Future thinking and medicine adherence: a study of typically developing and chronically ill adolescents
Future thinking is thought to play a fundamental role in guiding adaptive, futureoriented behaviour across the life span (Michaelian, Klein, & Szpunar, 2016; Schacter, Benoit, & Szpunar, 2017; Seligman, Railton, Baumeister, & Sripada, 2013; Taylor, Pham, Rivkin, & Armor, 1998), and is considered to be of profound importance during adolescence (Nurmi, 1991). With its wide-ranging influence on behaviour, future thinking has attracted attention from across psychological disciplines, with each approaching the study of future-oriented cognition from differing theoretical perspectives. Across three studies, this thesis draws together several different approaches to the study of future thinking in an effort to better understand the nature of future-oriented cognition in adolescence and the role it plays in countering myopic, short-sighted decision making during this critical period of development. Ultimately, this thesis aims to investigate whether future thinking determines treatment adherence in adolescents with chronic illness and whether living with a chronic health condition might disrupt the way in which a young person thinks or feels about the future. Chapter 1 provides an overview of our current understanding of future thinking and of the dominant perspectives that exist in the literature. Following this, Chapter 2 reviews previous research on medication adherence in the context of adolescent chronic illness and considers the potential role future thinking might play in predicting adolescents’ adherence to treatment. Then, in Chapter 3, two studies conducted with typically developing adolescents are described. Both explore how different measures of future thinking overlap in adolescence and aim to provide insight into how different aspects of future-oriented cognition relate to impulsive decision making in typically developing teens. Studies 1 and 2 reveal that there is more than one way for an adolescent to be oriented to the future and that only certain aspects of future thinking are associated with adaptive decision making in adolescence. More specifically, the capacity to imagine one’s personal future with episodic detail, known as episodic future thinking (EFT), and feeling connected, or similar, to one’s future self were shown to predict future-oriented decision making during an intertemporal choice task. Chapter 4 investigates the potential link between future thinking and treatment adherence in adolescents with chronic illness and reveals that young people who are more future-oriented in their decision making are more likely to adhere to their prescribed medications. This may suggest that intentional nonadherence is determined, at least in part, by a patient’s tendency to discount future rewards. Adolescents who felt more connected to their future selves were also more likely to adhere, suggesting that teens who perceive their present and future selves to be similar are more willing to make decisions or behave in ways that prioritise their health in the future. Chapter 5 compares chronically ill adolescents and typically developing matched controls on various measures of future thinking and finds little evidence to suggest that living with chronic illness impacts adversely on how an adolescent thinks or feels about their future. However, although the chronically ill adolescents thought as much about the future as their healthy peers, the results of this comparison suggest that chronically ill young people may be more vulnerable to “living in the present” and making short-sighted decisions that could jeopardise their interests in the future. Finally, Chapter 6 discusses the implications the findings of this thesis have for our understanding of future thinking in adolescence, the role it plays in guiding adaptive behaviour, and how future interventions might be designed to encourage both typically developing and chronically ill adolescents to make better decisions by increasing the priority they give to the future and their future self.
Future thinking, Future self-connectedness, Medicine Adherence, Episodic Future Thinking, Temporal Discounting
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