Positive, but distal consequences of reducing alcohol use among at-risk users may have little impact on behavior due to temporal discounting (Mazur, 1987), in which delayed rewards are devalued relative to more proximal rewards, even if such distal rewards actually provide considerably more value. Delay discounting may be manipulated using a variety of means, one of which involves utilizing prospective thinking about future autobiographical events and is termed Episodic Future Thinking (Atance and ONeill, 2001). Episodic future thinking (EFT) has been demonstrated in previous studies to be effective in reducing delay discounting relative to a variety of control conditions (Benoit, Gilbert, and Burgess, 2011; Daniel, Stanton, and Epstein, 2013a, 2013b; Lin and Epstein, 2014; Peters and Büchel, 2010) and recently among substance-abusing populations (Snider, LaConte, and Bickel, 2016; Stein et al., 2016). The present study examined EFT in a novel sample of at-risk alcohol users. Participants were randomized to EFT, episodic past thinking (EPT), or a control condition in which non-autobiographical events were recalled (CET). Immediately following intervention, results demonstrated significantly less discounting in EFT and EPT, relative to CET. At follow-up, EFT demonstrated significantly less temporal discounting and alcohol use, when compared to both EPT and CET. No differences among conditions in alcohol demand or alcohol use intentions were observed. The present study contributes a number of novel findings to the literature, most notably that engaging in EFT predicts reductions in alcohol use prospectively and that reductions in delay discounting associated with EFT persist at least a week later, without any additional intervention. Such findings suggest that EFT manipulations influence the valuation of future rewards. Additionally, findings support EFT as a useful supplement to existing empirically-supported treatments or a component of novel substance use disorder treatments. / Ph. D.

Alcohol use disorder is common, and treatments are currently inadequate. Some of the acute effects of alcohol on the brain, such as altering the decision-making and future thinking capacities, mirror the effects of chronic alcohol use. Therefore, interventions that can address these shortcomings may be useful for reducing the negative effects of alcohol use disorder in combination with other therapies. The signature of those interventions may also be evident in the signature of large-scale, dynamic brain networks, which can show whether an intervention is effective. One such intervention is episodic future thinking, which has been shown to reduce delay discounting and orient people toward pro-social, long-term outcomes. To better understand decision making in high-risk individuals, we examined delay discounting in an adolescent population. When the decision-making faculties were challenged with difficult choices, adolescents made decisions inconsistent with their predicted preference, complemented by increased brain activity in the central executive network and salience network. Using these results and the hypothesis that the default mode network would be implicated in future thinking and intertemporal choice, we examined the neural effects of a brief behavioral intervention, episodic future thinking, that seeks to address these impairments. We showed that episodic future thinking has both acute and longer-lasting effects on consequential brain networks at rest and during delay discounting compared to a control episodic thinking condition in alcohol use disorder. Our failure to show group differences in default mode network prompted us to scrutinize it more carefully, from a position where we could measure the ability to self-regulate the network rather than its resting-state tendency. We implemented a real-time fMRI experiment to test the degree to which people along the alcohol use severity spectrum can self-regulate this network. Our results showed that default mode network suppression is impaired as alcohol use disorder severity increases. In the process, we showed that direct examination of resting-state networks with these methods will provide more information than measuring them at rest alone. We also characterized the default mode network along the real-time fMRI pipeline to show the whole-brain spatial pattern of regions associated and unassociated with the network. Our results indicate that resting-state brain networks are important markers for outcomes in alcohol use disorder and that they can be manipulated under experimental conditions, potentially to the benefit of the afflicted individual. / Doctor of Philosophy / Alcohol is the most widely-used mind-altering substance in the United States. Even though most people do not develop a problem with alcohol use, many people will at some point develop drinking patterns that classify as an alcohol use disorder. Brain damage from drinking can come from the toxicity of alcohol, but also as a result of behaviors associated with drinking too much, including injury, violence, accidents, and other health-related issues. Interventions at the behavioral level can be effective at curbing drinking patterns before damage accrues, and a better understanding of those interventions at the level of the brain may make them more effective. This work investigated the decision-making processes and the ability to think clearly about the future, two faculties that begin to become diminished in alcohol use disorder. In our first set of studies, we tested a brief behavioral intervention called episodic future thinking, which helps people orient themselves away from short-term rewards like alcohol and toward long-term goals that could happen if they stopped drinking as much. We showed that one hour-long, intensive session produced changes in the connectivity between the prefrontal cortex and the lower brain. We also generated data in a long-term experiment suggesting repeated reminders of the episodic future thinking intervention produce changes in large-scale brain networks that are disrupted in substance use disorders. In a separate set of experiments, we showed that people can gain control over one of these networks, called the default mode network, to the point of being able to control a brain-machine interface just by following simple instructions. However, we demonstrated that the degree to which someone can control this brain activity was associated with their drinking severity. In other words, the more people drank, in terms of volume and frequency, the less control they had over their own brain activity. This finding is important because many researchers have shown that activity in this brain region is related to many psychopathologies, including substance use disorders. Other researchers have been developing ways in which the ability to control this brain activity can be trained. While we did not find evidence of a training effect in a small group of healthy people (5), it may be the case that people impaired by alcohol use disorder can improve through practice or through cutting back on drinking. Ultimately, we hope that the research presented here will help to guide the development of treatments for alcohol use disorder to be more effective.

