Todd Maddox, Ph.D.

Health care inequities are well-established in chronic pain care. Immersive digital therapeutics may transcend such barriers by offering in-home access with no Wi-Fi connectivity required, and easy to use, gaze-based navigation, and therapeutic delivery. The objective of this report is to determine whether clinical effectiveness, therapeutic program engagement, and virtual reality (VR) device usability of an Food and Drug Administration (FDA)-authorized, proprietary skills-based VR program for… Show more

Health care inequities are well-established in chronic pain care. Immersive digital therapeutics may transcend such barriers by offering in-home access with no Wi-Fi connectivity required, and easy to use, gaze-based navigation, and therapeutic delivery. The objective of this report is to determine whether clinical effectiveness, therapeutic program engagement, and virtual reality (VR) device usability of an Food and Drug Administration (FDA)-authorized, proprietary skills-based VR program for chronic pain (i.e., RelieVRx®) are affected by key sociodemographic factors (age, gender, race/ethnicity, and socioeconomic status [SES]) often associated with reduced patient engagement and clinical effectiveness. We report a secondary analysis of a large (n = 1,093) randomized controlled trial that compared skills-based VR with active sham VR. The sample was demographically diverse with self-reported nonmalignant chronic low back pain ≥3 months duration with average pain intensity and pain interference ≥4/10. Data were collected from January 31, 2022, to October 31, 2022. The clinical effectiveness, therapeutic program engagement, and VR device usability of skills-based VR were generally unaffected by age (<65 vs. 65+ years), gender (male vs. female), race/ethnicity (White vs. Black vs. other), and SES (education and income), with a few exceptions (age difference for therapeutic program engagement; race/ethnicity difference for device usability). National calls for improved access to nonpharmacological pain care are addressed with this skills-based VR program, which is self-administered in-home, requires no Wi-Fi connectivity, uses gaze-based navigation, and requires on average 6 min/day. Show less

In this perspective, we discuss the promise of virtual reality (VR) as an immersive therapeutic (ITx) delivery device. We review the neurobiology of learning and show that VR broadly engages multiple learning systems in the brain in synchrony thus having the unique potential to increase the effectiveness and speed of therapeutic change. We examine one application of VR in the delivery of chronic pain management therapy. We discuss the strengths and weaknesses of current therapies such as pain… Show more

In this perspective, we discuss the promise of virtual reality (VR) as an immersive therapeutic (ITx) delivery device. We review the neurobiology of learning and show that VR broadly engages multiple learning systems in the brain in synchrony thus having the unique potential to increase the effectiveness and speed of therapeutic change. We examine one application of VR in the delivery of chronic pain management therapy. We discuss the strengths and weaknesses of current therapies such as pain education and cognitive behavior therapy and suggest that VR has the potential to deliver self-administered, accessible, low risk, in-home chronic pain therapy. We briefly review effectiveness data from an FDA-authorized 8-week self-administered behavioral skills VR program for chronic low-back pain called RelieVRx®, discussing the strengths and weaknesses of the data. We conclude by predicting that ITxs will continue to develop as our knowledge of their effectiveness in treating chronic pain and other mental and physical health conditions grows. Show less

Patients with end stage kidney disease (ESKD) face challenges in comprehending and pursuing available treatment options, particularly with the rising interest in home-based dialysis. Providers struggle to deliver effective, individualized, and cost-efficient training, leading to lower adoption and retention rates. Cannulation, machine use, and safety training remain significant barriers. Using learning science - the marriage of psychology and the neuroscience of learning - we show that… Show more

Patients with end stage kidney disease (ESKD) face challenges in comprehending and pursuing available treatment options, particularly with the rising interest in home-based dialysis. Providers struggle to deliver effective, individualized, and cost-efficient training, leading to lower adoption and retention rates. Cannulation, machine use, and safety training remain significant barriers. Using learning science - the marriage of psychology and the neuroscience of learning - we show that interactive virtual reality (IVR) can address these barriers to home dialysis success by providing the experiential learning necessary for deeper understanding and increased competence. We show that IVR broadly engages multiple learning centers in the brain, thus spreading the wealth of knowledge while reducing cognitive load. We conclude by presenting a practical example of the potential of IVR in objective assessment of home dialysis equipment use and cannulation skills training. Show less

Objective
To determine whether an 8-week, self-administered in-home, behavioral skills virtual reality program for chronic low back pain (RelieVRx) that trains diaphragmatic breathing, biofeedback, cognition and emotion regulation, mindfulness, and pain education skills, is superior to a strong active Sham at day 56 for improving pain intensity and pain interference, in a large real-world sample.

