Cognitive Psychopathology and Neuropsychology Unit A multidimensional approach to impulsivity Lucien Rochat, PhD IEC Rio 7-8 th December 2015 Lucien.Rochat@unige.ch
Impulsivity: A general definition « Variety of actions that appear poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation and that often result in undesirable consequences » Daruna & Barnes, 1993, p.23 Problematic in older adults • Financial decision-making (e.g., selling a house, making large purchases, signing financial power of attorney paperwork) • Medical decision • Driving • Retirement Financial abuse of older adults : frequent and understimated ( see Denburg & Hedgcock, 2015)
Impulsivity: the UPPS model Lack of premeditation Sensation Lack of Impulsivity seeking perseverance Urgency Whiteside & Lynam (2001)
Urgency « Tendency to experience strong reactions, frequently under conditions of negative/positive affects » World Cup Final Berlin (Germany) July 2006
Lack of premeditation « Poor tendency to think and reflect on the consequences of an act before engaging in that act »
Lack of perseverance « Difficulties in remaining focused on a task that may be boring, long or difficult »
Sensation seeking « Tendency to enjoy and pursue activities that are exciting and openness to trying new experiences »
UPPS scale : Examples Urgency « I have trouble resisting my cravings » « When I feel rejected, I will often say things that I later regret » (Lack of) Premeditation « I have a reserved and cautious attitude toward life » « Before making up my mind, I consider all the advantages and disadvantages » (Lack of) Perseverance « Unfinished tasks really bother me» « I concentrate easily » Sensation seeking « I quite enjoy taking risks » « I welcome new and exciting experiences and sensations, even if they are a little frightening and unconventional» Whiteside & Lynam, 2001
Impulsivity and problematic behaviours/1 Lack of Lack of Addiction Variable Urgency Sensation Seeking perseverance premeditation ● ● Cigarette Smoking status ● Dependance severity ● Craving (hedonic) ● Craving (relief from negative affect) ● ● Alcohol Regular consumption ● ● ● Diagnosis of dependence ● ● ● Alcohol abuse ● Impact in daily life ● ● ● ● Drugs Diagnosis of dependence ● ● ● Impact in daily life ● ● ● ● Buying Diagnosic of compulsive buying ● Symptoms severity ● Gambling Frequency and types of games ● ● Diagnosis of pathological ● ● gambling Impact in daily life ● ● ● Cyber Impact of internet use in daily life ● addiction Excessive use of video games ● Frequency of mobile phone use ● ● Dependency to mobile phone Note . ● = significant predictor ( p <.05), after controlling for the other dimensions of impulsivity Billieux, Rochat, & Van der Linden, 2014; Rochat, Billieux, Gagnon, & Van der Linden, in prep.
Impulsivity and problematic behaviours/2 Domain Variable Urgency Lack of Lack of Sensation perseverance premeditation seeking ● ● ● Borderline Diagnosis ● ● Borderline traits ● Self-mutilation ● Emotional instability ● Risky sex ● Suicidality ● Antisocial Antisocial conducts ● Psychopathy ● ● Verbal aggressivity ● ● Physical aggressivity ● ● Sexual agression ● ● General violence ● Intimate partner violence ● ● Eating disorders Bulimic symptoms ● ● Obesity (BMI > 30) ● Food concerns ● Frequency of purging ● Relief from negative affect ● ● Weight fluctuations ● ● ● ADHD Diagnosis ● Opposition conducts ● Inattention symptoms ● ● Sleep disorders Insomnia severity ● Nocturnal regrets ● ● Conterfactual thinking Note . ● = significant predictor ( p <.05), after controlling for the other dimensions of impulsivity Billieux, Rochat, & Van der Linden, 2014; Rochat, Billieux, & Van der Linden, in prep.
