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Making Intelligent Decisions the ability to make the right decision should (by definition) free consumers from a great deal of regret anxiety 38 weeks pregnant discount 300 mg eskalith overnight delivery. However depression blood test developed generic eskalith 300mg mastercard, because the "right" option is not always readily apparent when one faces a decision depression zine generic eskalith 300 mg line, the human psyche has developed highly intelligent methods for determining the best answer depression symptoms more common in adults purchase 300 mg eskalith, such as cost-benefit analyses anxiety attack help cheap eskalith 300 mg with visa. The agentic self must oversee the active parts of the decision making process depression definition for history generic 300 mg eskalith overnight delivery, such as problem solving, but it is not involved in automatic information processing actions such as categorization. Indeed, one review of the problem solving literature (Crinella & Yu, 2000) concluded that almost all problem solving requires executive functioning. On that basis, Schmeichel, Vohs, and Baumeister (2003) proposed that the logical style of problem solving, with its inefficient manner but highquality output, would be deeply related to self-regulatory resources. The fewer resources people have, they predicted, the worse they would be able to solve problems. Another experiment tested the idea that only higher-order, intelligent processing would be interrupted by self-regulatory resource depletion by including a task that required a rudimentary mental task as well one that needed more advanced thinking. As expected, self-regulatory resource depletion condition related to ability to correctly work out the answers to the reading comprehension questions but was unrelated to memorization skills. A series of studies by Amir, Dhar, and Baumeister (2005/unpublished) had participants first undergo a brief depletion manipulation and then confront one of several standard decision problems. The results suggested that ego depletion brought on by brief acts of self-control can shift decision making toward simpler, lazier, and more superficial styles of decision making. First, depleted participants seem less inclined to face up to tradeoffs in a cognitively complex, integrative manner. Simonson (1989) proposed that choosing a compromise option requires more cognitive work than simply choosing an extreme one, because the compromise requires the person to process multiple, conflicting criteria and trade some degree of one for some measure of the other. Second, depleted participants showed a stronger version of the asymmetric dominance effect (also called the attraction effect; Huber, Payne, & Puto, 1982). This effect can be understood in the context of a decision problem that has both an easy and more difficult choice. That is, it is a choice between three options, two of which are quite different in specific attributes but similar in overall quality (hence the difficult choice), and the third is a decoy that is clearly inferior to one of the other options on all attributes (the easy choice). Depleted participants avoided the difficult choice by letting the easy decision stand in for the difficult one as well. In other words, depleted participants were more likely than others to pick the item that was superior to the decoy. Third, depleted participants were more likely than others to choose to do nothing. In this pair of studies, participants were asked to choose between two products. The bottom line is that making decisions can be an effortful, thoughtful task in which the various product options and attributes are carefully weighed and compared-but this sort of decision process requires considerable resources. They become more prone to biases, and they also become more prone to choose not to choose anything. When consumers inhibit impulses or force themselves to do what they do not want to do, they will be less prepared to make rational decisions, especially under circumstances of complex layers of information. Decision making, then, is more than a function of opportunity or willingness, this research implies, but also executive functioning ability. In the current section, we look at the opposite side of that equation, whether making choices affects subsequent self-control. Recall that we described the relationship between decision making and self-regulation as related to their constituency as components of executive control. To be clear, by decision making we mean the type of active, option-weighing, high-level processing that was studied in the work by Schmeichel et al. Willfully engaging in control over oneself would seem to naturally relate to exerting control over the environment in the form of making choices. Extant findings suggest that although people generally like the idea that they have control over their life outcomes, at the time same people may find making choices onerous. In 2003 Starbucks boasted that each store offered consumers over 19,000 beverage "possibilities" and that the number was growing with the introduction of their new superheated option. The rational choice model would likely say that having more options is better for consumers because each option increases the potential for preference-matching. Although this may be true relative to conditions under which no options are available, more likely is that people today view the proliferation of choice with distress, resulting in what Schwartz (2000) refers to as "the tyranny of freedom. Their research included eight studies that converged on the conclusion that making choices depletes self-regulatory resources. In one study participants made a series of binary choices between different versions of household products. For instance, participants in the choice condition were asked to choose between different colors of t-shirts, different colors of socks, and differently-scented candles. Participants in the no-choice condition were asked to give their opinions on eight advertisements taken from popular magazines. Thus, participants in both conditions were asked to evaluate the stimuli and engage in detailed thought processing, but only in the binary choice condition did participants render a decision. For the second task, participants were taken to a second room with a new experimenter and asked to hold their arm in a tank of freezing cold water for as long as they could (the cold pressor task). As would be predicted on the basis of a limited-resource model of self-control, participants who had previously made decisions were less able than were participants who had not had to make choices to keep their arm submersed in icy cold water. A second experiment that also used this manipulation found that participants in the choice condition, as opposed to no-choice condition, procrastinated longer when they could have been studying for an upcoming intelligence test. Afterwards, they attempted to solve unsolvable puzzles (in one study) or were asked to perform mathematic problems (in another study). In line with the previous findings, these experiments showed that participants who made decisions about how the course should be run persisted less at the subsequent puzzle, as well as attempted fewer math problems and got fewer correct, as compared to participants who only evaluated aspects of the course. There were several confounds with the laboratory experiments, namely the idea that being in the choice condition primed the idea of choices, which led to participants in that condition being more aware of their ability to choose to stop the second task. Then they asked the same shoppers to complete as many 3 digit + 3 digit addition problems as they could. A second experimenter surreptitiously recorded the length of time spent on the math problems, and this measure in addition to number of problems attempted was the indicator of self-control ability. As expected, shoppers who said that they had made many active choices were less persistent at the math problems, both in terms of number of problems attempted and duration, than were shoppers who said they had made fewer choices. This effect held even when statistically controlling for amount of time spent shopping and other pertinent variables such as age and gender. Given that all shoppers were exposed to the same scale that would have primed them with the same choice-related concepts, it is unlikely that a simple priming effect could explain the naturalistic experiment. In other words, this field study showed that compared to consumers who had consumers who had made fewer choices during their shopping trip, those who had made multiple