Stephanie Marita Carpenter

Health decisions are nearly always consequential and difficult. Virtually every person is faced with important health decisions at some point during their lifetime. With an interest in health psychology, my colleague and I developed an integrative account of the roles of emotion in decision-making. In Part I, we illustrate how emotional inputs into decisions may rely on physiological signals from emotions experienced while making the decision, and we review evidence suggesting that the failure to represent the emotional meaning of options can often reduce decision quality. We propose that health-related decrements in the ability to generate emotional reactions lead people to inaccurately represent emotional responses and compromise decisions, particularly about risk. Part II explores complex decisions in which choice options involve tradeoffs between positive and negative attributes. We first review evidence showing that difficult tradeoff decisions generate negative affect and physiological arousal. Next, we propose that medical decision-making will be linked to short- and long-term stress and health outcomes. An ongoing line of my research thus seeks to expand upon these ideas and combine behavioral and physiological measures to investigate the interplay between stress reactivity and choice behavior, particularly in the context of health decisions (Carpenter & Niedenthal, 2018).

There has been a recent move toward the use of technology-based interventions, and particularly mobile Health (mHealth) interventions that intervene in real-time via an individual’s mobile phone or other device. Engagement is critical to increasing the efficacy of mHealth interventions, yet people frequently abandon technology-based intervention tools, such as smartphone applications, quickly and after minimal use (Eysenbach, 2005; Grist, Porter, & Stallard, 2018). A line of my ongoing research is focused on developing strategies to increase engagement in mHealth just-in-time adaptive interventions (JITAIs; cf. Carpenter, Mencitas, Nahum-Shani, Wetter, & Murphy, 2020; Nahum-Shani, Shaw, Carpenter, Murphy, & Yoon, 2022). These JITAIs are being developed to prevent and treat several health conditions across the adult lifespan, including obesity, poor oral health, chronic stress, and substance use (e.g., alcohol misuse, smoking). JITAIs adapt to an individual’s internal state (e.g., emotions) and external context (e.g., location) to intervene in real-time during moments when an individual is most likely to engage in an intervention (e.g., when feeling positive, during a lunch break, while at home). This research program currently includes the conduct of multiple Micro-Randomized trials (MRTs), which are experimental designs employed in the field to develop effective JITAIs. This program seeks to identify the emotional states under which smokers from different groups are more or less likely to engage in a cessation intervention and to develop persuasive interventions leveraging strategies grounded in decision science (Carpenter, Yap, Patrick, … & Nahum-Shani, 2022). For example, intervention messages that are framed in self-relevant ways, through highlighting a concrete charity or product that the person cares about, plausibly increase the perceived connection between the person and health behavior intervention, which in turn promotes engagement. Through identifying the conditions in which people are likely to engage in an intervention, this line of research seeks to develop efficacious interventions aimed at promoting health behavior change.

Emotional inputs are any signal to the system that indicates, either consciously or non-consciously, the presence of an affective state. These inputs include physical signals from physiological reactions, facial expressions, and body postures, among others. The goal of this research program is to examine the proposition that disrupting emotional inputs (e.g., facial expressions) leads to the inaccurate assessment of risk in a choice context, and thus meaningfully influences risk assessment (Carpenter & Niedenthal, 2020). This research also has implications for health behaviors, including when health is compromised. For instance, several neurological disorders (e.g., Bells Palsy, infection or inflammation of the facial nerve, head trauma, head or neck tumor, stroke, etc.) disrupt movement of the facial musculature and plausibly disrupt emotional inputs that rely on facial expressions. Ongoing research is currently recruiting a sample of facial nerve paralysis patients at the University of Wisconsin-Madison Facial Nerve Clinic to examine the prediction that patients with facial nerve damage will be more risk seeking. This research seeks to advance our understanding of how engagement is influenced by health-related disruptions in emotional processing (cf. Carpenter & Niedenthal, 2018; Chaiet & Carpenter, 2017).

When faced with risky decisions, people typically choose to diversify their choices by allocating resources across a variety of options. Another line of my research examines under what conditions environmental cues lead people to invest more in high-risk/high-return choice options. This work sheds light on a key process by which people manage risks (cf. Ackerman, Maner, & Carpenter, 2016).

People respond in a variety of ways to difficult choice situations (e.g., for instance, which medical treatment to choose), with some individuals feeling satisfied with their choices, while others continue to reconsider their choices long after a decision has been made. One question of interest is whether some people are more likely than others to anticipate and deal with the discomfort elicited by difficult choices. It is plausible that some people have a need or desire to reduce this discomfort and do so by using emotion regulation strategies. This research indicates that pre-decisional value change reduces choice-induced emotional discomfort by allowing an individual to change their evaluation of a choice option before making a judgment or a choice. Across three studies, we predicted and found that discomfort occurs in difficult choice situations (like those involving medical treatments), and that changing one’s values before making a choice relieves this discomfort as reflected in measures of physiological arousal and self-reports of both emotions and emotion regulation (Carpenter et al., 2016).

The emotions individuals experience when thinking about and/or interacting with outgroups strongly influences attitude formation and subsequent engagement. Recent experimental work has shown that emotions conveyed through different smiles during social dilemma games influence attitudes toward outgroup members and intentions to engage in future cooperation (Rychlowska, … Carpenter, & Manstead, 2021). An important ongoing direction of my research investigates how the physiological experience of stress and other negative emotions influence these engagement processes in health domains (Carpenter & Niedenthal, 2018).

Understanding how emotions and self-regulation influence behavior across the adult lifespan are also topics of growing interest. To investigate this, one project has examined the impact of induced mild positive feelings on working memory and complex decision-making among older adults. Results indicated that older adults in a positive mood state chose better on a risky decision task than neutral feeling participants and earned more money overall. Participants in the positive-feeling condition also demonstrated improved working-memory capacity. These effects of positive-feeling induction have implications for emotion theory and practical implications for people of all ages dealing with complex decisions (Carpenter, Peters, Vastfjall, & Isen, 2013).

Situations that involve a creative outcome, such as selecting items for recipe creation or home improvement projects, are common in daily life. When making these choices people of all ages are exposed to complex and busy environments (e.g., supermarkets, doctor’s offices) where they must regulate their attention to inhibit a vast amount of distracting information to stay focused on the task at hand. Drawing from past research suggesting that distracting information can prime older adults with concepts that improve cognitive flexibility and convergent thinking (Kim, Hasher, & Zacks, 2007), and that divergent thinking is enhanced by attending to distracting information (Kasof, 1997), another ongoing program of research examines how a vulnerability to distracting information may lead to greater creativity in older than younger adults (Carpenter, Chae, & Yoon, 2020). My ongoing explorations of aging build upon this existing research to investigate how emotions and cognitive factors influence when adults of all ages, including older adults (aged 65+) engage in behaviors that impact their health and well-being. This includes identifying strategies to help engage older adults in health behavior change interventions that promote healthy lifestyle choices.