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Temporal and social discounting of pain and illness

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Title: Temporal and social discounting of pain and illness
Authors: Story, Giles
Item Type: Thesis or dissertation
Abstract: Unhealthy behaviour often entails short-term indulgence at the expense of long-term health. This thesis examines an hypothesis that temporal discounting, a measure of the extent to which a person devalues delayed benefit, predicts unhealthy behaviour. The work also evaluates temporal discounting as a psychological model for unhealthy behaviour, in particular unhealthy behaviour that is enacted in spite of healthy goals, and behaviour with painful consequences. Studies examining relationships between temporal discounting and health behaviour are systematically reviewed, with the finding that discounting of reward correlates with many forms of appetitive unhealthy behaviour. It is proposed that while steep discounting predisposes to unhealthy behaviour, goal-incongruent behaviour is better explained by the interfering effect of prelearned or innate values. Also, conventional discounting fails to account for the fact that many people prefer to expedite inevitable pain or illness. An explanation is that people dislike waiting for pain, termed ‘dread’. The empirical work of this thesis establishes how dread depends on delay, by asking participants to titrate the timing and severity of their own pain or that of others. For the average participant, the dread of pain accumulated at a decreasing rate as pain was delayed. Dread was found to be less marked when deciding on behalf of socially close others. Unexpectedly a tendency to dread future pain in one-off choices did not predict saving a budget of pain relief in sequential choices. Further experiments examined social discounting for pain, finding that participants appear more averse to causing pain in others than in themselves, a tendency that is discounted with social distance. Conclusions are that temporal discounting of reward is a promising marker of appetitive unhealthy behaviour, with a considerable evidence base, while dread offers a candidate marker for engagement in health-promoting behaviour with painful consequences, a possibility which demands further investigation.
Content Version: Open Access
Issue Date: Jun-2015
Date Awarded: Oct-2015
URI: http://hdl.handle.net/10044/1/30815
DOI: https://doi.org/10.25560/30815
Supervisor: Vlaev, Ivo
Department: Department of Surgery & Cancer
Publisher: Imperial College London
Qualification Level: Doctoral
Qualification Name: Doctor of Philosophy (PhD)
Appears in Collections:Department of Surgery and Cancer PhD Theses

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