Efficient delivery of health care services depends on people's ability to accurately assess the severity oftheir pain and seek medical care promptly when it is needed. Yet empirical studies have identified manyinstances in which people systematically misvalue their pain-e.g., patients experiencing heart failure maydelay seeking medical attention for several hours after the onset of severe physical symptoms, often withlethal consequences. The goal ofthe proposed research is to investigate the psychological and neuralmechanisms underlying the valuation of pain and explain why and how failures of valuation occur.Behavioral and functional neuroimaging experiments will investigate (a) the relation between different typesof valuation of pain (e.g., experienced versus remembered pain, (b) the relation between individualdifferences in pain valuation and dispositional differences in negative affect, and (c) the neural pathwaysthat mediate the influence of different types of pain valuation on decision-making. By advancing ourunderstanding ofthe psychological and neural mechanisms involved in pain-related decision-making, theproposed experiments can potentially help to improve measurement of pain in clinical settings and developnovel interventions to enhance the quality of patients' pain-related decisions.Public health relevance: This research seeks to understand how people determine the value of their painwhen making pain-related decisions. The proposed experiments have the potential to explain why it is thatpeople often make poor decisions about pain, e.g., failing to seek prompt medical attention whenexperiencing severe physical symptoms. By shedding light on the mechanisms involved in pain-relateddecision-making, the research has the potential to improve measurement of pain in clinical settings and todevelop more effective policies for identifying and treating individuals at risk for misreporting of physicalsymptoms.PHS 416-1 (Rev, 9/08) Page 2 Number pages consecutively at the bottom throughout Form Page 2 the application. Do not use suffixes such as 2a, 2b,Kirschstein-NRSA Individual Fellowship Application NAME OF APPLICANT (Lasf, first middle initial) Yarkoni, Tai (To be completed by applicant- follow PHS 416-1 instructions)18. GOALS FOR KIRSCHSTEIN-NRSA FELLOWSHIP TRAINING AND CAREERMy long-term goal is to develop an interdisciplinary research program in the area of cognition-emotioninteraction and decision-making by setting up a cognitive neuroscience laboratory at a first-tier researchuniversity. To achieve this goal, I have developed my NRSA fellowship application with three aims in mind.First, I will extend my present basic research on economic decision-making to the domain of physical pain.Physical pain is a biologically-salient, experimentally-controllable signal of considerable clinical importance,and thus presents ideal domain for translational research on emotional and cognitive influences on decision-making. My intellectual development in this area will benefit greatly from Dr. Tor Wager's expertise in thecognitive neuroscience of pain. Second, I aim to acquire expertise in the use of a state-of-the-art multilevelmodeling approach to fMRI analysis currently being developed in Dr. Wager's lab. This approach affordspowerful investigation of questions that cannot be easily addressed using the analyses techniques I amcurrently familiar with. Third, I aim to develop a truly interdisciplinary perspective on human decision-makingby supplementing my background in cognitive neuroscience with a better understanding of behavioraleconomic models and techniques. My development in this area will be supported by Dr. Elke Weber, aleading expert in the area of judgment and decision-making.19. ACTIVITIES PLANNED UNDER THIS AWARD: Approximate percentage of proposed award time In activities identified below. (See instructions.) Year Research Course Work Teaching Clinical First 90 10 Sec 100 Thir 100PREDOCTORAL FELLOWSHIPS ONLYFourthFifthMD/PhD FELLOWSHIPS ONLY Sixt hBriefly explain activities other than research and relate them to the proposed research training.In my first year, I will enroll in or audit classes on multivariate statistics, pain, and behavioral economicsintended to provide me with the skills needed to carry out the proposed experiments.20, TRAINING SITE(S) Is the Primary Training Site the same as the Sponsoring Institution? Yes D NoIf No, provide detailed information below for the Primary Training Site LocationOrganizational Name:DUNS:Streeti: street 2:City: County: state:Province: Country: Zip/Postal Code:
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