choices were less able to engage in the selfcontrol needed to persevere at tedious math problems in the middle of a shopping mall. In short, because the executive aspect of the self is involved in both decision making and controlled processes, the two functions are intimately related. The assumption is that self-regulatory resources grease the wheel for both decision-making processes and controlled processes to operate smoothly. If there are fewer self-regulatory resources due to decision making, self-regulation will be crippled; and, as we saw earlier, if there are fewer self-regulatory resources because of more basic acts of self-control, decision making will be poorer. Studies showing how easily goal attainment can be thwarted hint at the preciousness and fragility of self-regulatory resources. If people see that their current state is discrepant from their desired goal state, they may engage in behavior to try to meet their goal. In order to be effective at producing behavior change, goals should be specific, consistent, and attainable. People need to be motivated to change, and see themselves as capable of changing, in order for effective self-regulation to occur. A breakdown in monitoring is a key reason why goals are not met, and improved monitoring is one of the best ways to improve self-control in all spheres. Willpower or self-control strength is necessary to bring behavior in line with the standard. Self-control functions like a muscle that can be depleted with use but strengthened over time. Self-regulation is governed and limited by a finite supply of energy or strength that is used for all controlled responses and actions (as well as for other executive functions, such as making choices). Engaging in one self-control task leaves less energy available for subsequent self-control tasks. Self-control can affect consumers in areas as varied as eating, spending, and making choices and decisions (including purchasing decisions). If people have to restrain their eating when they are hungry for dietary or other reasons, they use some of their self-control energy and thus have less of this resource available subsequently to engage in other self-control tasks. Likewise, people who engage in initial acts of self-control may be less able to control their eating. People whose selfregulatory capacity is reduced by engaging in self-control tasks of various kinds are more likely to make subsequent impulsive purchases and to choose self-indulgent products than people whose self-control was not depleted. Self-regulatory resource depletion brought on by brief acts of self-control was found to impair intelligent thought and shift decisions toward simpler, lazier, and more superficial styles of decision making. This research implies that decision making is more than just a function of opportunity or willingness; decision making is also executive functioning ability. Not only does engaging in self-control affect subsequent decision making, but decision making can affect self-control as well. Active decision making can render subsequent self-control less successful due to its depleting effect on self-regulatory resources. Self-regulatory resources provide the energy for both active decision making and a wide variety of self-control tasks. Although the original research compared obese versus nonobese consumers, Herman, Olmstead, and Polivy (1983) revolutionized research on eating with their insight and empirical data showing that chronic dieting is the driver of most of the effects found between obese and nonobese participants, due to the fact that the obese people were very often chronically dieting. Goal-striving and the implementation of goal intentions in the relation of body weight. Obesity, externality, and susceptibility to social influence: An integrated analysis. Long-term follow-up of behavioral treatment for obesity: Patterns of weight regain among men and women. Intellectual performance and ego depletion: Role of the self in logical reasoning and other information processing. When goals are counter-productive: the effects of violation of a behavioral goal on subsequent performance. Perfectionism, perceived weight status, and self-esteem interact to predict bulimic symptoms: A model of bulimic symptom development. Self-regulation and self-presentation: Regulatory resource depletion impairs impression management and effortful self-representation depletes regulatory resources. Self-regulation and the extended now: Controlling the self alters the subjective experience of time. Perfectionism, body dissatisfaction, and self-esteem: An interactive model of bulimic symptom development. Adaptive self-regulation of unattainable goals: Goal disengagement, goal re-engagement, and subjective well-being. Yet, between the daily activities of consumers and the ultimate ends to which they aspire there is a vast terrain in which more specific and mundane goals and affect provide direction and energy to behavior. That is, we focus on the motivational and volitional properties of goals and the interplay between goals and affect in consumer behavior. Proposing that consumer behavior is goal-directed seems like arguing that water is wet. Surprisingly, however, even though motivational and volitional concepts abound in the marketing literature, systematic research on goal-directed consumer behavior has been lacking. For example, both abstract goals such as values (Kahle, Beatty, & Homer, 1986; Kamakura & Novak, 1992) and concrete goals important in decision making and information processing (Bettman, 1979; Bettman, Luce, & Payne, 1998; Keller, 1987; see also Fishbach & Dhar, this volume) have been examined. If behaviors such as the purchase of routine products are thought of as the pursuit of simple, unproblematic goals, then attitude-behavior models may be interpreted as models of goal-directed behavior. In fact, these models have often been applied to situations in which the behavior is actually a more long-term, complex goal, such as losing weight (see the review by Sheppard, Hartwick, & Warshaw, 1988). In general, however, understanding goal-directed consumer behavior has not been emphasized in consumer research. Research on affect has a longer tradition in the study of consumer behavior (Bagozzi, Gopinath, & Nyer, 1999; Cohen, Pham, & Andrade, chapter 11, this volume). However, despite the clear linkages between the goals of consumers and the affect they experience, there is little literature on the interface between affect and goal-directed behavior (Bagozzi et al. The chapter focuses on goals that are selected in a reflective manner and pursued consciously, although we acknowledge that there are important and frequent automatic, nonconscious influences on goal pursuit (Chartrand & Bargh, 2002; see also Fishbach & Dhar, chapter 24, this volume). We start with a discussion of important issues related to goals and goaldirected behavior in general. We then turn to affect, distinguishing between endogenous (integral, task-relevant) and exogenous (incidental, ambient) affective influences and considering various functions of affect in goal pursuit. Goals differ from other motivational constructs, such as needs and drives, because they tend to be more concrete and domain-specific, thus exerting a stronger influence on particular consumer behaviors. Although, in the final analysis, high-level goals, such as trying to be independent, converge with terminal values, such as the importance of freedom, goals normally differ from values because they direct and energize behavior actively, rather than merely providing abstract evaluative criteria for appraising objects, events, or actions. Goals are relevant if an attempt to attain a desirable state can fail, or if consumers need to sacrifice something in order to get what they want. Turning off the air conditioner is usually not a goal but an act, but it becomes a goal when it is steaming hot outside and the consumer desires to be environmentally friendly. Following other goal theories, we assume that many of the interesting consumer behaviors are organized around the pursuit of goals, that goals are hierarchically structured from lower to higher levels, that goal-directed behavior is characterized by effort expenditure and persistence in the face of temptations and interruptions, and that goals are accessible to conscious awareness, although they need not always be top-of-mind during goal pursuit (Austin & Vancouver, 1996; Emmons, 1996; Locke & Latham, 1990). Before discussing how goal pursuit takes place, we examine goal features and goal structure. First, we discuss several goal features that characterize and distinguish the goals that consumers pursue.

