Although associations between insomnia and central sensitization were previously reported in patients with chronic non-cancer pain, those have not been elucidated among cancer survivors undergoing opioid therapy for chronic cancer pain. Several risk factors for insomnia in cancer patients have been recognized, including chronic pain and treatment with opioid. Additionally, by introducing fresh ideas about the basis of cognitive effort costs, it is hoped that this thesis will provide stronger foundations on which experimental research on cognitive effort can be built in the future. Overall this thesis extends our understanding of the link between effort and control, suggesting in particular that the expression of Pavlovian biases can be framed in terms of effort-based decision-making. Finally, in a standalone theoretical chapter, I discuss the rationale for effort costs, which currently are not well understood I introduce and extend two existing ideas from outside of neuroscience which I think may be informative in this regard. I present initial evidence that indeed willingness to exert effort and the strength of Pavlovian biases seem to be negatively correlated, while effort also seems to be negatively associated with both depression and anxiety symptoms. Subsequently, in the final experimental chapter, I use this task to test directly the hypothesis that the strength of Pavlovian bias is influenced by effortful cognitive control. In the third experimental chapter, I present a new task for measuring cognitive effort sensitivity, suitable in particular for individual differences research. Following a simple programme of behavioural training, participants showed reduced influence of Pavlovian biases on behaviour, a result which is consistent with increased cognitive control. In the first two experimental chapters I examine whether Pavlovian biases are in principle modifiable, a necessary precondition for demonstrating that they are also controllable. In this thesis I investigate the role of effort in the specific case of control over Pavlovian biases. Related to this, decreased ability to exert effort has been implicated in the symptoms of conditions including depression and anxiety. Effort is a key determinant of cognitive performance, particularly for processes involving cognitive control – without it, performance may be slow, inaccurate or biased.
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January 2023
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