目的　本研究嚐試探討無望感與未來思考及情緒困擾間的關係，旨在驗證MacLeod的未來思考研究，以及區分病例組與對照組的敏感性。 研究對象　非病人樣本，主要為大學生以及部分社會人士，共123名；病人樣本則為台北巿立萬芳醫院的門診病患，共49名。 研究方法　非病人樣本採用隨機取樣，病人樣本採用隨機立意取樣之病例對照研究設計。 研究材料　包括「貝克無望感量表」、「貝克焦慮量表」、「貝克憂鬱量表第二版」、「語意歷程作業」、「語文流暢作業」、與「未來思考作業」共六項。 研究結果　本研究結果符合MacLeod先前的研究結果為，即(1)無望感與正向未來思考的減少有關；與(2)憂鬱與正向未來思考的減少，及負向未來思考的增加有關。不符合MacLeod的研究果為：焦慮與未來思考的關係不顯著。另外，以「正向未來思考」及「負向未來思考」來區分病人與非病人就目前的樣本而言，是不具有敏感性的。 結論　對於臨床工作而言，須注意正向未來思考減少對個案的影響，並進一步的給予適宜的處置，以預防疾病的再發。 關鍵字　無望感、正向未來思考、負向未來思考、情緒困擾

Psychosis encompasses a constellation of symptoms that have far-reaching social, physical and functional consequences for sufferers. One of the key clinical concerns in the management of psychotic illnesses is the risk of suicide, which is greatest in the early stages of psychosis. Hopelessness is consistently associated with risk for suicide but as a concept it is not well defined and is not specific enough to be of use in prediction of suicide. Future-directed thinking, particularly regarding positive future events, constitutes an aspect of hopelessness that is closely associated with risk for suicide. This study employed the Future Thinking Task to investigate whether future-directed thinking in first episode psychosis is significantly different from that of matched controls in performance or content, and to clarify the nature of its association with suicide risk in this patient group. In addition, the association of future-directed thinking with the negative symptoms of psychosis was investigated. The results showed that individuals with psychosis were impaired in future-directed thinking globally, particularly with respect to the coming year. Specific deficits were shown in the domains of relations with other people and personal development and understanding. Associations were shown between future-directed thinking and suicide, and reduced positive future-directed thinking was shown to be strongly associated with increased severity of negative symptoms. The results suggest avenues for novel interventions to improve hopelessness, suicide risk and the severity of negative symptoms in psychotic illness, and thereby improve functional outcomes.

Episodic future thinking is defined as the ability to mentally project oneself into the future into a specific time and place. Episodic future thinking has been explored extensively in neuroscience. However, it has not been determined whether the measurement of episodic future thinking might be valuable in a clinical neuropsychological setting. The current study examined the relationship between episodic future thinking and instrumental activities of daily living (IADLs), which is a domain of adaptive functioning frequently assessed by neuropsychologists to examine independent living potential including the ability to handle finances, prepare food, complete household duties, and manage medications. A secondary aim was to examine whether episodic future thinking is related to IADLs over and above standard measures of cognition. 61 older adults with heterogeneous neurological conditions and 41 healthy older adults completed a future thinking task (the adapted Autobiographical Interview), two measures of IADLs (an informant report measure called the Everyday Cognition Scale and a performance-based measure called the Independent Living Scales), and standard measures of memory and executive functioning. Episodic future thinking was significantly associated with performance-based IADLs when accounting for age, education, gender, and depression (r=.26, p=.010). Episodic future thinking significantly predicted performance-based IADLs over and above executive functioning (R2=.025, p=.030). Episodic future thinking was not predictive of performance-based IADLs over and above memory (p=.157). Episodic future thinking was not significantly associated with informant reported IADLs when accounting for age, education, gender, and depression (p=.284). This study suggests that episodic future thinking is significantly associated with IADLs, beyond what can be accounted for by executive functioning. Episodic future thinking may provide information about IADLs to clinical neuropsychologists so they can improve their recommendations for independent living.