I often made decisions or embarked upon courses of action bipolar mood disorder journal best 300mg eskalith, without adequate preparation mood disorder unspecified dsm v discount eskalith 300mg without prescription, without considering all the risks involved anxiety hotline order 300 mg eskalith with mastercard, and the best possible alternative depression anger test purchase 300 mg eskalith. But after I had set the wheels in motion anxiety light headed eskalith 300mg mastercard, so to speak depression prevalence 300 mg eskalith with visa, I continually worried over how it would come out, whether I had done the right thing. I not only feel better, sleep better, and work better, but my business is running much smoother. For example, I used to worry and fume about having to go to the dentist, and other unpleasant tasks. If the unpleasantness is all that important to cause so much concern, and not worth the worry involved, you can simply decide not to go. But, if the decision is that the trip is worth a little unpleasantness, and a definite decision is made to go-then forget about it. If the decision is made to go through with it-not to run away physically-why mentally keep considering or hoping for escape. I used to detest social gatherings and go along only to please my wife, or for business reasons. I went, but mentally I resisted it, and was usually pretty grumpy and uncommunicative. Then I decided that if the decision was to go along physically, I might as well go along mentally-and dismiss all thought of resistance. Last night I not only went to what I would formerly have called a stupid social gathering, but I was surprised to find myself thoroughly enjoying it" 2. Consciously practice the habit of "taking no anxious thought for tomorrow," by giving all your attention to the present moment. Your creative mechanism can respond appropriately and successfully to present environment-only if you have your full attention upon present environment-and give it information concerning what is happening now. Your creative mechanism will react appropriately in the "now" if you pay attention to what is happening now. William Osier said that this simple habit, which could be formed like any other habit, was the sole secret of his happiness and success in life. If you have not read his excellent little essay, "A Way of Life," in which he describes the advantages of this habit, I urge you to do so. What sights, sounds, odors are present in your environment right now that you are not conscious of? The American Indian and the early pioneers had to be alert to the sights and sounds and feels in their environment in order to survive. So does modern man, but for a different reason: Not because of physical dangers, but because of the dangers of "nervous disorders" which come from confused thinking, from failure to live creatively and spontaneously, and to respond appropriately to environment. This becoming more aware of what is happening now, and attempting to respond only to what is happening now, has almost magical results in relieving the "jitters. Keep constantly in mind that the job of your creative mechanism is to respond appropriately to present environment-here and now. Many times, if we do not "stop and think" about this, we continue to react automatically to some past environment. We do not react to the present moment, and the present situation, but to some similar event out of the past. Without realizing it, he was attempting to react to some environment out of his past where "groups of people" were a significant factor. Now, one factor in the situation "groups of people"-was reacted to as if it were the entire past situation. When he was able to "see" that he was "acting as if" he were a 10-year-old schoolboy, as if every gathering was an elementary school class, and as if every group leader was the cruel school teacher, his anxiety disappeared. Other typical examples are the woman who responds to every man she meets "as if" he were some individual man out of her past; the man who reacts to every person in authority "as if" he were some individual authority out of his past 3. Another cause of confusion, and the resulting feelings of nervousness, hurry, and anxiety, is the absurd habit of trying to do many things at one time. The businessman, instead of concentrating upon and only trying to "do" the one letter that he is presently dictating, is thinking in the back of his mind of all the things he should accomplish today, or perhaps this week, and unconsciously trying mentally to accomplish them all at once. The habit is particularly insidious because it is seldom recognized for what it is. When we feel jittery, or worried, or anxious in thinking of the great amount of work that lies before us, the jittery feelings are not caused by the work, but by our mental attitude-which is "I ought to be able to do this all at once. When we work with this attitude, we are relaxed, we are free from the feelings of hurry and anxiety, and we are able to concentrate and think at our best. He had found, through many years of counselling, that one of the main causes of breakdown, worry, and all sorts of other personal problems, was this bad mental habit of feeling that you should be doing many things now. Just as only one grain of sand could pass through the hourglass, so could we only do one thing at a time. It is not the job, but the way we insist upon thinking of the job that causes the trouble. Gilkey, because we form a false mental picture of our duties, obligations and responsibilities. There seem to be a dozen different things pressing in upon us at any given moment; a dozen different things to do; a dozen different problems to solve; a dozen different strains to endure. No matter how hurried or harried our existence may be, said Dr, Gilkey, this mental picture is entirely false. Even on the busiest day the crowded hours come to us one moment at a time; no matter how many problems, tasks or strains we face, they always come to us in single file, which is the only way they can come. To get a true mental picture, he suggested visualizing an hourglass, with the many grains of sand dropping one by one. This mental picture will bring emotional poise, just as the false mental picture will bring emotional unrest. Just as an electronic brain cannot give the right answer if three different problems are mixed up and fed in at the same time, neither can your own success mechanism. The shoemaker found that if he cut out the leather, and laid out the patterns before retiring, little elves came and actually put the shoes together for him while he was sleeping. Edison has said that each evening her husband would go over in his mind those things which he hoped to accomplish the next day. Sometimes, he would make a list of the jobs he wanted to do, and problems which he hoped to solve. Bechterev said, "It happened several times when I concentrated in the evening on a subject which I had put into poetic shape, that in the morning, I had only to take my pen and the words flowed, as it were, spontaneously, I had only to polish them later. Joseph Rossman, in the Psychology of Invention, says, "When stumped by something, he would stretch out in his Menlo workshop and, halfdozing, get an idea from his dream mind to help him around the difficulty. Priestley dreamed three essays, complete in every detail-"The Berkshire Beast," "The Strange Outfitter," and "The Dream. He kept a number of ideas "hatching" and each night before retiring would select an "incubating idea" and "stir it up" by thinking intensely about it. Vic Pocker arrived in this country from Hungary with no money and unable to speak English. His savings were wiped out in the depression, put in 1932 he started a small welding shop of his own, which he called Steel Fabricators. Practice Exercise: In Chapter Four you learned how to induce physical and mental relaxation while resting. Continue with the daily practice in relaxation and you will become more and more proficient. In the meantime, you can induce something of "that relaxed feeling," and the relaxed attitude, while going about your daily activities, if you will form the habit of mentally remembering the nice relaxed feeling that you induced. Stop occasionally during the day, it need only take a moment, and remember in detail the sensations of relaxation. Sometimes forming a mental picture of yourself lying in bed, or sitting relaxed and limp in an easy chair helps to recall the relaxed sensations. Mentally repeating to yourself several times, "I feel more and more relaxed," also helps. You will be surprised at how much it reduces fatigue, and how much better you are able to handle situations. For by relaxing, and maintaining a relaxed attitude, you rewove those excessive states of concern, tension and anxiety, which interfere with the efficient operation of your creative mechanism. In time, your relaxed attitude will become a habit, and you will no longer need to consciously Practice it. Happiness is Good Medicine Happiness is native to the human mind and its physical machine. We think better, perform better, feel better, and are healthier when we are happy. He found that when thinking pleasant thoughts they could see better, taste, smell and hear better, and detect finer differences in touch. William Bates proved that eyesight improves immediately when the individual is thinking pleasant thoughts, or visualizing pleasant scenes. Margaret Corbett has found that memory is greatly improved, and that the mind is relaxed, when the subject is thinking pleasant thoughts. Harvard psychologists studied the correlation between happiness and criminality and concluded that the old Dutch proverb, "Happy people are never wicked," was scientifically true. They found that a majority of criminals came from unhappy homes, had a history of unhappy human relationships. A ten-year study of frustration at Yale University brought out that much of what we call immorality and hostility to others is brought about by our own unhappiness. Schindler has said that unhappiness is the sole cause of all psychosomatic ills and that happiness is the only cure. It appears that in our popular thinking about happiness we have managed to get the cart before the horse. Happiness is not a moral issue, any more than the circulation of the blood is a moral issue. Happiness is simply a "state of mind in which our thinking is pleasant a good share of the time. One of the most pleasant thoughts to any human being is the thought that he is needed, that he is important enough to help and add to the happiness of some other human being. However, if we make a moral issue out of happiness and conceive of it as something to be earned as a sort of reward for being unselfish, we are very apt to feel guilty about wanting happiness. Happiness comes from being and acting unselfishly-as a natural accompaniment to the being and acting, not as a "pay off" or prize. If we are rewarded for being unselfish, the next logical step is to assume that the more self-abnegating and miserable we make ourselves, the more happy we will be. The premise leads to the absurd conclusion that the way to be happy is to be unhappy. If there is any moral issue involved it is on the side of happiness rather than unhappiness. It but fastens and perpetuates the trouble which occasioned it, and increases the total evil of the situation. I have found that one of the commonest causes of unhappiness among my patients is that they are attempting to live their lives on the deferred payment plan. They do not live, nor enjoy life now, but wait for some future event or occurrence. They will be happy when they get married, when they get a better job, when they get the house paid for, when they get the children through college, when they have completed some task or won some victory. Riches and honors, power and pleasure, have waited on my call, nor does any earthly blessing appear] to have been wanting to my felicity. In this situation, I have diligently numbered the days of pure and genuine happiness which have fallen to my lot; they amount to fourteen. But we can, by taking thought, and making a simple decision, be happy and think pleasant thoughts a large share of the time, regarding that multitude of little events and circumstances of daily living which now make us unhappy. To a large extent we react to petty annoyances, frustrations, and the like with grumpiness, dissatisfaction, resentment and irritability, purely out of habit. Much of this habitual unhappiness-reaction originated because of some event which we interpreted as a blow to our self-esteem. Even impersonal events can be interpreted, and reacted to , as affronts to our self-esteem. The bus we wanted to catch had to be late; it had to go and rain when we had planned to play golf; traffic had to get into a snarl just when we needed to catch the plane. They act like sheep-as if they were slaves, and meekly react as they are told to react. You are letting outward events and other people dictate to you how you shall feel and how you shall react. Later, I was told I could never take post-graduate courses in Germany, and that it was impossible for a young plastic surgeon to hang out his own shingle and go into business for himself in New York. I did all these things-and one of the things that helped me was that I kept reminding myself that all these "impossibles" were opinions, not facts. I not only managed to reach my goals-but I was happy in the process-even when I had to pawn my overcoat to buy medical books, and do without lunch in order to purchase cadavers. But I kept reminding myself that it was merely my opinion that this was a "catastrophe" and that life was not worth living. I not only got over it, but it turned out that it was one of the luckiest things that ever happened to me. The Attitude That Makes for Happiness It has been pointed out earlier that since man is a goalstriving being, he is functioning naturally and normally when he is oriented toward some positive goal and striving toward some desirable goal. Happiness is a symptom of normal, natural functioning and when man is functioning as a goal-striver, he tends to feel fairly happy, regardless of circumstances. He maintained an aggressive attitude, he was still goal-oriented despite his misfortune. Hollingworth has said that happiness requires problems, plus a mental attitude that is ready to meet distress with action toward a solution. Refuse to admit their badness; despise their power; ignore their presence; turn your attention the other way; and so far as you yourself are concerned at any rate, though the facts may still exist, their evil character exists no longer.

