1. Biological basis - brain, nervous system, hormones, genetics
2. Sensation and perception - how we detect and interpret the world
3. Learning and memory - conditioning, skill acquisition, forgetting
4. Cognition - thinking, language, intelligence, decision-making
5. Emotion and motivation - feelings, needs, goals, stress
6. Personality and individual differences - traits, temperament, identity
7. Developmental psychology - changes from infancy through ageing
8. Social psychology - influence, relationships, groups, prejudice
9. Mental health - anxiety, depression, trauma, psychological therapies
10. Research methods and ethics - how psychological claims are tested

How emotions influence decision-making

1. Emotion acts as a fast value signal

• A positive feeling can make an option seem more beneficial and less risky.
• A negative feeling can make the same option seem dangerous, even when the facts have not changed.
• This is useful when time is limited, but risky when the feeling comes from a source unrelated to the decision.

2. Emotions change what we notice and remember

• Fear and anxiety increase attention to possible loss, threat, and uncertainty.
• Anger can increase confidence, blame of others, and willingness to take risks.
• Sadness may increase preference for immediate comfort or rewards.
• Positive mood may promote creativity and broad thinking, though it can sometimes reduce careful scrutiny.

3. Emotion changes risk perception

4. “Incidental” emotions can bias unrelated choices

• Integral emotion: a feeling caused by the decision itself, such as anxiety about a risky investment.
• Incidental emotion: a feeling carried over from something else, such as anger after an argument influencing a financial or hiring decision.

5. Emotion can improve decisions

• signal personally important values or consequences
• draw attention to genuine danger
• motivate preparation, empathy, persistence, or repair of harm
• allow rapid action when extensive analysis is impossible
• help us learn from rewards and mistakes

6. Emotion can impair decisions

7. The best decisions use emotion and reflection together

1. Name the emotion: “I am anxious,” “I am angry,” or “I am unusually excited.”
2. Ask whether it belongs to this decision: Is the feeling evidence about the choice, or spillover from something else?
3. Delay irreversible choices when emotion is intense.
4. Use external structure: write options, probabilities, costs, benefits, and a worst-case plan.
5. Seek a second perspective, especially for high-stakes decisions.
6. Revisit the decision after emotional intensity drops.

Key ways it helps

1. Builds trust and rapport
   Patients communicate more openly when they feel respected and safe. Using empathy, attentive listening, a calm tone, and appropriate eye contact helps establish this relationship. Communication rests on empathy, listening, knowledge, and rapport, and these are learnable skills. Berek & Novak's Gynecology describes these as foundations of effective patient communication.
2. Recognizes emotions behind words
   A patient may express fear as anger, avoid questions because of anxiety, or appear “non-compliant” because they feel overwhelmed. Psychological understanding helps the clinician respond to the emotion, not only to the medical problem.
   Example:
   • Less helpful: “You need to calm down.”
   • Better: “I can see this result is worrying. Tell me what concerns you most.”
3. Improves active listening
   Active listening means giving the patient time to speak, not interrupting too early, asking open questions, and summarizing what was heard. It helps reveal symptoms, beliefs, worries, financial constraints, family pressures, and treatment barriers that may otherwise remain hidden.
   Useful opening questions include:
   • “What is your main concern today?”
   • “What do you think is causing this?”
   • “How is this affecting your daily life?”
   • “What were you hoping we could help with?”
4. Adapts information to stress and health literacy
   Anxiety, pain, shock, and grief reduce a person’s ability to absorb complex information. Psychology supports use of plain language, short explanations, repetition, visual aids, and pauses for questions.
   Instead of asking, “Do you understand?”, use teach-back:
   “I want to make sure I explained it clearly. Could you tell me how you will take this medicine when you get home?”
   This checks the explanation, not the patient’s intelligence.
5. Supports shared decision-making
   Patients have different values, goals, cultural beliefs, and tolerance for risk. A psychologically informed clinician explores these before recommending a plan. Shared decision-making involves understanding the patient’s goals, explaining reasonable options, discussing benefits and harms, and deciding together. Sabiston Textbook of Surgery identifies these as core components of shared decision-making.
   Example: for two medically reasonable treatments, ask:
   “Both are possible options. What matters most to you: avoiding surgery, faster symptom relief, cost, or recovery time?”
6. Improves adherence without blame
   People may not follow a plan because of fear of side effects, misunderstanding, stigma, depression, cost, forgetfulness, or lack of support. Rather than saying, “Why didn’t you take your medication?”, try:
   “Many people find it difficult to take medicines every day. What got in the way for you?”
   This reduces defensiveness and makes problem-solving possible.
7. Helps manage difficult conversations
   Psychological skills are especially useful when giving bad news, discussing uncertainty, handling anger, or speaking with families. A simple empathic sequence is:
   • Name the emotion: “This sounds frightening.”
   • Understand: “Anyone in your situation might feel worried.”
   • Respect: “You have handled a lot already.”
   • Support: “We will work through the next steps with you.”
   • Explore: “What questions are on your mind right now?”

In short

• understand emotional reactions
• listen for the patient’s real concerns
• explain information in a memorable way
• reduce fear and confusion
• respect values and cultural context
• involve patients in decisions
• improve trust, satisfaction, and follow-through with care

Start with your own calm

• Speak slowly, quietly, and in short sentences.
• Keep an open posture, neutral facial expression, and appropriate personal space.
• Do not match their volume, anger, or sarcasm.
• Avoid arguing, interrupting, or using medical jargon.

Acknowledge the emotion

• “I can see that this is worrying you.”
• “You seem very upset, and I want to understand what happened.”
• “Waiting while you are unwell can be frustrating.”
• “It sounds as though you are afraid something serious may be wrong.”
• “I want to help us find a way forward.”

Listen before explaining

• “What is worrying you most right now?”
• “Can you tell me what happened from your point of view?”
• “What were you expecting to happen today?”
• “What would help you feel safer or more comfortable?”

“So your main concerns are the pain, the long wait, and not knowing what the plan is. Have I understood that correctly?”

Give clear information and choices

• “I do not have the test result yet. I expect it within about an hour.”
• “Here are the next two steps.”
• “You can choose whether we discuss this now with your relative present or speak privately first.”
• “Would you prefer to sit here or in a quieter area while we talk?”

Set respectful limits with an angry patient

“I want to help you, and I will listen. I cannot continue if you shout at or threaten staff. Let us speak one at a time, and we can work out the next step.”

• “Calm down.”
• “You are being irrational.”
• “There is nothing to be angry about.”
• “If you do not cooperate, you will not get help.”

For an anxious patient

• Reduce stimulation if possible: quieter space, fewer people talking, fewer interruptions.
• Ask permission before examination or procedures.
• Explain before touching: “I am going to check your blood pressure now. It will squeeze your arm for a few seconds.”
• Use simple grounding or paced breathing if appropriate: “Let us take one slow breath in, then breathe out slowly.”
• Check understanding with teach-back: “Just so I know I explained it clearly, what will you do if the pain gets worse at home?”

Involve support, when appropriate

Put safety first

• maintain an exit route and personal space
• do not block the door or corner the person
• call for trained colleagues or security early, according to local policy
• continue using brief, calm, non-confrontational language
• assess urgent causes such as pain, hypoxia, hypoglycemia, delirium, substance intoxication or withdrawal, and psychiatric crisis

A short script

“I can see you are upset. I want to understand and help. Please tell me what is worrying you most. I will listen, then I will explain what I can do next. We need to speak without threats or shouting so that everyone remains safe.”