Patients and Methods
Participants included a national sample of demographically… Show more

Objective
To determine whether an 8-week, self-administered in-home, behavioral skills virtual reality program for chronic low back pain (RelieVRx) that trains diaphragmatic breathing, biofeedback, cognition and emotion regulation, mindfulness, and pain education skills, is superior to a strong active Sham at day 56 for improving pain intensity and pain interference, in a large real-world sample.

Patients and Methods
Participants included a national sample of demographically diverse individuals with self-reported nonmalignant chronic low back pain ≥3 months duration with an average pain intensity and pain interference of ≥4/10. Participants were randomized 1:1 to RelieVRx or active Sham, and data were collected from January 31, 2022, to October 31, 2022. We evaluated group differences in brief pain inventory, pain intensity, and pain interference to day 56 (end of treatment).

Results
Of the 1067 participants (772 women, 293 men, and 2 others; mean ± SD age, 50.8±13.2 years) randomized (1:1) into 2 groups: RelieVRx (n=536) and Sham (n=531) comprised the modified intention-to-treat analytic dataset. RelieVRx was superior to Sham for pain intensity and pain interference reductions from pretreatment to day 56 (difference from Sham, pain intensity: 0.406 [0.170-0.642] and pain interference: 0.523 [0.285-0.760]). Pain intensity and interference reductions for RelieVRx at day 56 were clinically meaningful (pain intensity: 2.0 [out of 10] points [1.73-2.06], pain interference: 2.3 points [1.99-2.33]).

Conclusion
An 8-week self-administered behavioral skills virtual reality program was found to impart clinically meaningful improvements above a strong active control comparison on pain intensity and pain interference in clinically severe and diverse adults with chronic low back pain. Show less

Educating and training patients with chronic kidney disease, their caregivers, and health care providers effectively is critical for ensuring high-quality care and achieving successful kidney care outcomes for patients. When this is lacking, it can lead to gaps in care and knowledge that negatively impact patient health and satisfaction, while increasing health care costs. In this article, we offer a three-step framework, grounded in learning science - the marriage of psychology and the… Show more

Educating and training patients with chronic kidney disease, their caregivers, and health care providers effectively is critical for ensuring high-quality care and achieving successful kidney care outcomes for patients. When this is lacking, it can lead to gaps in care and knowledge that negatively impact patient health and satisfaction, while increasing health care costs. In this article, we offer a three-step framework, grounded in learning science - the marriage of psychology and the neuroscience of learning - to determine the optimal education and training solution for any given learning task. First, one identifies the learning task to be solved. Second, the learning systems in the brain that need to be engaged to learn the specific task must be identified. Finally, the learning solution that optimally engages the relevant brain system is identified. We provide details of each step and examples in which the three-step framework can be applied. In addition, we discuss the use of these learning solutions to educate nephrology care providers about roles they may be considering for their careers, and the knowledge and skills required for those roles. Show less

Patients with chronic kidney disease (CKD) often struggle to understand their disease and its treatment options. The learning content they receive does not provide the experience necessary to truly understand their disease and its treatment options. Nephrology care providers struggle to convey their knowledge effectively to patients, which leads to dissatisfaction. By applying learning science (the marriage of psychology and the neuroscience of learning), digital technologies like virtual… Show more

Patients with chronic kidney disease (CKD) often struggle to understand their disease and its treatment options. The learning content they receive does not provide the experience necessary to truly understand their disease and its treatment options. Nephrology care providers struggle to convey their knowledge effectively to patients, which leads to dissatisfaction. By applying learning science (the marriage of psychology and the neuroscience of learning), digital technologies like virtual reality can address these shortcomings by providing the experiential learning necessary for a deeper understanding. We show that virtual reality broadly engages multiple learning centers in the brain, thus spreading the wealth of knowledge while reducing cognitive load. We conclude by showing how virtual reality technology could be incorporated into existing CKD education and training workflows. Show less