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Azelaic acid is a natural product of Pityrosporum ovale depression knee pain order eskalith 300 mg with amex, and has both antibacterial and anti-keratinizing activity depression chinese definition purchase 300mg eskalith free shipping. Tissue binding is high and it is eliminated over a period of at least one month after treatment has been discontinued anxiety medication for dogs buy eskalith 300 mg lowest price. This explains the ongoing clinical benefit after stopping drug therapy and also the persistent risk of teratogenicity after a course of treatment mood disorder group curriculum cheap eskalith 300mg without a prescription. It is given orally for severe acne or rosacea and should only be prescribed under hospital supervision mood disorder genetic discount eskalith 300 mg with mastercard. Mechanism of action the primary action of retinoids is inhibition of sebum production anxiety shortness of breath generic eskalith 300mg, reducing the size of the sebaceous glands by 90% in the first month. These drugs also inhibit keratinization of the hair follicle, resulting in reduced comedones. Drug interactions There is an increased incidence of raised intracranial pressure if isotretinoin is prescribed with tetracyclines. Approximately 30% of subjects respond within 4ͱ2 months, but hair loss recurs once therapy is discontinued. In women, cyproterone acetate combined with ethinylestradiol prevents the progression of androgenic alopecia. The anti-androgen activity (both central and peripheral) of cyproterone acetate makes it the systemic drug of choice for female hirsutism, if topical depilation has failed or the hirsutism is too general. It is given with ethinylestradiol to prevent pregnancy (feminization of the fetus). Eflornithine, an irreversible inhibitor of ornithine decarboxylase, is a topical cream licensed for female facial hirsutism. Contraindications Systemic use of any vitamin A analogue is contraindicated in pregnant or breast-feeding women. No Topical glucocorticosteroid (systemic if exfoliative) Continue till improved Healing? Management of atopic eczema should include avoidance of trigger factors and the use of emollients. Dry skin is a major factor and emollients should be used when bathing and applied as often as necessary. E45 or Alpha Keri) is usually all that is necessary for dry, fissured scaly lesions. Inflammation should be treated with short courses of mild to moderate topical glucocorticosteroids. A more potent glucocorticosteroid may be required for particularly severely affected areas or for a more general flare up. Potassium permanganate solution can be used in exudating eczema for its antiseptic and astringent effect; treatment should be stopped when weeping stops. Weeping eczema may require topical glucocorticosteroids and often antibiotics to treat secondary infection. Immunosuppressant therapy, such as ciclosporin, is sometimes effective in severe, resistant eczema. Scalp seborrhoeic dermatitis is often improved by coal tar, salicylic acid and sulphur preparations. Avoidance of precipitating factors, emollients and topical glucocorticosteroids are used. They include hydrocortisone and its fluorinated semi-synthetic derivatives, which have increased anti-inflammatory potency compared to hydrocortisone (Chapter 40). Topical glucocorticosteroids are widely used and effective in treating eczema, lichen planus, discoid lupus erythematosus, lichen simplex chronicus and palmar plantar pustulosis, but rarely in psoriasis. The symptoms of eczema are rapidly suppressed, but these drugs do not treat the cause. The lowest potency glucocorticosteroid preparation that will control the disease is preferred. Occlusive dressings should be used only in the short term (two to three days) and increase potency considerably. Potent fluorinated glucocorticosteroids should not be used on the face because they cause dermatitis medicamentosa. Many preparations are available, some of which are listed in descending order of anti-inflammatory potency in Table 51. The skin lesions are characterized by epidermal thickening and scaling due to increased epidermal undifferentiated cell proliferation with abnormal keratin. Topical and systemic steroids are reserved for cases that do not respond to these simple remedies and their use should be monitored by a specialist, as they can worsen the disease in some patients. Occasionally refractory cases justify immunosuppression with methotrexate (Chapters 48 and 50), but chronic use can cause cirrhosis. Potential recipients need to be warned about this and their liver function must be monitored meticulously. Ciclosporin is an alternative (Chapter 50), but causes hypertension and nephrotoxicity. Regular monitoring of blood pressure and plasma ciclosporin concentration is essential. Recently, the use of biological agents (alefacept, etanercept, efalizumab, infliximab) has been found to produce good remissions in otherwise refractory psoriasis (see Table 51. Secondline therapies (phototherapy or systemic drugs) should only be used under the supervision of a dermatologist. Vitamin D receptors are present in keratinocytes, T and B lymphocytes and dermal fibroblasts of psoriatics, and the stimulation of vitamin D receptors on keratinocytes inhibits proliferation and differentiation. Adverse effects include local irritation, facial and perioral dermatitis, and possible hypercalcaemia and hypertriglyceridaemia if used too extensively. Psoralen is taken orally two hours before phototherapy, or applied topically immediately before phototherapy; the usual course lasts for four to six weeks. Technological advances in psoralens and Adverse effeccts of cutaneoulsly applied glucocorticosteroids these include the following: נhypothalamicΰituitaryΡdrenal suppression where very potent drugs are used long term on large areas of skin or when systemic absorption is increased under occlusive dressing; נspread of local infection ͠bacterial or fungal; נatrophic striae; נdepigmentation and vellus hair formation; נperioral dermatitis when applied to the face; נrebound exacerbation of disease. Yes No Salicylic acid topically, or Coal tar topically, or Dithranol topically Continue as necessary Improving? Phototherapy combined with coal tar, dithranol, vitamin D or vitamin D analogues allows reduction of the cumulative dose of phototherapy required to treat psoriasis. It is given orally for the treatment of severe resistant or complicated psoriasis and other disorders of keratinization. A therapeutic effect occurs after two to four weeks, with maximal benefit after six weeks. Because it is highly teratogenic, women must take adequate contraceptive precautions for one month prior to and during therapy and for two years after stopping the drug. Unlike its parent compound, etretinate, acetretin is not highly bound to adipose tissue. Its elimination t1/2 is shorter than that of the parent drug, but even so pregnancy must be avoided for two years after stopping treatment. Impetigo or infected