivity to specific masculine features) (Haselton & Gangestad, 2006) Clothes preferences (wearing red/pink clothing during ovulation) (Beall & Tracy, 2013) Risk behavior - health psychology (Pearson & Schipper, unublished study) Self-esteem, selfacceptance, bodily perception (Iannello & Bruschi, in prep)

244 Aim H IGT Influence of hormonal fluctuations during menstrual cycle Risk preferences in IGT Personality

245 Sample N=100 age range: 22-45, Mean: 25.67; SD: 3.47 Fertile Phase 33 Infertile Phase 67

246 Materials! Ad hoc questionnaire to identify the menstrual cycle phase! Dickman Impulsivity Inventory (Dickman, 1990)! A computerized version of the Iowa Gambling Task

247 Results W i n n i n g s Disfunctional Impulsivity Low high Fertile Infertile Phase Phase (F 1,67 = 2.209; n.s.) Phase*disfunctional impulsivity (F 1,67 = 5.049; p<.05)

248 H IGT Influence of hormonal fluctuations during menstrual cycle Risk preferences in IGT Personality

249 The two personal shoppers work together They are guided by clients individual and by objects and tasks characteristics More research is needed to better understand this relationship

250 Thank you!

251 UNVERSITA CATTOLICA DEL SACRO CUORE-MILANO Department of Psychology ADVERTISING, BRAND AND NEUROMARKETING OR HOW CONSUMER BRAIN WORKS Beniamino Stumpo, Michela Balconi, Federica Leanza Research Unit in Affective and Social Neuroscience Department of Psychology, Catholic University of Milan Iterion Market Research

252 Emotion and decision Classical economists begin from the prerequisite that people maximize their individual utility and are rational and self-centred Recent research don t share the idea of a rational and optimizing individual and experimental data about decisional processes underline that people often act in non rational way, but they maintain their effectiveness Emotions are a fundamental component for decision making: emotional information elaboration, which operate simultaneously to cognitive processes, are able to explain what rational decision theory and limited rationality theory don t illustrate Motivation and attitude: some recent contributions underlined the role of subjective attitude (for example proactive and prosocial attitudes) THEY DETERMINE PREFERENCE AND CHOICE

253 The Decision Making Process Normative theory: in a economic setting, the decision is linked at the utility function It is concerned with identify the best decision to take Ideal decision maker: fully informed, able to compute with perfect accuracy and fully rational. Descriptive theory: the people aren t fully rational (Simon, 1967) The emotions and motivations drive the behavior The prospect theory of Kahneman and Tversky

254 Decisions: a multi-dimensional picture Controlled Processes: serial, deliberative and often associated to a subjective perception of effort Cognitive I Emotional II Automatic Processes: multitasking, they are out of consciousness and they don t need a particular effort, so they are faster than the controlled processes III VI

255 The prefrontal cortex Three important prefrontal areas: The anterior cingulate cortex The dorsolateral prefrontal cortex The orbitofrontal cortex Recent study with EEG Decision + Emotion -Alpha (8-13 Hz) -Beta (13-30 Hz) -Gamma (>40 Hz) -Tetha (4-8 Hz) -Emotional responsiveness in the area prefrontal (Balconi, 2009). -Positive correlation with the use of working memory in tasks related to reward ( Kawasaki, 2012)

256 Reward System The orbitofrontal cortex, the nucleus accumbens and the anterior cingulate cortex are the areas responsible of the sense of reward and pleasure Reward-selective neurons, that is, neurons that shows different firing rates depending on the expected reward outcome, are present in many different brain areas. (Schultz, Nat Reviews Neurosci, 2000) Izuma et al (2008): the existence of an overlap between the neural monetary reward and social

257 The experiment Decision-making and shopping choices are meaningfully linked also to advertising (Krugman, 2008). Advertising (ADV) and emotions: a classical issue in consumer and ADV psychology. Key process nowadays: consumer s engagement in ADV, which means to build an emotional link between brand, product, persons (Wang, 2006; Schultz & Block, 2011; Liu, 2012; Mira & Kimiagary, 2013; Balconi, Leanza & Stumpo, in press). A study has been realized using an innovative approach, based on an integration of neurosciences and qualitative: neuro-quali.