We previously reported the efficacy of an 8-week home-based therapeutic immersive virtual reality (VR) program in a double-blind randomized placebo-controlled study. Community-based adults with self-reported chronic low back pain were randomized 1:1 to receive either (1) a 56-day immersive therapeutic pain relief skills VR program (EaseVRx) or (2) a 56-day sham VR program. Immediate posttreatment results revealed the superiority of therapeutic VR over sham VR for reducing pain intensity;… Show more

We previously reported the efficacy of an 8-week home-based therapeutic immersive virtual reality (VR) program in a double-blind randomized placebo-controlled study. Community-based adults with self-reported chronic low back pain were randomized 1:1 to receive either (1) a 56-day immersive therapeutic pain relief skills VR program (EaseVRx) or (2) a 56-day sham VR program. Immediate posttreatment results revealed the superiority of therapeutic VR over sham VR for reducing pain intensity; pain-related interference with activity, mood, and stress (but not sleep); physical function; and sleep disturbance. At 3 months posttreatment, therapeutic VR maintained superiority for reducing pain intensity and pain-related interference with activity, stress, and sleep (new finding). Show less

Prior work established post-treatment efficacy for an 8-week home-based therapeutic virtual reality (VR) program in a double-blind, parallel arm, randomized placebo-controlled study. Participants were randomized 1:1 to 1 of 2 56-day VR programs: 1) a therapeutic immersive pain relief skills VR program; or 2) a Sham VR program within an identical commercial VR headset. Immediate post-treatment results demonstrated clinically meaningful and superior reduction for therapeutic VR compared to ShamVR… Show more

Prior work established post-treatment efficacy for an 8-week home-based therapeutic virtual reality (VR) program in a double-blind, parallel arm, randomized placebo-controlled study. Participants were randomized 1:1 to 1 of 2 56-day VR programs: 1) a therapeutic immersive pain relief skills VR program; or 2) a Sham VR program within an identical commercial VR headset. Immediate post-treatment results demonstrated clinically meaningful and superior reduction for therapeutic VR compared to ShamVR for average pain intensity, indices of pain related interference (activity, mood, stress but not sleep), physical function, and sleep disturbance. The objective of the current report was to quantify treatment effects to post-treatment month 3 and describe durability of effects. Intention-to-treat analyses revealed sustained benefits for both groups and superiority for therapeutic VR for pain intensity and multiple indices of pain-related interference (activity, stress, and newly for sleep; effect sizes ranged from drm=.56 −.88) and physical function from pre-treatment to post-treatment month 3. The between-group difference for sleep disturbance was non-significant and pain-interference with mood did not survive multiplicity correction at 3months. For most primary and secondary outcomes, treatment effects for therapeutic VR showed durability, and maintained superiority to ShamVR in the 3 month post-treatment period. Show less

Many patients with chronic kidney disease (CKD) and their providers are dissatisfied with patients' depth of useful knowledge about CKD and its treatment options. This increases stress and decreases satisfaction, while increasing health care costs. In this article, we will apply learning science - the marriage of psychology and the neuroscience of learning - to examine problems seen in current CKD education. The goal is to determine the characteristics of a CKD education curriculum that… Show more

Many patients with chronic kidney disease (CKD) and their providers are dissatisfied with patients' depth of useful knowledge about CKD and its treatment options. This increases stress and decreases satisfaction, while increasing health care costs. In this article, we will apply learning science - the marriage of psychology and the neuroscience of learning - to examine problems seen in current CKD education. The goal is to determine the characteristics of a CKD education curriculum that optimizes the speed of initial learning and long-term retention of CKD and treatment information. We will show that initial learning and long-term retention are optimized when microlearning is incorporated, spaced over time, and supplemented with periodic testing. We conclude by showing how spaced microlearning and testing could be incorporated into a CKD education curriculum. Show less

On March 12, 2020, with more than 20,000 confirmed cases and almost 1000 deaths in the European Region, the World Health Organization classified the COVID-19 outbreak as a pandemic. As of August 15, 2020, there are 21.5 million confirmed cases of COVID-19 and over 766,000 deaths from the virus, worldwide. Most governments have imposed quarantine measures of varied degrees of strictness on their populations in attempts to stall the spread of the infection in their communities. However, the… Show more