eczema is treated topically for no more than two weeks with antimicrobial agents. Chapter 45 gives a more detailed account of the clinical pharmacology of antifungal drugs. Drug interactions Drug interactions include the following: נConcomitant therapy with tetracycline increases the risk of raised intracranial pressure. Fungal skin infection Candida infection of the skin, vulvovaginitis or balanitis Drug therapy Topical antifungal therapy with nystatin cream (100 000 units/g) or ketoconazole 2%, clotrimazole 1% or miconazole 2% cream Comment Alternative topical agents are terbinafine 1% or amorolfine 0. Consider underlying diabetes mellitus Fungal nail infections, onychomycosis dermatophytes Griseofulvin, 10 mg/kg daily for 6ͱ2 months, or alternatively fluconazole, 200 mg daily for 6ͱ2 months If systemic therapy is not tolerated, tioconazole 28% is applied daily for 6 months. Topical amorolfine 5% is an alternative Severe cases may require additional topical ketoconazole 2% or clotrimazole 1% Pityriasis capitis, seborrhoeic dermatitis (dandruff) Topical steroids ͠clobetasol propionate 0. The clinical presentation of an adverse cutaneous drug reaction is seldom pathognomonic and may vary from an erythematous, macular or morbilliform rash to erythema multiforme. However, immunologically mediated reactions may take months to become clinically manifest. Contact dermatitis is usually eczematous and is most commonly seen with antimicrobial drugs or antihistamines. The diagnosis of a drug-induced cutaneous reaction requires an accurate drug history from the patient, especially defining the temporal relationship of the skin disorder to concomitant drug therapy. In milder cases and fixed drug eruptions, re-administration (rechallenge) with the suspect agent may be justified. The treatment of drug-induced skin disorders involves removing the cause, applying cooling creams and antipruritics, and reserving topical steroids only for severe cases. Systemic aciclovir therapy is required for buccal and vaginal herpes simplex Comment Topical penciclovir (2% cream) is an alternative for recurrent orolabial herpes. Systemic valaciclovir or famciclovir are new alternatives to aciclovir For plantar warts use 1. The reaction is like severe sunburn and the threshold returns to normal when the drug is discontinued. Photoallergy (like drug allergy) is a cell-mediated immune reaction that only occurs in certain individuals, is not dose related and may be severe. These reactions are usually eczematous, and may persist for months or years after withdrawal of the drug. Key points נTreatment of skin disorders depends on accurate diagnosis; steroids are not useful for all rashes and indeed may cause harm if used inappropriately. Acne is treated first line with keratolytics; if systemic antibiotics are indicated, use oral oxytetracycline or erythromycin (but do not use tetracyclines in children under 12 years). In eczema, it is important to identify the causal agent and minimize/eradicate exposure if possible. For dry, scaly eczema, use emollients plus a keratolytic; for wet eczema use drying lotions or zinc-medicated bandages. Topical glucocorticosteroids are often required, but do not use high-potency glucocorticosteroids on the face. Use the lowest potency steroid for the shortest time possible required to produce clinical benefit. Although glucocorticosteroids are effective, tachyphylaxis occurs, and on withdrawal pustular psoriasis may appear. She is started on a seven-day course of co-trimoxazole, two tablets twice a day, as she has a history of penicillin allergy with urticaria and wheezing. By the following morning she feels much worse, with itchy eyes, has had fevers overnight and is complaining of arthralgia and buccal soreness, and is seen by her community physician. He notes conjunctivitis, with swollen eyelids, soreness and ulceration on her lips and buccal and vaginal mucosa. She has a generalized maculo-papular rash which involves her face and has become confluent in areas on her abdomen and chest, and there is evidence of skin blistering and desquamation on her chest. Answer the most likely diagnosis of a rapidly progressive generalized body rash involving the eyes, mouth and genitalia with systemic fever and early desquamation is erythema multiforme-major (Stevens Johnson syndrome, see Chapter 12, Figures 12. The most common causes of this syndrome are viral infections, especially herpes virus, drugs and (less frequently) systemic bacterial infections, such as meningitis, nephritis and streptococcal infection. In this patient the most likely aetiology is that she is taking co-trimoxazole, which contains 400 mg of sulphamethoxazole and 80 mg of trimethoprim per tablet. Stopping the offending agent is the most important part of her initial management. Her further management should include admission to hospital for intravenous fluids to maintain hydration, supportive care for the skin in order to minimize further desquamation and secondary infection with sterile wet dressings and an aseptic environment, analgesia if necessary, and maintenance and monitoring of her hepatic and renal function. If her condition is very severe, the patient may need to be transferred to a burns unit. Short courses of high-dose glucocorticosteroids early in the disease have been recommended, but controlled clinical studies have not demonstrated the benefit of glucocorticosteroids in this condition. The disease may progress for up to four or five days and recovery may take from one to several weeks. The mortality rate for Stevens Johnson syndrome is 5%, but increases to about 30% if the diagnosis is toxic epidermal necrolysis with more extensive desquamation. The structures of the eye itself are divided into the anterior and posterior segments. The posterior segment consists of the sclera, choroid, retina, vitreous and optic nerve. The ocular secretory system is composed of the main lacrimal gland located in the upper outer orbit, and accessory glands located in the conjunctiva. Parasympathetic innervation is relevant in that many drugs with anticholinergic side effects cause the symptom of dry eyes (see Table 52. Tear drainage starts through small puncta located in the medial aspects of the eyelids. Blinking causes tears to enter the puncta and drain through the canaliculi, lacrimal sac and nasolacrimal duct into the nose. The nose is lined with highly vascular epithelium which permits direct access of absorbed drugs to the systemic circulation. Consequently, even though the dose administered as eye drops is much smaller than the usual dose of the same drug. At the pupillary margin, the sphincter smooth muscle is organized in a circular orientation with parasympathetic innervation which, when stimulated, leads to pupillary constriction (miosis) (see Table 52. The ciliary body serves two specialized functions, namely secretion of the aqueous humour and accommodation. Parasympathetic stimulation contracts the ciliary muscle and allows the lens to become more convex, focusing on near objects.