Impulsivity takes many forms, one of which is termed impulsive choice. Impulsive choice entails preference for an outcome due to its immediacy relative to more optimal outcomes that take longer to come to fruition. For example, one may wish to have another serving of a decadent dessert after dinner—but doing so may undermine a longer-term goal of improved health and nutrition. If having the extra serving becomes a habit, the consequences of that choice compound and may lead to, for example, obesity. A high degree of impulsive choice such as this is indeed related to issues such as obesity, drug addictions (e.g., alcohol, opiates), and more; it may also cause these conditions. Because impulsive choice may lead to the development of poor health conditions, being able to reduce impulsive choice may reduce the occurrence of these conditions and/or help treat them. To date, a variety of studies have been conducted to examine ways to reduce impulsive choice, but it was unclear what methods may be most useful for clinical use in humans. Thus, the first portion of the enclosed research was a literature review in which successful methods for reducing impulsive choice were identified. A particular intervention called Episodic Future Thinking (EFT), which entails vivid imagination of one’s future, was one of the most promising found. However, it was unclear if its positive effects on impulsive choice were due to EFT itself or a placebo-like effect, which can arise from being able to guess the purpose of the intervention. The remaining portions of this dissertation focused on determining whether people are able to identify the purpose of EFT, and subsequently, if this awareness accounts for the positive effects of EFT on impulsive choice. Across three experiments, we demonstrated that naïve individuals are able to figure out the purpose of EFT (Experiments 1a and 1b), but that being aware of its purpose is unrelated to its positive effects (Experiment 3). These findings give hope that this intervention could be clinically useful, but it did appear that its benefits did not generalize well to novel settings (Experiment 2). Overall, the results of the research showed that EFT produces genuine changes in impulsive choice, but that further research will need to be conducted to understand why it works, and ultimately, how its generalizability can be increased.

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This dissertation investigates self-projection (i.e., future and past preferences reasoning) and possible underlying mechanisms [Theory of Mind (ToM), executive function (EF)] in early development. All children were tested in person prior to the COVID-19 pandemic. Our first objective was to explore preschoolers' understanding that the preferences they may hold in the future (Future Preferences task, adapted from Bélanger, Atance, Varghese, Nguyen, & Vendetti, 2014; Experiment 1), and likely held in the past (Past Preferences task; Experiment 2), differ from their current preferences. To do so, we implemented a novel continuous measure of children's preferences (faces rating scale; Kopp et al., 2017; adapted from; Wong & Baker, 1988) in addition to the more standard categorical response measure (item selection) used in children's future preferences reasoning research (Bélanger et al.). In addressing our second objective to investigate children's past preferences reasoning, we designed a new task (Past Preferences task) to complement our Future Preferences task. In Chapter 2 (Experiments 1 & 2), we found 3-, 4-, and 5-year-olds' success in reasoning about their future and past preferences generally improved with age. Results from our continuous preferences measure further revealed subtle developments in preschoolers' preferences reasoning not gleaned from our categorical data alone. We found that, around age 4, children demonstrate some understanding that they will prefer child items less and adult items more in the future (as an adult) than they do now and, around age 3, children similarly demonstrate some understanding that they preferred child items less in the past (as a baby) than they do now. While cross-experiment comparison in Chapter 2 revealed asymmetry in preschoolers' preferences reasoning (future, relative to past, preferences reasoning was more challenging), this asymmetry was not replicated in Chapter 3 using a more rigorous within-subjects design. Besides clarification of asymmetry in preferences reasoning, our final objectives were to confirm the relation between preschoolers' reasoning about changes in their future and past preferences and explore possible mechanisms underlying children’s self-projective abilities. In Chapter 3, children's ability to reason about their future and past preferences were significantly correlated - but not after controlling for their receptive language ability. Unexpectedly, we did not find support for asymmetry in children's self-projection abilities; that is, children did not find it more difficult to reason about their future as compared to their past preferences. Finally, children's future and past preferences reasoning were not related to or predicted by their performance on the ToM and EF tasks after controlling for age, language ability, and sex. Taken together, this dissertation provides unique and timely contributions to the literature on self-projection and, specifically, how this capacity develops, as well as children’s reasoning about how preferences change over time.