On March 12, 2020, with more than 20,000 confirmed cases and almost 1000 deaths in the European Region, the World Health Organization classified the COVID-19 outbreak as a pandemic. As of August 15, 2020, there are 21.5 million confirmed cases of COVID-19 and over 766,000 deaths from the virus, worldwide. Most governments have imposed quarantine measures of varied degrees of strictness on their populations in attempts to stall the spread of the infection in their communities. However, the isolation may have inflicted long-term psychological injury to the general population and, in particular, to at-risk groups such as the elderly, the mentally ill, children, and frontline healthcare staff. In this article, we offer the most up-to-date review of the effects of COVID-19 confinement on all the disorders listed in the Diagnostic and Statistical Manual of Mental Disorders. We make data-driven predictions of the impact of COVID-19 confinement on mental health outcomes and discuss the potential role of telemedicine and virtual reality in mental health screening, diagnosis, treatment, and monitoring, thus improving the above outcomes in such a difficult time. Show less

Directly relevant to addiction research

This studied showed that the environmental context (i.e., framing) interacted with the nature of the incentives to affect optimized learning across the lifespan.

This study examined optimal learning as a function of incentives.

In this manuscript we used functional magnetic resonance imaging to examine the neural correlates of decision making across the lifespan. We took a computational machine learning approach whereby we correlated brain activation with parameters from a machine learning model. Several interesting results emerged but two that were most compelling were that older adults recruited more of their frontal brain regions to solve the task and that uncertainty was modulated by activation in the striatum, a… Show more

In this manuscript we used functional magnetic resonance imaging to examine the neural correlates of decision making across the lifespan. We took a computational machine learning approach whereby we correlated brain activation with parameters from a machine learning model. Several interesting results emerged but two that were most compelling were that older adults recruited more of their frontal brain regions to solve the task and that uncertainty was modulated by activation in the striatum, a dopamine producing region. The implications for training across the lifespan are many. Show less

Here we introduce a neuroscience based model of skill learning.

Stereotype threat involves situations in which people are or feel themselves to be at risk of conforming to negative stereotypes about their social group. Stereotype threat has been shown to reduce the performance of individuals who belong to negatively stereotyped groups.

In this study we showed the individuals places in a stereotype threat situation, in which they usually perform poorly, can be made to perform well simply by telling them to minimize losses instead of maximize gains… Show more

Stereotype threat involves situations in which people are or feel themselves to be at risk of conforming to negative stereotypes about their social group. Stereotype threat has been shown to reduce the performance of individuals who belong to negatively stereotyped groups.

In this study we showed the individuals places in a stereotype threat situation, in which they usually perform poorly, can be made to perform well simply by telling them to minimize losses instead of maximize gains. This simple but powerful manipulation worked in the research reported here and in a number of other studies from our lab.

The implications of this research for sports and the workplace environments is clear. Show less

We studied the effects of explicit instruction on optimized speech and language learning.

This work explores the serotonergic basis of emotion, attention and learning. The implications for learning in depression are discussed.

In this paper we explore the effects of rewards vs. punishments on optimal training.

This article examines the effects of age and information content on optimized learning.

In this manuscript we put individuals under pressure by telling them that they needed to learn a new speech language but that they had a partner in this endeavor. They and their partner both need to achieve some performance level to receive a monetary bonus. If one does not achieve the performance level neither will receive the monetary bonus. Prior to starting the learning task they are informed that their partner has completed the task and met the performance criterion so the pressure is on… Show more

In this manuscript we put individuals under pressure by telling them that they needed to learn a new speech language but that they had a partner in this endeavor. They and their partner both need to achieve some performance level to receive a monetary bonus. If one does not achieve the performance level neither will receive the monetary bonus. Prior to starting the learning task they are informed that their partner has completed the task and met the performance criterion so the pressure is on them.

Note the similarity between this situation and many situations in business environments. We showed that performance pressure IMPROVES learning of this type. Importantly, previous work in our laboratory showed that this type of learning is mediated by the striatum.

The implications for learning languages and in business are many and suggest that pressure can be good or bad depending upon the situation. Show less

In this research we showed that older adults approach decision making problems using qualitatively different strategies from younger adults. In particular, older adults tend to incorporate their vast lifelong experience into their decisions. Sometimes this helps and sometimes it hurt,

This study explored optimized learning as a function of underlying genetic makeup.

In this paper we showed the a very low power infrared laser shined for 5-minutes on the forehead improves executive function (in this case rule learning). The implications for business and training in general are many.

This article examined the brain basis of speech and language learning.

