Cognition, Conation and Emotion in Decisions: The Conative Affect Theory

Medical decision making does not take place in a vacuum. Patients told, for example, of a cancer diagnosis and asked to decide on the next step in their treatment, are not just deciding based on the medical realities of their disease with strictly rational cognitive processes. They are also thinking about the impact on their jobs and finances; on their families and futures. These thoughts, and their emotional impact, will affect a patient’s risk assessment of those medical choices, creating cognitive biases such as anchoring, hyperbolic discounting, and loss aversion. 

Current theoretical approaches to understanding these decision making biases tend to focus on individual parts of the decision making process, seeking either to explain only a single outcome or addressing only one segment of the decision making process.  These theories also tend to reduce two important concepts, conation and volition, into a single idea when defining the relationships between emotion and cognition in a decision process, even though literature has identified the importance of the separating these concepts as they explain different parts of the decision process.   Conation, or the mechanism by which a decision is made, can also be thought of as a decision strategy where decisions result from meeting an acceptability threshold, rather than achieving a global optimum. Volition, on the other hand, is the will or action that is necessary to implement a decision.

This paper proposes a new, more comprehensive, theory that builds upon previous theories and is grounded in evidence garnered from neuroimaging studies of identified relevant theories. This new theory, the Conation Affect Theory, facilitates greater understanding of the cognitive biases in decision making, even as the neurological origins of those biases are still not totally identified.  It allows for emotion to play a part as both an input into the decision stream and as mechanism to create and access stored decision heuristics, concepts which characterize previous theory. A main advancement of this theory is that it separates out two previously conflated concepts, conation and volition. These two concepts are almost certainly a part of all decision making , even though the supporting evidence for the role of these concepts in decision making comes from the literature on individual diseases (e.g. ADHD, Tourette’s syndrome, Parkinson’s, depression, and addiction) that have been identified as resulting from, or in, failures in the conative or volitional functions of the brain.

Improving medical decision making requires understanding the implications of these two functions in the decision process and being able to apply knowledge of the interaction of the patient’s emotional state, both current and anticipated, on the cognitive aspects of his or her choices. It is our goal that this model be used to assist in the identification of these conative and volitional failures, as well as be used to develop interventions to counteract some of the negative effects of underlying disorders, or situational alterations of affect, on the decision process.