Yes / Objectives To examine the impact of memory accessibility on episodic future thinking. Design Single-case study of neurological patient HCM and an age-matched comparison group of neurologically Healthy Controls. Methods We administered a full battery of tests assessing general intelligence, memory, and executive functioning. To assess autobiographical memory, the Autobiographical Memory Interview (Kopelman, Wilson, & Baddeley, 1990. The Autobiographical Memory Interview. Bury St. Edmunds, UK: Thames Valley Test Company) was administered. The Past Episodic and Future Episodic sections of Dalla Barba's Confabulation Battery (Dalla Barba, 1993, Cogn. Neuropsychol., 1, 1) and a specifically tailored Mental Time Travel Questionnaire were administered to assess future thinking in HCM and age-matched controls. Results HCM presented with a deficit in forming new memories (anterograde amnesia) and recalling events from before the onset of neurological impairment (retrograde amnesia). HCM's autobiographical memory impairments are characterized by a paucity of memories from Recent Life. In comparison with controls, two features of his future thoughts are apparent: Reduced episodic future thinking and outdated content of his episodic future thoughts. Conclusions This article suggests neuropsychologists should look beyond popular conceptualizations of the past–future relation in amnesia via focussing on reduced future thinking. Investigating both the quantity and quality of future thoughts produced by amnesic patients may lead to developments in understanding the complex nature of future thinking disorders resulting from memory impairments. / Institute of Psychological Sciences, University of Leeds

Despite decades of effort in developing evidence-based treatments, drug addiction remains one of the most problematic and enduring public health crises. Developing a new generation of theoretically-derived interventions constitutes an important clinical and scientific gap that, if addressed, may open innovative treatment opportunities. Based on the Reinforcer Pathology theory, altering the temporal window over which reinforcers are integrated (i.e., measured by delay discounting) would alter drug valuation and consumption. The first investigation—in 2 separate studies— test the Reinforcer Pathology theory by examining the effect of expanding and constricting the temporal window of integration using two mating narratives (long-term and short-term relationships, respectively) on cigarette valuation among cigarette smokers. The second investigation, test the Reinforcer Pathology theory by assessing the effect of remotely delivered Episodic Future Thinking (EFT) narratives (expands the temporal window) on real-world alcohol consumption among individuals with alcohol use disorder (AUD). Together, these investigations supported the Reinforcer Pathology theory and demonstrated its relevance for understanding and intervening in addiction. The current findings provide scientific justification to further investigate Reinforcer Pathology based interventions that expand the temporal window to change drug valuation and consumption. The construction of multi-component treatments that incorporate Reinforcer Pathology based interventions to systematically alter the temporal window may provide a novel intervention to reduce alcohol consumption. / Doctor of Philosophy / The following studies provide evidence that altering the temporal widow (how far in the future one can imagine and integrate into the present) would alter drug valuation. In the following studies, we used narratives describing long-term or short-term mating relationships (Study 1) and Episodic Future Thinking (EFT; represents one's capability to pre-experience the future; Study 2) to alter the valuation of cigarettes and alcohol, respectively. In the first study, cigarette smokers who read and vividly imagined long-term romance relationship narrative (expands the temporal window) valued cigarettes less than control (imagined looking for a lost key). In contrast, those who read and vividly imagined a short-term sexual encounter (shortens the temporal window) valued cigarettes more than controls. The second study employed EFT (expands the temporal window) as a strategy to reduce alcohol consumption, in real-world settings, over two weeks in individuals with alcohol use disorder. The study found that expanding the temporal window using EFT reduced alcohol consumption. Together, these two studies provide support to employing interventions that extend the temporal window to change drug valuation and consumption. The construction of multi-component treatments that incorporate interventions expanding the temporal window may reduce drug consumption.