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Intuition allows us to make quick decisions in an uncertain environment, not wasting too much time on analyzing possible consequences. Evaluative judgments and decisions are quite often influenced by intuitive feelings rather than analytical conclusions. A doctor in an emergency room, for instance, won't have the time to evaluate the benefits and risks of two similar treatments analytically. The emotion which helps us boost our decision process is called affect.

Affect is used as a cue when people define the positive or negative quality of a stimulus; it is experienced as a state and is used whenever quick assignments or attributions are needed to make decisions or judgments. Hence, affect is used as an umbrella term referring to states of valence and arousal; it sometimes even includes states of mood, although these are of a more diffuse, low-intensity and long-lasting character. To give an example of experiencing affect, just imagine how fast we associate feelings with words like cancer or emergency. Thus, some researchers call the reliance on such feelings and their utilization in decision making the affect heuristic.

In this entry, a short theoretical background of affective influence in cognition is given, followed by a brief description of psychological models on this topic. Then, various examples according to the affect heuristic and its possible effects in the medical context are examined.

Theoretical Background

Two main attempts can provide a theoretical background for findings on the affect heuristic: First, Epstein's dual-process theory separates “two modes of thinking” into analytical and intuitive, emotional ways of information processing. Secondly, Damasio's theory of “somatic markers” accounts for the importance of affect in decision making.

Epstein's development of the cognitive-experimental self theory introduces a dual process of thinking, assuming two major systems by which people adapt to the world: rational and experimental. Constructs about the self and the world in the rational system refer to beliefs, whereas those in the experimental system refer to implicit beliefs. Neither of the two thinking styles is predominant; they rather function simultaneously. The experimental system is developed through a very long historical evolution and therefore operates more intuitively and automatically. In contrast, the rational system needs more effort to operate; it is mostly used within the medium of language due to its shorter evolutionary history. A wide range of research supports the theory, emphasizing the use of the experimental system in heuristic processing.

Damasio's concept explaining the importance of intuition or affect in decision making was developed by asking the question, “What in the brain allows humans to behave rationally?” His observations led him to the conclusion that human behavior is influenced by “somatic markers” learned in a lifetime. The theory assumes that people mark images with positive or negative feelings, which are directly connected to bodily states. As a result, images can be associated with negative markers that imply an alarming state, or they can be linked to positive markers, meaning a beacon of incentive feeling linked to a bodily state. These assumptions were tested in experiments with patients who had damage to the ventromedial frontal cortices of the brain. Patients with this damage are unable to experience “feelings” and are impaired in their ability to associate affective feelings and anticipated consequences. A gambling game was provided to the participants, where they had to choose cards from any of four card decks. Each chosen card resulted in a gain or loss of a certain amount of money. Patients with the damage to the ventromedial frontal cortices showed their impairment in anticipating future outcomes by their inability to avoid card decks with great outcomes but also great losses. In contrast, “normal” subjects and patients with brain damage outside the prefrontal sections “learned” how to choose the card decks with the lower but continuous payoff. These findings proved that somatic markers increase the accuracy and efficacy of the decision process.

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