This work explores optimal training in speech and language as a function of age and executive function level.

This study asks the question of whether learning is superior when to-be-studied items are blocked by type or are presented in a random order. The results suggest that learning a verbal rule is best with blocked presentation whereas learning a more complex structure that is not verbalizable is best with random presentation. Interestingly, if you ask people which approach they felt led to better learning, they will say that blocked presentation is best. This is an excellent example of a situation… Show more

This study asks the question of whether learning is superior when to-be-studied items are blocked by type or are presented in a random order. The results suggest that learning a verbal rule is best with blocked presentation whereas learning a more complex structure that is not verbalizable is best with random presentation. Interestingly, if you ask people which approach they felt led to better learning, they will say that blocked presentation is best. This is an excellent example of a situation in which people's beliefs are incongruent with performance.

The implications for learning and business are many. Show less

This publication examined speech processing in older adults

Here we explore the effects of normal aging on learning and decision-making with an emphasis on understanding how recent events are weighted.

The work addresses the brain basis of decision making with an emphasis on biases in the way that decisions are made. The implications for decisions in business are obvious.

A brain model of exploratory learning. This work is directly relevant to VR and AR applications

Here we develop and test a computational cognitive neuroscience model of criterion learning.

Here we examine optimized learning as a function of dopamine genetic status with a focus on attention.

This work examines the emotional correlates of alcohol abuse. The implications for neurotransmitter systems such as dopamine and acetyhcholine are explored.

The work explores the dopamine genetic involvement in domain general category learning. The implications for personalized learning are clear.

We examined learning and optimized training in a neuropsychological patient group with trouble hoarding.

This work shows that people with music training are better at speech learning due to improvements in perceptual and cognitive processes.

Dopamine genetic influences on optimized speech recogntion

This is a book chapter that summarizes a large body of work conducted in my laboratory that explores the relationship between motivation and learning across the lifespan.

Although normal aging has its challenges, there are many instances in which older adults are superior to younger adults, especially when the goal is to forgo short run rewards in the interest of long-run profits.

The implications for business are many including the fact that personality, incentives and age… Show more

This is a book chapter that summarizes a large body of work conducted in my laboratory that explores the relationship between motivation and learning across the lifespan.

Although normal aging has its challenges, there are many instances in which older adults are superior to younger adults, especially when the goal is to forgo short run rewards in the interest of long-run profits.

The implications for business are many including the fact that personality, incentives and age interact in affecting performance. Show less

In this research we examine whether deliberative learning in older adults can be optimized by using socially relevant information as learning feedback. We find that socially relevant feedback does optimize deliberative but not automatic learning. The implications for optimized training across the lifespan and across domains (e.g., business) are many.

In this research we explored how an individual's personality affects optimized learning under conditions where they are asked to maximize gains vs. minimize losses. We show that individuals who focus on advancement and accomplishments learn better when the goal is to maximize gains, whereas individuals who focus on safety and responsibility learn better when the goal is to minimize losses.

This work shows that optimized learning depends upon motivation, personality and incentives. The… Show more

In this research we explored how an individual's personality affects optimized learning under conditions where they are asked to maximize gains vs. minimize losses. We show that individuals who focus on advancement and accomplishments learn better when the goal is to maximize gains, whereas individuals who focus on safety and responsibility learn better when the goal is to minimize losses.

This work shows that optimized learning depends upon motivation, personality and incentives. The implications in business are many.

This research suggests that productivity is maximized when one matches the task goal to maximize gains or minimize losses with the individual's personality. Show less

This article examines genetic effects on optimized speech and language learning

This article examines optimized speech perception and the effects of depression.

Here we develop a computational cognitive neuroscience model of optimized learning that accounts for the temporal dynamics of feedback.

Here we explore the effects of age, emotion, and motivation on learning in younger and older adults. The implications for education and business are clear.

Here we develop a hybrid model of decision making that we attribute to the influence of Dr. William K. Estes.

Here we examined optimized learning in children with ADHD. The implications for education and business are clear.

Here we develop a model of context dependent savings in learning. Critical brain regions include the prefrontal cortex and striatum. The implications for best practices in learning and retention are clear.

Here we explore optimized learning in patients with Parkinson's disease.

Theoretical model of speech learning from a dual-systems approach.

Here we use positively valenced information to enhance and optimize learning in depressed individuals. The implications for education and business are clear.

