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The complex nature of willpower and conceptual mapping of its normative significance in research on stress, addiction, and dementia

Dubljević, VeljkoNeupert, Shevaun D.  ; New York Vol. 44,  (2021). DOI:10.1017/S0140525X20000886

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Ainslie's theoretical framework on willpower as suppression, resolve, and habit has important ramifications for the ethical and psychological literature on autonomy and mental time-travel. Emerging from Ainslie's study is the idea that subcomponents of willpower correlate with the temporality of autonomous decisions: past decisions can form habits, suppression deals with present distorting influences, whereas resolve is future-oriented, linked with mental time-travel and perseverance in goals.

Mental time-travel has implications for responding to and preparing for stressors. More stress is associated with poorer health and cognitive functioning, but most research has focused on what happens after stressors occur. Thus, the bulk of the stress literature emphasizes suppression, which indicates how current reactions to past stressors are handled. Recently, we put forth a conceptual framework that integrates the temporal space of anticipation before stressors occur (Neupert, Neubauer, Scott, Hyun, & Sliwinski, 2019), which emphasizes the future-oriented component of resolve.

Future-oriented thinking with respect to stress can take the form of proactive coping, stressor forecasting, and anticipatory coping. Proactive coping comprises efforts that prevent a stressor before it occurs and tend to be rather stable between individuals. We found that people who were high in proactive coping reported less negative affect in the face of stress (Polk, Smith, Zhang, & Neupert, 2020) and less COVID-19 stress (Pearman, Hughes, Smith, & Neupert, 2020).

Although proactive coping tends to be stable and associated with reduced stressor exposure, stressor forecasting is dynamic and involves predictions about domain-specific stressor occurrence in a defined upcoming time period. Using a daily diary design where people reported for consecutive days on their stressor forecasting across six stressor domains (e.g., work, home-related events, and so forth), we found that younger adults benefitted more than older adults in terms of better emotional responses to home-related events when they were able to predict the upcoming stressor (Neupert & Bellingtier, 2019).

In contrast to reactive coping that involves coping with an event that has already occurred (akin to suppression) and proactive coping that is supposed to prevent a future stressor from occurring (akin to resolve), anticipatory coping involves specific efforts to prepare for the stressful consequence of an upcoming event that is likely to happen. Similar to stressor forecasting, anticipatory coping is dynamic and domain-specific; the demands of the predicted upcoming stressor need to match the coping effort in order to be adaptive. Stagnant deliberation involves trying (but failing) to think about solutions to an upcoming stressor, but can be adaptive for certain people in certain situations: Older adults who reported increases in stagnant deliberation from one day to the next were able to maintain their emotional well-being in the face of home stressors (Neupert & Bellingtier, 2019).

In the context of habits/addictions, there are important differences between people (e.g., proactive coping) as well as dynamic and context-specific processes (e.g., stressor forecasting and anticipatory coping) that play a crucial role in resolve (forward-looking) and suppression (present-focused). Using a daily diary design with participants undergoing medication-assisted treatment for addiction, we found that increases in daily stressors were associated with increases in cravings to use illegal drugs as well as the likelihood of using illegal drugs (Neupert et al., 2017). Our results suggest a cyclical process; increase in previous-day illegal drug use was also associated with an increase in exposure to stressors the next day, especially for those who had sought treatment many times in the past.

Therefore, what are the normative implications of this work? Ethical discussions on autonomy and automaticity in decision making have long drawn attention to psychological literature (Bauer & Dubljević, 2019). There is an emerging consensus that automaticity may in fact enable autonomy (Dubljević, 2019). If, following Ainslie, we reconceptualize habits as crystallized automatic behaviors based on previous decisions and accumulation of expertise, then bad habits are no less autonomous (maladaptive coping) than good habits (adaptive coping). Similarly, if we assume that suppression is a necessary (but not sufficient) condition for autonomy, we have the conceptual mapping necessary to clarify limitations to autonomous decision making in people struggling with addiction and people living with dementia.

Addiction usually serves as a test-case for conceptions of autonomy (Dubljević, 2013), and our study discussed above contributes to this ethical debate. Autonomy as a normative concept presupposes capacities to form long-term intentions, develop plans, exert rationality, and mature powers of volition (i.e., self-control). Thus, in this view, controlling influences such as coercion (external) or compulsion (internal) do not automatically reduce autonomy but need to be assessed for their degree and justifiability. We have developed ideal-typical degrees of coercion and compulsion for clarifying loss of autonomy in addiction (Dubljević, 2013) and fronto-temporal dementia (Dubljević, 2020).

The clarification of subcomponents of willpower as suppression, resolve, and habit allows for a nuanced application of autonomy in additional cases (e.g., other dementias). The crucial point in applying autonomy to dementia cases is whether patients are able to use suppression to resist “mild compulsions,” use resolve to maintain “long-term aims,” and to “show commitment” to them by forming adaptive habits. In these terms, late-stage dementia patients are more akin to minors than to adults; they lack the resources they once had for self-control, and capacities for appreciating their critical interests in addition to maintaining and updating rational life-plans in view of changing circumstances. However, there is a wide-spread assumption that as soon as people are diagnosed with dementia, they are not capable of maintaining any level of autonomy, which leads to stigmatization (Dubljević, 2020). Part of the problem of maintaining day-to-day functioning is the response society has to dementia patients. Dementia causes memory issues and learning difficulties, which are exacerbated when patients are, unwillingly, placed in a completely new environment such as a nursing home. Typically, dementia is clinically specified in seven stages, each characterized by an anticipated pattern of symptoms (Reisberg, 1988). Ainslie's framework for willpower supports a stage-like approach to autonomy in dementia, facilitating ethical guidelines least likely to cause additional suffering.

In conclusion, Ainslie's study has reframed our work on addiction, stress, and dementia. It also offers novel ways of exploring autonomy.

Financial support

We have received no external funding for this work.

Conflict of interest

We have no conflicts of interest to declare.