Why do adolescents make such risky decisions? For years, the belief was that they unthinkingly make impulsive choices. If they would just pay attention to the facts and carefully weigh the pros and cons of an action, the thinking went, adolescents would choose more wisely.
Not so, says Valerie F. Reyna, Human Development. Most risk taking in adolescents is not impulsive at all. “Adolescents think very much about the odds,” she says. “They think in a more precise way than adults do. Essentially they are willing to take a calculated risk, whereas adults are much more likely to reject that risk even when the odds are in their favor.”
These surprising findings come from Reyna’s latest series of studies regarding risk taking and decision making among people of all ages. In these studies, Reyna has applied fuzzy-trace theory, a theory of decision-making she developed with department colleague Charles J. Brainerd. Fuzzy-trace theory says people process information in two ways: One is verbatim analysis, which focuses on the literal-level details; the other is gist-based intuition, which focuses on the bottom-line meaning of information. People move between these two ways of processing, but Reyna’s research has shown that children are much more literal, or verbatim oriented, and adults are more gist or intuitively oriented.
Bottom-Line Insight Grows with Age
“Adolescents are in transition between the way adults think and the way children think,” says Reyna, “And the ones who take the most risk are much more literal. They’re thinking about the facts and the details about those facts, weighing the risk-and-reward ratio.”
In a real-life situation, that can lead to what adults consider extremely risky behavior. For example, when deciding whether to have unprotected sex, both an adult and an adolescent might agree that the benefits of sex are considerable, and they may both be aware that the probability of contracting HIV from one act of unprotected sex is quite low even with an infected partner. The adult, however, will look beyond the facts at the underlying gist of the situation.
“Adults will look at this possibility of contracting HIV and see that as a catastrophic outcome,” Reyna says, “while adolescents will conclude, correctly, that the odds are in their favor. We criticize adolescents for thinking ‘It won’t happen to me,’ but objectively they are right. They probably won’t get HIV with one act of unprotected sex. But that’s not the point. Adults are using qualitative thinking, and they will say, ‘It’s not worth the risk.’ Insight into the bottom line is what grows with age.”
Most risk taking in adolescents is not impulsive at all. “Adolescents think very much about the odds.…They think in a more precise way than adults do.…willing to take a calculated risk.”
Reyna’s findings have applications to the judicial system where the U. S. Supreme Court has already ruled on two separate occasions that adolescents should not be punished with the same severity as adults for similar crimes because their brains are not fully developed. These decisions were based on earlier studies by other researchers, which showed that the adolescent brain is more geared toward reward than the adult brain and that adolescent immature cognitive control results in less inhibition. Thus, adolescents are inclined to actions that bring more risk and can stray into criminal behavior more easily than adults. “But there’s this massive third aspect to brain development that my lab has promulgated,” says Reyna, “which is that how you think about your options also changes from adolescence to adulthood, and that, too, can affect culpability.”
Can Gist Thinking Be Taught to Adolescents?
Working with other researchers, Reyna conducted another study to see if gist thinking could be taught to adolescents, or whether it is so closely tied to brain development that it can only be attained through maturity. The researchers took a 14-hour public health curriculum approved by the Centers for Disease Control (CDC) and added elements of fuzzy-trace theory to it. Then they randomly divided groups of teenagers into three groups. One group was exposed to the usual CDC-approved course; another was taught the CDC-approved course with the added elements of gist-based thinking; and the third, the control group, learned a different health curriculum entirely. The teens taught gist-based thinking changed their decision-making process and moved toward thinking about the bottom line, while the others did not show this change in their thinking process. The fuzzy-trace theory curriculum produced significantly better self-reported health knowledge, attitudes, and behaviors than either of the other two groups.
“We tried to convey to the students the way an adult would think about these things—for instance, that unprotected sex is like playing Russian roulette,” says Reyna. “Teens are in a transitional period in their thinking process, and we found that you can nudge that transition by showing them how a gist-based thinker would view these choices.”
How Patients Make Medical Decisions
In another series of studies, Reyna looked at how people make medical decisions. “Over the last few decades, patient-centered, shared decision making has become the norm,” Reyna says. “In the past, it was a top-down system where the doctor made the decisions. Now the patients need to make informed decisions, and that can be very difficult to do.” Understanding the thought processes behind how patients assimilate complicated medical information to arrive at a decision can help health professionals communicate more effectively.
Often people are trying to decide the gist of their situation, Reyna says. Patients faced with a life-threatening illness, for instance, may be in the situation where things are bad and the only possibility of life is to take a risk. “People think ‘I’m either going to die for sure, or I’m going to take this treatment, which is a risk, and there’s a possibility for life.’ So they will choose the risk,” Reyna says.
But when has the situation shifted from whether they are going to die to how they are going to die? This is the point when the patient must decide whether to seek hospice care geared to keeping them comfortable instead of painful, ultimately useless treatments. “Knowing when you’re in one situation and not the other is not straight forward,” Reyna says. “Physicians are not a hundred percent certain when someone is going to die. So as a physician, you have to decide when there’s enough information to know that a patient has gone from one gist to the other gist, and then you have to convey to the patient that they are really in this other situation where the bottom line gist has changed.”
In a healthcare situation, even one that does not include a terminal diagnosis, communicating the gist of the situation isn’t easy. Using fuzzy-trace theory, Reyna and her colleagues have developed various tools to help physicians explain health situations to patients in ways the patient can understand. An interactive computer program, for instance, helps patients understand the bottom-line gist of their genetic risk for breast cancer. “Genetics is quite difficult to understand,” says Reyna. “Patients can type in questions, and the computer will answer. It’s not giving them a list of facts; that would be verbatim information. At the end of the day, patients need to know what those facts boil down to. If they can understand the gist, they can make an informed decision.”