Major Depression Disorder is a psychological condition that adversely affects all aspects of a person's life. However, many individuals function relatively normally in the world despite the fact that they have elevated levels of depressive symptoms.

In this research we explored the relationship between elevated depressive symptoms and two forms of learning that are common in everyday life. Based on previous research we predicted that elevated depressive symptoms would adversely effect… Show more

Major Depression Disorder is a psychological condition that adversely affects all aspects of a person's life. However, many individuals function relatively normally in the world despite the fact that they have elevated levels of depressive symptoms.

In this research we explored the relationship between elevated depressive symptoms and two forms of learning that are common in everyday life. Based on previous research we predicted that elevated depressive symptoms would adversely effect deliberative learning that is mediated by frontal brain regions, but that it would accentuate learning in more automatic systems mediated by striatal brain regions. We found support for this prediction and hypothesized that the reciprocal connections between deliberative and automatic brain regions account for these findings. Specifically, automatic systems are enhanced because processing in deliberative systems are deficient.

The implications of this work for business are many. For example, personality (e.g., depression) can have a positive or negative effect on learning depending upon the nature of the task. Show less

This reviews our work on optimized training for speech and language

This is a review of the work we have done on optimized speech and language learning.

Here we explore the relationship between sleep, depression and cognitive control.

Here we examine the effects of stress on decision making across the lifespan. The implications for best practices in learning are clear.

Here we explore the effects of depression on optimized decision making and learning. The implications for business and education are clear.

Here we examine best practices in optimized learning and unlearning and test a computational cognitive neuroscience model.

Here we explore the effects of emotionally valenced feedback on learning in older adults. The implications for best practices in optimized learning are clear.

Here we explored optimized learning in depression and identified reward and punishment conditions that optimized learning. Implications for best practices are clear.

Here we explore the effects of explicit dimensional instructions on optimized learning and best practices. The implications for best practices in learning are clear.

The effect of gaming on children and young adults development has been in the news extensively over the past several years. From a purely cognitive perspective the research suggests the first person shooter games improve hand eye coordination and response time. Real time strategy games are thought to influence some aspects of executive function.

In this research we had a group on non-gamers play Starcraft or Sims for several weeks. We conducted a broad array of pre and post-tests to tap… Show more

The effect of gaming on children and young adults development has been in the news extensively over the past several years. From a purely cognitive perspective the research suggests the first person shooter games improve hand eye coordination and response time. Real time strategy games are thought to influence some aspects of executive function.

In this research we had a group on non-gamers play Starcraft or Sims for several weeks. We conducted a broad array of pre and post-tests to tap cognitive function. We found that individuals who played Starcraft showed broad based improvements in many aspects of executive function related to cognitive flexibility (loosely defined as one's ability to "think outside the box").

This work suggests that some types of games can improve critical cognitive functions like learning and memory. Show less

This research examines the effects of feedback presentation timing on deliberative and more automatic learning processes. We found that a slight delay in the feedback of about 1/2 second optimizes automatic learning processes, whereas feedback timing has little effect on deliberative learning. Importantly, the 1/2 delay converges well with recent work exploring the timecourse of striatal dopamine release following feedback presentation.

This implications for learning in general are many… Show more

This research examines the effects of feedback presentation timing on deliberative and more automatic learning processes. We found that a slight delay in the feedback of about 1/2 second optimizes automatic learning processes, whereas feedback timing has little effect on deliberative learning. Importantly, the 1/2 delay converges well with recent work exploring the timecourse of striatal dopamine release following feedback presentation.

This implications for learning in general are many and suggest that different types of learning tasks are optimized with different types of training environments. Show less

This is a study that examines optimized speech and language learning across the lifespan.

This study examines optimal training as a function of personality, emotion, incentives and age.

Here we explore predictors of best practices in learning.

Here we explore the effects of working memory load and temporal window on decision making. The implications for best practices in learning are clear.

Here we examine optimized learning in anorexia nervosa.

Here we examine age related declines in new category learning. The implications for best practices are many.

Here we examined optimized learning across the lifespan. The implications for best practices are many.

Here we examined optimized learning as a function of gain maximization vs. loss minimization. The implications for best practices, emotion and feedback are clear.

Here we explored age based differences in strategy use during learning. The implications for best practices are many.

