A multidimensional approach to impulsivity Lucien Rochat, PhD IEC - - PowerPoint PPT Presentation

A multidimensional approach to impulsivity

Lucien Rochat, PhD

IEC Rio 7-8th December 2015

Cognitive Psychopathology and Neuropsychology Unit

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

• ften result in undesirable consequences »
• 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) Daruna & Barnes, 1993, p.23

Impulsivity: the UPPS model

Whiteside & Lynam (2001)

Impulsivity

Lack of perseverance Lack of premeditation Urgency Sensation seeking

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

• penness 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

Addiction Variable Urgency Lack of perseverance Lack of premeditation Sensation Seeking 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

addiction Impact of internet use in daily life 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

Impulsivity and problematic behaviours/1

Billieux, Rochat, & Van der Linden, 2014; Rochat, Billieux, Gagnon, & Van der Linden, in prep.

Domain Variable Urgency Lack of perseverance Lack of premeditation Sensation 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

• Impulsivity and problematic behaviours/2
• 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

Rochat et al., 2008

Lack of premeditation Urgency Lack of perseverance Sensation seeking

Q16 Q11 Q6 Q1 Q14 Q9 Q7 Q4 Q15 Q12 Q8 Q2 Q13 Q10 Q5 Q3

Model 1

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

* p <. 01 * p <. 01

• 4
• 3
• 2
• 1

1 2 3 4 urgence Lprem Lpers RS patients ctrl

Impulsivity dimensions scores F(4, 55) = 2.98, p < .05, ή2

part = .18

Go/NoGo task

• Respond as quickly as possible to all

number except «3»

• Number ’3’ : 11% probability
• 252 numbers
• Measures:
• Number of « False Alarms» (= inhibition)
• RT variability: SD/M (= sustained attention)

2 + 8 + 3

Multiple linear regressions

Lack of premeditation

Age MMSE RTs Sustained attention Mental flexibility

β = . 44*

Age MMSE Mental flexibility Inhibition (FA) Sustained attention WM

Lack of perseverance

β = . 45* β = . 39*

* p < .05

Inhibition (FA)

WM RTs

F(7, 51) = 3.22, p< .01, adjR2 = .21 F(7, 51) = 3.94, p< .01, adjR2 = .26

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