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Embarrassment in consumer purchase: the roles of social presence and purchase familiarity depression screening test goldberg discount eskalith 300mg fast delivery. The scope and persistence of mere-measurement effects: Evidence from a field-study of customer satisfaction measurement mood disorder secondary to tbi eskalith 300mg line. Self-generated validity and other effects of measurement on belief anxiety 504 plan buy eskalith 300 mg without a prescription, attitude depression test after baby buy cheap eskalith 300mg, intention and behavior depression symptoms test online order 300 mg eskalith free shipping. Diminished lifetime substance use over time: An inquiry into differential underreporting depression definition mayo clinic discount 300 mg eskalith with visa. Using information to change sexually transmitted diseased related behaviors: An analysis based on the theory of reasoned action. Construct accessibility and depression: An examination of cognitive and affective factors. Cultural variation in unrealistic optimism: Does the West feel more invulnerable than the East? Knowledge accessibility and activation: Subjectivity and suffering from unconscious sources. Accessibility of social constructs: Information processing consequences of individual and contextual variability. Understanding high-stakes consumer decisions: Mammography adherence Following false alarm test results. Depressive realism and health risk accuracy: the negative consequences of positive mood. Increasing the persuasiveness of fear appeals: the effect of arousal and elaboration. Do messages from your body, your friends, your doctor, or the media shape your health behavior? The interaction between order effects and perceived controllability on the self-positivity bias: Implications for self-esteem. Avoiding anxiety, being in denial or simply stroking self-esteem: Why self-positivity? Gender differences in unrealistic optimism about marriage and divorce: Are men more optimistic and women more realistic? The effect of decompositional questions on judgments of frequent behaviors," Journal of Marketing Research, 34(August), 335ͳ46. Ease-of-retrieval as an automatic input in judgments: A mere accessibility framework? Strategies for formulating proxy-reports and their effects on convergence to self-reports. The effect of message framing on breast self-examination attitudes, intentions, and behavior. Context effects in the measurement of comparative optimism in probability judgments. Asking sensitive questions: the effects of type of referent and frequency wording in counterbiasing methods. Questions and answers in attitude surveys: Experiments on question form, wording, and context. Response scales: Effects of category range on reported behavior and subsequent judgments. Asking questions: A practical guide to questionnaire design, New York: Jossey Bass. Thinking about answers: the application of cognitive processes to survey methodology, New York: Jossey-Bass. Are self-enhancing cognitions associated with healthy or unhealthy biological profi les? Page Moreau University of Colorado David Glen Mick University of Virginia Understanding creativity has been one of the most vexing challenges facing psychologists over the past 50 years. But more mundanely, creativity is also evident in the toil of an individual working to customize their pickup truck, or the clever way a mother uses hair spray to remove an ink stain. In everything from vehicles and homes to clothing and a mundane fi x for a stain, creativity permeates the consumption realm. Yet few attempts have been made to translate basic observation into theoretical treatise, and even fewer attempts have been made to empirically document the role of creativity in the consumer behavior literature. Our discussion will integrate considerations of creativity from the perspectives of the product, the process, the person, and the environment, and will consider the implications of each within the consumption realm. As basic as this defi nition appears, a modern understanding of creativity has been long in coming, and at various points emphasis has been on the creative person, the creative process, and the creative environment. To appreciate the modern conceptualization of creativity and how its various facets interrelate, it is useful to trace a brief history of creativity research. By the late 18th century a great deal of effort had been expended trying to decipher the source and nature of creative genius. This interest in creativity coincided with a time of great debate over the indemnity of individual freedom versus the need for social strictures and the rule of law. Even casual observation confirmed that creative individuals often flout convention and disdain rules, which are personality characteristics that would later become hallmarks of the creative person. The question was how to encourage creativity while maintaining a semblance of order. If the Renaissance demonstrated one thing, it was that creativity could not flourish in repressive societies. The inherent tension between creative expression and social prescription would ultimately culminate in the doctrine of individualism, if not the French Revolution itself (see Albert & Runco, 1999). The debate about creativity intensified with the onset of the Industrial Revolution. Intellectuals of the day hastened to point out that individuals were increasingly being subjugated to rote tasks and undifferentiated, sprawling urban areas that stripped all manner of creativity from daily life. It is notable that these early considerations of creativity made little attempt to distinguish between its individual and social aspects, seeing them as parts of an indivisible whole. As the discussions of creativity progressed, however, the social aspects of creativity were largely lost. For the most part, the modern study of creativity has been a study of the internal workings of the individual, stripped of social context. This was not always the case, and a number of prominent psychologists have recently commented on the need to put more of the social back into the psychology of creativity (Csikszentmihalyi, 1999; Hennessey, 2003). The treatment of creativity as a formal topic of scientific investigation is a 20th century development. The first half the 20th century can be characterized as the psychodynamic period of creativity research (Sternberg & Lubart, 1999). Great paintings, epic literature, monumental structures, all were displaced attempts to quell this inveterate conflict. Interestingly, and despite the fact that this psychodynamic tension should apply to anyone, creativity continued to be largely viewed as a unique ability possessed by a gifted few (the notion that it was somehow divinely imparted did, however, fall into decline). The psychodynamic period was characterized by case studies of eminent individuals in order to try and glimpse the wellspring of creative inspiration. In his speech, Guilford asserted the incontrovertible importance of creativity to psychology (and all aspects of human functioning) and beseeched the field to do better in investigating this crucial phenomenon. Though it would be many years before the creativity research revolution Guilford envisioned would be realized, there is no doubt his speech gave creativity research a major boost. Thus, the 1950s and 1960s can be broadly characterized as the psychometric period of creativity research (Plucker & Renzulli, 1999; Sternberg & Lubart, 1999). During this time a number of creative batteries were developed, perhaps the best known of which were the Torrance Tests of Creative Thinking (1966). The development of pencil-and-paper tests that could be administered to a wide swath of the population brought the study of creativity from the domain of rarified genius to the realm of ordinary individuals. Viewing creativity as a normal cognitive process made it accessible to mainstream methods of cognitive science (Hershman & Leib, 1988). Coincidentally, the psychometric period saw the development of other psychological tests, particularly intelligence tests, so it is not surprising that considerable effort went into investigating the empirical connection between creativity and intelligence. Though some level of intelligence is necessary for creativity, it proved of surprisingly limited explanatory power (Albert & Runco, 1999). As a result, those scholars who had equated creativity with intelligence were forced to cast a wider nomological net. Analogical reasoning and metaphorical thinking emerged as possible critical links to creative insight, and the 1970s and 1980s would witness a number of important discussions on the role of figurative language in creative thought (see. During this time period social psychologists began to consider motivational aspects of creativity, finding intrinsic motivation to be particularly crucial (see. As the study of creativity branched into different areas, not surprisingly the literature became fragmented. Social psychologists focused on motivation and personality traits, cognitive psychologists on the process of creative thought, educational psychologists on the efficacy of creative education programs, and so forth. The field of psychology lacked a unifying perspective and research was accused of being atheoretical and descriptive. Moreover, despite important progress, creativity still remained an underdeveloped topic in psychology. This presents the obvious challenge of studying a phenomenon that is fluid and emergent using a methodology predicated on structure and control. Within the domain of consumer psychology, creativity was basically persona non grata to this point, save for a few pioneering researchers (Hirschman, 1980; Price & Ridgeway, 1982). In 1988, the first academic journal dedicated to empirical research on creativity was launched, the Creativity Research Journal. More than a dozen edited books on creativity were also issued in this general time period (see. What was once an obscure topic in psychology became a required chapter (if not a dedicated book) in nearly any compendium of psychological research, including research on problem solving (Lubart & Mouchiroud, 2003), motivation (Hennessey, 2000), group dynamics (Paulus & Nijstad, 2003), artificial intelligence (McDonough, 2002), and positive psychology (Nakamura & Csikszentmihalyi, 2003), and now consumer psychology. This "golden age" (Plucker & Renzulli, 1999) of creativity research produced valuable advances in the experimental procedures used to study creativity, and some of the most influential studies to date have been of the experimental variety (see Runco & Sakamoto, 1999, for a review). Ironically, advances in the experimental procedures used to study creativity have highlighted the value of other methodologies, particularly when used in tandem with experiments. The confluence perspective holds that creativity is a product of multiple, simultaneous, often interactive influences. Moreover, some studies have begun to incorporate variables from multiple domains in order to gauge relative effects on creativity in a given context. For example, Burroughs and Mick (2004) examined the interactive effects of time (an environmental constraint) with locus of control (a personality variable) and with situational involvement (a motivational variable) on creative outcomes. Though the value of a confluence perspective may seem somewhat self evident, it is important to keep in mind that for most of its history the study of creativity was a search for the "magic bullet" or allencompassing mechanism to explain it (Mumford, 2003). The potential for applying a confluence perspective to research on creativity in consumer behavior is high. Consumption is a social phenomenon exemplified by strong personal, situational, and cultural forces, often acting in unison. Both motivational and ability factors are crucial to a wide variety of consumption activities. Consumer behavior also ranges from immediate and localized problem solving to enduring and complex social exchange. It is difficult to envision a better contemporary setting for studying the spectrum of creative behaviors than consumption. This is not an idle opportunity, as researchers have repeatedly pointed out the lack of studies of creativity in real-world settings (see. There have been several recent special sessions on creativity at national consumer research conferences (see. Even more encouraging, articles explicitly dedicated to the topic of creativity have begun to appear in the leading marketing and consumer research journals (see. The rest of this chapter will be dedicated to building a confluence model of consumer creativity and highlighting opportunities for further research in this area. Thus, while researchers may focus on the creative individual or the creative process, it always comes back to the outcome produced. A creative outcome is one that provides a unique solution to a practical problem, and a huge portion of research on creativity has been conducted under the auspices of problem solving. This led researchers to specify the dimensions of creativity more broadly (and develop techniques for assessing these dimensions). The Novelty and Functionality Dimensions of Creativity It is universally accepted that, to be creative, an outcome must be novel. Novelty is usually gauged in terms the extent to which the outcome departs from what is typical or conventional in a given situation, problem, or context. In consumer behavior, novelty can bee seen in the application of a product to a purpose other than that for which it was originally intended, the alteration of a product to enhance its performance or appearance, or the combination of two or more products in a new way, perhaps to achieve functional synergies. While the functionality of an outcome is relatively easy to determine in the context of problem solving, this notion is less applicable to expressive and artistic forms of creativity. An artistic product can be functional, but this is clearly not what sets it apart as creative. Here creativity is derived from an outcome that is not only unusual, but exhibits a certain beauty, elegance, or attractiveness. Because researchers have historically tended to focus on one domain of creativity (problem solving/scientific) or the other (artistic), the question of what to label this second dimension has not been at issue. However, many acts of creative consumption contain both functional and aesthetic aspects. Changes in the appearance of a product can, and often do, arise from practical considerations, while a very practical problem can be solved in an elegant way. This led Burroughs and Mick (2004) to propose the possibility of a three-dimensional conceptualization of creativity, where the most creative acts of consumption are high in novelty, functionality, and aesthetics. Two examples help illustrate the usefulness of moving to a three-dimensional conceptualization of creative consumption. The first example highlights how creativity driven by a practical need can also have an aesthetic quality.

The first time was about 15 minutes into the class without any particular events (which established the baseline of happiness) anxiety vs heart attack purchase eskalith 300 mg free shipping. The second time was immediately after the instructor announced that he would give each student a KitKat candy bar to eat later in the class; it measured news utility anxiety 10 days before period buy 300 mg eskalith amex. The third time was about 10 minutes after the announcement of the news; it measured anticipation utility mood disorder and personality disorder cheap eskalith 300 mg without prescription. The fourth time was right after the students had received the chocolate candy and were eating it; it measured consumption utility mood disorder with anger buy generic eskalith 300 mg. The last time was some 10 minutes after the consumption; it measured memory utility depression test beyond blue generic 300 mg eskalith otc. Compared with the baseline anxiety exhaustion buy eskalith 300 mg on line, the students reported the greatest happiness when they heard the news, followed by when they ate the chocolate candy, and lastly when they anticipated and recalled the consumption. First, it shows the existence of news utility, besides consumption, anticipation, and memory utilities. Second, it shows the possibility for news to generate even greater happiness than consumption. Compared with news utility, anticipation utility has been well documented in the literature. According to traditional discounted utility theory, people should be willing to pay more for the immediate kiss than for the delayed kisses, because experiences in the future are discounted and their appeal diminish. However, Loewenstein found that respondents were willing to pay more for receiving the kiss in three days than receiving it immediately or in three hours. The net effect of the anticipated pleasure and frustrations of waiting depends on the familiarity with the consumption event and the vividness of the imagined consumption experience (Nowlis, Mandel, & McCabe, 2004). If a consumer has never visited a restaurant, she will experience less anticipated pleasure than someone who has been or who actually sits in the restaurant and waits for her dinner to be served while watching other patrons enjoy their meal. Memory of past events can influence happiness in two ways (Elster & Loewenstein, 1992). For example, a person can derive pleasure by recalling the details about her last trip to Paris. In reality, cognition utilities may comprise a large portion of the happiness from the stimulus and sometimes even larger than that of consumption utility. This is especially true if one integrates these cognition utilities over time and compares the sum (temporal integral) with the sum (temporal integral) of the consumption utility. What our Kitkat example shows is that sometimes even momentary (not-integrated) news utility may exceed momentary consumption utility. Consumption utility is like a light source, and cognition utility is like its halo. But simply increasing wealth is not sufficient; it also requires an understanding of the relationships between wealth and happiness. The second part of this chapter reviews literatures on the ability of consumers to understand such relationships and make choices that maximize happiness. First, consumers fail to accurately predict which option will bring them the best experience. Second, even if they could make accurate predictions, consumers may fail to base their choices on such predictions. In this section, we review eight specific reasons why consumers fail to maximize happiness: the first four are related to failure to make accurate predictions and the last four are related to failure to follow predictions about consumption experience. Gilbert, DriverLinn, and Wilson (2002) refer to this type of misprediction as impact bias (see also Wilson & Gilbert, 2003). As we reviewed earlier, when an emotion-triggering event happens, people will make sense of it and make the event seem ordinary (Wilson et al. Another reason for impact bias is focalism, that is, consumers pay too much attention to the focal event, overlook the dilution-of-attention effect (as we reviewed earlier), and thereby overestimate the affective impact of the focal event. For example, when predicting how much happier one will be if she moves from a smaller apartment to a larger one, she focuses her attention on the size dimension, but once she moves to the larger apartment, size is just one of many things that affect her life. Distinction Bias A recent graduate who currently lives in a 500-square-foot studio without indoor parking has found a job and has two options for housing, one a 1,250-square-foot apartment with indoor parking and the other a 1,500-square-foot apartment without indoor parking (rent is the same for both options). In comparison he notices the clear difference in size between the two options and predicts himself to be happier by living in the bigger apartment despite the lack of indoor parking so he chooses the bigger place. In reality, he may well be happier if he rents the smaller apartment, because the difference between 1,250 and 1,500 square feet may make less of a difference in his day-to-day consumption (living) experience than the difference between having and having no indoor parking. As the example illustrates, when making a choice, the person overpredicts the difference in experience