A major interest of mine is to understand how personality affects decision making and learning. Other publications summarized above and below address this important topic as well. In this research we address the question of how learning and decision-making differs in individuals who are proactive vs. those who are procrastinators and how that is affected by whether the goal is to maximize gains or minimize losses. Because this study was conducted in a university research setting we defined… Show more

A major interest of mine is to understand how personality affects decision making and learning. Other publications summarized above and below address this important topic as well. In this research we address the question of how learning and decision-making differs in individuals who are proactive vs. those who are procrastinators and how that is affected by whether the goal is to maximize gains or minimize losses. Because this study was conducted in a university research setting we defined proactive individuals as those who met their research experience quota early in the semester and procrastinators as those who waited until the end of the semester to meet their research experience quota. End-of-semester participants (procrastinators) performed better minimizing losses as compared to maximizing gains, while the opposite was true for beginning-of-semester participants (proactive individuals). This work suggests that personality types should not be viewed as "good" or "bad". Rather one can obtain the maximum ability out of nearly any personality type simply by matching the local goal to maximize gains or minimize losses to the individual's personality.

Another example of how personality and incentives affect optimized training. Show less

This study examines how humans can teach and optimize robot performance

Here we explore the effects of sleep deprivation on ego depletion.

Here we explore the influence of sleep on optimized learning. The implications for best practices are many.

Here we explore the effects of range and discontinuity on optimized learning and retention. The implications for best practices in learning are many.

Here we examined learning in children. The implications for best practices in learning are many.

Here we examined the effects of motivation and incentives on optimized learning. The implications for the effects of motivation and incentives on best practices in learning are clear.

Here we explore the effects of sleep on optimized learning. The implications for best practices in learning are many.

In this study we examined decision making across the lifespan. We showed that older adults were more likely to forgo short run gains in the interest of much greater long run profits. Specifically, older and younger adults were asked to make a series of sequential decisions. Each decision involved choosing from one of two options and receiving a monetary reward with the aim of maximizing long-run payout. Participants were given no information regarding the underlying reward structure associated… Show more

In this study we examined decision making across the lifespan. We showed that older adults were more likely to forgo short run gains in the interest of much greater long run profits. Specifically, older and younger adults were asked to make a series of sequential decisions. Each decision involved choosing from one of two options and receiving a monetary reward with the aim of maximizing long-run payout. Participants were given no information regarding the underlying reward structure associated with the two options. Rather participants made sequential choices (200 total) and had to learn the reward structures through trial and error. Option 1 always yielded a larger reward than Option 2, but the more that Option 1 was chosen the smaller the reward associated with both options. Option 2 always yielded a smaller reward than Option 1, but the more that Option 2 was chosen the larger the reward associated with both options. Thus, the strategy that maximized long-run reward was to choose Option 2. When faced with this scenario, older adults consistently learned to choose Option 2 in spite of the fact that it was sub-optimal in the short run. Younger adults, on the other hand, were much more likely to choose Option 1 despite the fact that it was sub-optimal in the long-run.

This work shows that older adults are often better than younger adults at complex learning tasks that require a long run vision. Show less

This reviews a large body of work on optimized learning conducted in my and other labs.

This study explored optimal training in children as a function of personality, motivation and incentives.

Here we examine optimized learning and best practices by developing a computational model. We apply it in a sample of patients with Parkinson's disease.

Here we examined the effects of motivation and incentives on optimized learning in a classic test of learning. The implications for best practices in learning are many.

Here we examined best practices in learning across the lifespan.

Here we explored another best practice in learning. Sometimes the best practices is to have minimal attention and memory available to process feedback. Counterintuitive but true.

Here we examined best practices in learning.

In this paper we summarize a three factor theory that we proposed that shows how motivation and incentive structures affect different kinds of learning and decision-making. This is a lay presentation and provides a good starting point for someone new to this research area.

Here we examined best practices in decision making with a focus on emotion.

Here we examined prefrontal brain region contributions to optimized learning. The implications for best practices in learning are many.

Here we review an extensive literature on optimized and best practices in learning in PD patients.

Here we examined best practices in learning.

Here we examined motivational effects on best practices in learning.

Here we examined whether there is one or two pathways to stimulus encoding during optimal learning. The implications for best practices in learning are many.