258 The experiment Aim and Objectives Explore the impact of reward mechanisms and their prefrontal (dorsolateral prefrontal cortex DLPFC) correlates to support cognitive and emotive process in evaluating some consumer goods. We analysed the brain oscillation modulation in response to some ADVs of consumer goods. Evaluate the emotional contribution by analyzing the psychophysiological data (skin conductance response, heart rate). Explore the perceptual and attentional impact (count and length fixation) in response to some ADVs of consumer goods. Evaluate experiences, feelings, comprehension, etc of each respondent through semantic differential and individual qualitative interview

259 Subjects Subjects Females Males Tot Ages Ages Tot

260 Stimuli and procedure The subjects viewed five ADVs (30 ) of different markets, in casual order. Their reactions during and after the vision were measured by: consumer neurosciences tools (described later), semantic differential, individual qualitative interview (45 ). Food: Barilla Pharma: Enterogermina

261 Finance: Che Banca! Clothing: Calzedonia Consumer elettronics: Samsung

262 Tools BIOFEEDBACK Autonomic Recording (PULS, SCL, SCR) EYE-TRACKER Recording of eye position and its movements: Count Fixation Length Fixation EEG RECORDING EEG recordings were performed. Specifically, we measured brain activity: frontal (F3, Fz, F4) middle-central (Cz, C3, C4) temporo-parietal (P3/T7, Pz, P4/T8) occipital (Oz, O1, O2)

263 theta band modulation (mv2) Results CORTICAL INDEXES Theta band modulation 90,00 80,00 70,00 60,00 50,00 40,00 30,00 20,00 10,00 0,00 * * frontal central temporo-parietal occipital category types

264 LTA THETA LTA 0,10 0,05 0,00-0,05-0,10-0,15-0,20 F4 F3 category types

265 Count Fixation Video (F=30,670; p:.000) Results EYE MOVEMENTS 19,211 15,289 16,039 18,797 11,367

266 Results EYE MOVEMENTS Lenght Fixation Video (F=19,643;p:.000) 5,553 4,759 6,746 5,786 6,839 The gaze of the subject lingers on the ADV s details Decrease of attention while watching the Enterogermina ADV

267 Results AUTONOMIC MEASURES PULSE Highest number of pulsations detected during the vision of the third block Casa Video Enterogermina PULS Video*Blocks(F:3,017; p:,045) Enterogermina 76,942 77,609 75,465 75,197 Introduzione Intestino Casa Conclusione

268 The present research highlighted main neurophysiological results: - The specific activation of the prefrontal system response to good processing. A clear prefrontal (DLPFC) activity was found during ADV evaluation, mainly related to theta band variations. - The role of the reward system in reacting to different types of stimuli. A heterogeneous impact was observed in response to different ADVs: the higher positive value and preference expressed for some stimuli was related to theta frequency band modulation within the DLPFC. - The subjects have paid special attention to the Samsung spot (high number and duration fixations). On the contrary, a negative emotional reaction was found while watching the Enterogermina message. - Strong relationship has been observed between the explicit evaluation of the consumer s preference among the ADVs and brain activity.

269 SEMANTIC DIFFERENTIAL 5,689 5,576 5,504 4,414 4,513 Adjective: Beautiful (F:7,373; p.:,000)

270 SEMANTIC DIFFERENTIAL 5,116 5,099 4,520 4,313 4,891 Adjective: Interesting (F:1,805; p.:,144)

271 SEMANTIC DIFFERENTIAL 4,826 2,483 3,732 4,473 4,246 Adjective: Exciting (F:8,786; p.:.000)

272 Conclusions The neuro-quali integration has allowed for a substantial step forward in showing how consumer s brain works, especially when exposed to a rewarding, and therefore engaging, ADV: - Overall two ADV s (Samsung and Barilla) performed much better than others. In particular, the activation of the reward system is strongly related to higher qualitative/explicit scores. This clearly means that the reward system plays a key role in creating engagement and in making communication more effective. - Final question is: which kind of immaterial and psychological reward are these brands offering to persons in their fruition experience? - An interpretative answer is that these brands engage the consumer through a social reward based on the idea of sharing: the reassurance that one can count on someone else, and that one can be helpful towards others. One s own individuality has a precise and rewarding meaning and value, does not mean loneliness but is instead the basis for building sharing. - In times of crisis the psychological dimension of reciprocity becomes even more relevant: it is still possible to trust others, despite the many contrary clues coming from reality.

273 Decidere e comunicare nel Neuromanagement Dr.ssa Chiara Scortegagna Direttore Generale AdHocManagement s.r.l. Dr. Alessio Picci

274 Quante pubblicazioni? «Neuromanagement» 169 risultati «Organizational Neuroscience» 72 risultati «Organizational Cognitive Neuroscience» 91 risultati

275 How Business Schools Lost Their Way (Bennis, O Toole, 2005)

276 Riduzionismo

277 Ricostruzionismo

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