generated by two apparently distinct values on a particular dimension (in this case square footage). The distinction bias arises because consumers are in different evaluation modes during prediction versus consumption. If two options differ near zero (or the neutral reference point) on the relevant attribute, they will not overpredict. For example, suppose that the person mentioned above uses his current apartment size-500 square feet-as his neutral reference point. Then he will be relatively accurate when predicting the difference in happiness between living in a 600-square-foot apartment and a 1,000-square-foot apartment, but less accurate when predicting the difference in happiness between living in a 1,250-square-foot apartment and living in a 1,500-square-foot apartment. If consumers do not realize the distinction bias, they may sacrifice things that are actually important to their consumption experience. For example, students believed that their liking for their favorite ice cream would decrease if they had it every day, but in reality their liking did not decrease as much as predicted (Kahneman & Snell, 1992). For example, students believed that eating a tasty jellybean would reduce the enjoyment of a not-so-tasty jellybean. As we reviewed earlier, the diminishing-marginal-sensitivity notion suggests that people who have to experience multiple bad outcomes should experience them on one occasion, but most people prefer to experience them on separate occasions, believing that one bad outcome will make them more sensitive to another bad outcome if they are encountered together (Thaler, 1999). Whether more options are better depends on the size of the choice set (Iyengar & Lepper, 2000), the mode of evaluation (Hsee & Leclerc, 1998), and the level of involvement (Carmon et al. A related common belief is that having the right to choose makes people happier than having someone else make the choice for them. Again, as we discussed earlier, this belief is not true for choosing among undesirable alternatives (Botti & Iyengar, 2004). Projection Bias Consumers often fi nd themselves in different visceral (arousal) states (Loewenstein, 1996). For example, if a person is full now, she will underestimate how much she will enjoy her next meal when she is hungry again. For example, hungry shoppers at a grocery store may buy more items than they need (Nisbett & Kanouse, 1969) and have planned to buy, unless they are reminded of their grocery list (Gilbert, Gill, & Wilson, 2002). A currently hungry person may choose a candy bar over an apple for a future consumption occasion on which she will be full, only to find that she actually prefers the apple when that moment comes. Rule-Based Choice To choose the experientially optimal option, consumers not only need to accurately predict their future experience, but also need to base their choice on predicted experience. We have already discussed when consumers fail to accurately predict their future experiences. In decision making consumers may base their choice on many other factors than predicted experience. Decision rules come into being because they simplify decisions and they lead to optimal consequences under certain circumstances. Nevertheless, once these rules are internalized, people overapply these rules to circumstances that these rules do not lead to experientially optimal choices. Variety-seeking can also lead to an inconsistency between predicted experience and decision. In one of the original studies on variety-seeking, Simonson (1990) asked one group of students to make simultaneous choices of candies for future consumption occasions, and another group of students to make sequential choices of candies right before each consumption occasion. Most simultaneous choosers asked for a variety of snacks, but most sequential choosers asked only for their favorite snack repeatedly. What is more interesting about this study is that in a third group participants were in the same position as the simultaneous choosers and were asked to predict their future consumption experiences. This suggests that the simultaneous choosers were able to predict, if asked, that low variety would yield better experience, yet the rule of variety-seeking prevailed. In another study on variety-seeking, Ratner and her coauthors (1999) asked participants to construct a song-sequence from one of two sets of songs. One set contains more songs than the other, but the additional songs were less enjoyable. They found that those who were given the larger set constructed sequences with greater variety but enjoyed them less. Similarly, the "waste not" rule can also lead consumers to forego options that they predict more enjoyable and choose the less enjoyable one. Arkes and Blumer (1985) asked participants to imagine that they had purchased a $100 ticket for a weekend ski trip to Michigan and a $50 ticket for a weekend ski trip to Wisconsin. They later found out that the two trips were for the same weekend and had to pick one to use. Although the participants were told that the trip to Wisconsin was more enjoyable, the majority of them chose the more expensive trip to Michigan. Lay Rationalism Besides the specific rules we discussed above, consumers have a general tendency to resist immediate affective influence and base their choice on factors they consider "rational". One is lay economism-the tendency to base decision on the financial aspects of the options and ignore other happiness-relevant factors. In one set, the dinners increased in value (original price) over the 4-week period and the total value was relatively lower. In the other set, the dinners decreased in value over the period and the total value was relatively higher. Participants predicted greater enjoyment from consuming the temporally-increasing set of dinners, yet they chose the set with the greater value in total. Another manifestation of lay rationalism is lay scientism, a tendency to base decision on "hard" (objective and quantitative) attributes rather than "soft" (subjective and hard-to-quantify) attributes. For half of the participants, power was described as an objective wattage rating and sound richness as a subjective experience. For the other half, power was described as a subjective experience and sound richness as an objective quantitative rating. When power was framed as objective, more participants chose the more-powerful stereo than they predicted they would enjoy it more. When sound richness was framed as objective, more participants chose the richer-sounding stereo than they predicted they would enjoy it more. In other words, the objectivity/subjectivity manipulation had a greater influence on choice than on predicted experience. This finding corroborates the notion that consumers base their choice not purely on predicted experience, but also on what they consider "rational," in this case, objective. Impulsivity We define an impulsive choice as choosing an option that yields a better short-term (immediate) experience over an option that yields a better long-term (immediate plus future) experience. For example, eating fatty food may produce better short-term enjoyment than eating healthy food, but it may cause obesity and other health-related problems in the long run. Thus, eating fatty food rather than healthy food can be considered an impulsive choice. For example, some people eat fatty foods, because they underpredict the negative consequences in the future. But more often than not, consumers commit impulsive behavior even though they are keenly aware of its aversive consequence, and they simply cannot resist the temptation. For example, many substance abusers are fully aware that drugs are ruining their lives and may even warn their friends to stay away from drugs, but they cannot resist the craving. In other words, impulsive choosers fail to base their choice on what they predict will bring them the best overall experience. However, we want to suggest a relationship between impulsive behavior and rule-based decisions. So far we have reviewed impulsivity and rules-based-decisions as two unrelated topics. For example, consumers adopting the "waste not" rule may consciously or unconsciously want to preserve their savings so as not to suffer financially in the long run. In some cases, not wasting now can indeed serve that purpose and sometimes it cannot. The problem is that most consumers do not sufficiently distinguish these two types of cases and act too impulsively in the first case but overly apply the rule in the second. For example, consider a college student who plans to travel in Europe for one week. She thought traveling by air is more fun, so she paid $1,000 for a one-week air pass. She does not have much savings; if she spends more on the trip, she will not have enough money to go to school and finish college next semester. In Scenario 1, she does not have a train pass and to travel by train she will have to pay extra and cannot graduate next semester, an outcome that potentially lowers her well-being in the long run. In Scenario 2, she has a free train pass from a friend and traveling by train will not affect her graduation date. In reality she may not do differently in these scenarios; she may travel partially by train and partially by air in both scenarios. In Scenario 1, she travels partially by train because she wants to enjoy the train ride now even though doing so will deplete her savings for college and potentially lower her long-term well-being. In Scenario 2, she travels partially by air because she does not want to waste the $1,000 air pass she already paid for. Th is behavior is an example of sunk cost fallacy, which is an overapplication of the "waste not" rule. This example illustrates that the same behavior, namely, traveling partially by train and partially by air, can be considered as either too impulsive or too rule-abiding, depending on the situation. Medium Maximization When people exert effort to obtain a desired outcome, the immediate reward they receive is usually not the outcome per se, but a medium-an instrument that they can trade for the desired outcome. For example, points for consumer loyalty programs and mileage for frequent flyer programs are both media.

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