Stereotype threat involves situations in which people are or feel themselves to be at risk of conforming to negative stereotypes about their social group. Stereotype threat has been shown to reduce the performance of individuals who belong to negatively stereotyped groups.

In this paper we reinterpret stereotype threat within a broader motivational framework. We argue that negative stereotype situations do not always lead to poor performance. In particular, these can be addressed by… Show more

Stereotype threat involves situations in which people are or feel themselves to be at risk of conforming to negative stereotypes about their social group. Stereotype threat has been shown to reduce the performance of individuals who belong to negatively stereotyped groups.

In this paper we reinterpret stereotype threat within a broader motivational framework. We argue that negative stereotype situations do not always lead to poor performance. In particular, these can be addressed by asking individuals to minimize losses instead of maximize rewards.

This work shows that personality and incentives interact in affecting learning. Show less

In this research we asked how 24-hours of total sleep deprivation affected learning in automatic, striatally mediated systems. We found that a sub-group of individuals (those who were better at initially learning the task appropriate strategy) were buffered against the ill effects of sleep deprivation.

Pressure to perform is prevalent in everyday life. For many individuals in many situations, pressure leads individuals to "choke"--that is, to underachieve relative to their baseline level of performance. In this paper we reinterpret pressure within a broader motivational framework. We argue that pressure packed situations do not always lead to poor performance. In particular, these can be addressed by asking individuals to minimize losses instead of maximize rewards.

This work reviews optimized free throw shooting as a function of pressure

This article focuses on optimized training and the effects of pressure in highly experienced individuals.

Here we examined best practices in unsupervised learning.

Here we examined best practices in decision making.

Here we examine the brain basis of optimized learning and best practices in learning.

Here we examine the effects of motivation, emotion and incentives on best practices in learning.

In this study we show that more information is not always a good thing and that additional information is advantageous for some forms of learning but not others.

The article examines optimized learning under pressure.

This is a review of our and others work on optimized training.

Each day people are faced with situations in which they must choose a course of action based on uncertain information. For example, we might decide whether to bring or not bring an umbrella to work. Similarly, we might decide whether to visit or not visit a doctor when we feel some chest pain. When we make these types of decisions we incorporate information about the prevalence of each event and the costs and benefits of making correct or incorrect decisions. For example, in San Diego it rarely… Show more

Each day people are faced with situations in which they must choose a course of action based on uncertain information. For example, we might decide whether to bring or not bring an umbrella to work. Similarly, we might decide whether to visit or not visit a doctor when we feel some chest pain. When we make these types of decisions we incorporate information about the prevalence of each event and the costs and benefits of making correct or incorrect decisions. For example, in San Diego it rarely rains so we are biased not to bring an umbrella. On the other hand, if we have an important presentation to give we realize that the cost of being caught out in the rain is too great to chance it so we bring an umbrella anyway. Similar considerations are taken when we decide whether to go to the doctor. If we are middle-aged with high cholesterol, there is a good chance that we might be suffering from a small heart attack. On the other hand, if we are in our 20s and surf, we probably just had too much hot sauce on our burrito last night. Analogously, the cost of not going to the hospital if we did have a heart attack is much greater than the cost of going to the hospital just to find out that we have indigestion.

In this research, we offer a unified theoretical approach to understanding how people incorporate prevalence and cost/benefit information while making decisions. One general finding in this report and across a number of other studies conducted in our laboratory, is that people tend to focus more on accurate decision making even if it does not maximize reward. As just one example, it is much more advantageous to incorrectly go to the hospital only to find out that you have indigestion than it is to wait for something more serious to happen.
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This research report offers a summary and review of a large body of research conducted in my laboratory focusing on how prevalence of events is incorporated with information about the costs and benefits of correct and incorrect decisions during human decision-making.

These research reports focus on understanding the complex interplay between perception, personality, motivation, cognition and the brain on learning, memory and decision making. I have a special interest in optimizing performance through manipulation of motivation and incentive structures, and the development of scientifically-validated best practices in learning. Over 100 of these reports are included above. All others are available upon request. A full list of publications in available at the… Show more

These research reports focus on understanding the complex interplay between perception, personality, motivation, cognition and the brain on learning, memory and decision making. I have a special interest in optimizing performance through manipulation of motivation and incentive structures, and the development of scientifically-validated best practices in learning. Over 100 of these reports are included above. All others are available upon request. A full list of publications in available at the URL above.
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