UPPS Impulsive Behaviour Scale short form Modifications of the original UPPS Impulsive Behaviour Scale • 16 items (4 per each factor) • Caregivers had to assess impulsivity changes - 5-point Likert scale (from –2 “much less than 10 years ago” to +2 “much more than 10 years ago”) Rochat et al., 2008
UPPS scale short form for aging: examples « He (she) usually thinks carefully before doing anything » Much less than 10 years ago Slightly less than 10 years ago Like 10 years ago Slightly more than 10 years ago Much more than 10 years ago « In the heat of an argument, he (she) will often say things that he (she) later regrets » Much less than 10 years ago Slightly less than 10 years ago Like 10 years ago Slightly more than 10 years ago Much more than 10 years ago Rochat et al., 2008
UPPS scale short form for aging: examples « He (she) generally likes to see things through to the end » Much less than 10 years ago Slightly less than 10 years ago Like 10 years ago Slightly more than 10 years ago Much more than 10 years ago « He (she) quite enjoys taking risks » Much less than 10 years ago Slightly less than 10 years ago Like 10 years ago Slightly more than 10 years ago Much more than 10 years ago Rochat et al., 2008
Confirmatory factor analyses: fit indices Model 1 Sensation Lack of Lack of Urgency seeking premeditation perseverance Q3 Q5 Q10 Q13 Q1 Q6 Q11 Q16 Q4 Q7 Q9 Q14 Q2 Q8 Q12 Q15 Rochat et al., 2008
Impulsivity changes Lack of perseverance • M= 2.32 (SD= 4.58), 95% CI(1.31; 3.33); Cronbach ’α = .95 Lack of premeditation • M= 1.42 (SD= 4.20), 95% CI(0.48; 2.37); Cronbach ’α = .80 Urgency • M= 0.88 (SD= 3.86), 95% CI(0.10; 1.76); Cronbach ’α = .75 Sensation seeking • M= -2.24 (SD= 4.00), 95% CI(-3.14; -1.34); Cronbach ’α = .85 Rochat et al., 2008
Conclusion Multifactorial nature of impulsivity confirmed Good internal consistency No significant links with general cognitive measures ↑ impulsivity: poor self -control, decision-making difficulties in patients with AD Rochat et al., 2008
Comparisons F (4, 55) = 2.98, p < .05, ή 2 part = .18 4 * p <. 01 3 * p <. 01 2 1 scores patients 0 ctrl urgence Lprem Lpers RS -1 -2 -3 -4 Impulsivity dimensions
Go/NoGo task Respond as quickly as possible to all number except «3» Number ’3’ : 11% probability 2 + 252 numbers 8 + Measures: 3 Number of « False Alarms» (= inhibition) • RT variability: SD/M (= sustained attention) •
Multiple linear regressions Age F (7, 51) = 3.22, p < .01, adj R 2 = .21 MMSE RTs WM Lack of β = . 44* Inhibition (FA) premeditation Sustained attention Mental flexibility Age F (7, 51) = 3.94, p < .01, adj R 2 = .26 MMSE RTs WM Lack of Inhibition (FA) perseverance β = . 39* Sustained attention β = . 45* Mental flexibility * p < .05
Impulsivity and Parkinson Bayard, Joly, Ghisletta , & … Rochat, in revision
A laboratory decision-making task: the Game of Dice Task Brand et al., 2003
Impulsivity and Parkinson Bayard, Joly, Ghisletta , & … Rochat, in revision
Conclusions The dual processes of thinking and reasoning theory : automatic system vs. analytical (deliberative, reflexive) system (see Evans, 2003) Choices resulting from the automatic system depend on rapid and parallel processes produced via associative learning, and they remain unconscious until the decision is made • Hedonic function, search for immediate gratification By contrast, the analytical system is slower, sequential, requires controlled cognitive processes such as inhibition, and allows abstract and hypothetical thinking
Conclusions Impairment of the inhibition of prepotent responses precludes the activation of analytical/deliberative processing , which is necessary to consider the immediate benefits vs. the future costs of an action when making a decision Elders with high level of lack of premeditation: at risk of fraud, deceptive advertising, cold-calling, bad purchases, etc.
Impulsivity ? A multidimensional construct UPPS model of impulsivity: useful for understanding various problematic behaviors in the general population as well as in clinical samples An important cognitive processes: inhibition of a prepotent or automatic response • If impaired: risk of poor decision-making
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