Law and Human Behavior Affective Forecasting About Hedonic Loss and Adaptation: Implications for Damage Awards Edie Greene, Kristin A

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Law and Human Behavior Affective Forecasting About Hedonic Loss and Adaptation: Implications for Damage Awards Edie Greene, Kristin A. Sturm, and Andrew J. Evelo Online First Publication, February 25, 2016. http://dx.doi.org/10.1037/lhb0000181

CITATION Greene, E., Sturm, K. A., & Evelo, A. J. (2016, February 25). Affective Forecasting About Hedonic Loss and Adaptation: Implications for Damage Awards. Law and Human Behavior. Advance online publication. http://dx.doi.org/10.1037/lhb0000181 Law and Human Behavior © 2016 American Psychological Association 2016, Vol. 40, No. 2, 000 0147-7307/16/$12.00 http://dx.doi.org/10.1037/lhb0000181

Affective Forecasting About Hedonic Loss and Adaptation: Implications for Damage Awards

Edie Greene Kristin A. Sturm University of Colorado, Colorado Springs University of Colorado, Anschutz Medical Campus

Andrew J. Evelo John Jay College and the Graduate Center, City University of New York

In tort lawsuits, plaintiffs may seek damages for loss of enjoyment of life, so-called hedonic loss, which occurred as a result of an accident or injury. In 2 studies, we examined how people judge others’ adaptation and hedonic loss after an injury. Laypeople’s forecasts of hedonic loss are relevant to concerns about whether jurors appropriately compensate plaintiffs. Longitudinal data of subjective well-being (e.g., Binder & Coad, 2013) show that hedonic loss is domain-specific: Many physical impairments (e.g., strokes) inflict less hedonic loss than many persistent yet invisible ailments (e.g., mental illness and conditions that cause chronic pain). We used vignette methodology to determine whether laypeople (n ϭ 68 community members and 65 students in Study 1; 87 community members and 93 students in Study 2) and rehabilitation professionals (n ϭ 47 in Study 2) were aware of this fact. In Study 1, participants’ ratings of hedonic loss subsequent to a physical injury and a comparably severe psychological impairment did not differ. In Study 2, ratings of short- and long-term hedonic loss stemming from paraplegia and chronic back pain showed that neither laypeople nor professionals understood that hedonic loss is domain-specific. These findings imply that observers may forecast a future for people who suffered serious physical injuries as grimmer than it is likely to be, and a future for people who experience chronic pain and psychological disorders as rosier than is likely.

Keywords: affective forecasting, hedonic adaptation, hedonic damages, jury decision making

In tort lawsuits, people who sustain injuries can recover for losses can be claimed by people who were injured and by those losses that they are unable to quantify. These noneconomic dam- close to them who were deprived of a relationship or services ages compensate for pain and suffering, disability, disfigurement, provided by the injured or deceased person. and loss of enjoyment of life. This article focuses on judgments To our knowledge, only two empirical studies have examined about lost enjoyment of life, often referred to as hedonic loss, by how jurors determine damages for hedonic losses. Poser, Born- laypeople and by professionals who treat injury victims. stein, and McGorty (2003) showed that when mock jurors were Hedonic damages are intended to compensate for hedonic loss, instructed to make separate awards for hedonic loss and pain and the reduced ability, as a result of an injury, to find pleasure in the suffering, resulting noneconomic damage awards were larger than normal activities of life, including practical activities like eating when participants awarded a single sum for both, a finding con- and shopping, cognitive and emotional activities, interpersonal and firmed by Gregory and Winter (2011). These results suggest that leisure pursuits, and occupational tasks (Berlá, Andrews, & Berlá, hedonic loss represents a fuzzy concept to laypeople, which makes 1999). They are distinct from damages for pain and suffering that it difficult to assess and quantify. compensate for physical and emotional discomfort caused by the Our research asks a different question about how people deter-

This document is copyrighted by the American Psychological Association or one of its alliedinjury publishers. itself (Boan v. Blackwell, 2001). Damages for hedonic mine hedonic losses. We focus on the possibility that jurors’ This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. judgment of hedonic loss and subsequent assignment of damages is fraught with error because laypeople lack awareness of how others adapt, emotionally, to injuries and illness. So our studies Edie Greene, Department of Psychology, University of Colorado, explore how laypeople and professionals who work with injured Colorado Springs; Kristin A. Sturm, Department of Psychiatry, Univer- patients determine the extent of hedonic loss in various injury sity of Colorado, Anschutz Medical Campus; Andrew J. Evelo, Depart- scenarios. There is reason to suspect that laypeople, at least, may ment of Psychology, John Jay College and the Graduate Center, City do poorly. According to legal scholar Cass Sunstein (2008), he- University of New York. donic losses are often exaggerated because many injuries inflict We thank Missy Hernandez and Deidre Fudge for research assistance less hedonic damage than observers (i.e., jurors) anticipate. Sun- and Paul Andrews for providing materials. Correspondence concerning this article should be addressed to Edie stein dubbed these “illusory losses.” On the other hand, hedonic Greene, Department of Psychology, University of Colorado, Colorado losses can also be undervalued because other sorts of injuries Springs, 1420 Austin Bluffs Parkway, Colorado Springs, CO 80918. inflict more hedonic damage than observers expect. Sunstein E-mail: [email protected] termed these “enduring losses.” He contended that unless the legal

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system distinguishes between “harms that impose enduring losses, A prototypical study was conducted by Riis et al. (2005) ques- such as chronic pain and mental illness, and harms that do not, tioning 50 dialysis patients and 50 healthy controls about the such as losses of fingers and toes” (p. S158), tort cases will be rife global moods and specific emotions they experienced in a typical with errors. week. Both groups reported that their moods were generally pos- There is support for these concerns. Empirical studies have itive for the majority of waking hours. There were no differences shown that people can adapt affectively to very severe injuries in reports of the extent to which they experienced happiness, such as spinal cord damage (e.g., Krause, 1992). But laypeople frustration, anger, depression, and joy. Life satisfaction levels were lack the ability to predict future emotional states (Igou, 2008), comparable and although dialysis patients reported their health as which suggests they may be unaware of this fact and, as a result, being much worse than did healthy controls, they did not consider overestimate hedonic losses associated with serious injuries. Yet themselves to be less happy. other studies have shown that people cannot adapt well to condi- A number of studies examined the reasons that people are able tions that cause chronic pain (e.g., Shields & Wheatley Price, to return (approximately) to preinjury and preillness levels of 2005) and to certain degenerative illnesses (e.g., Smith & Wall- happiness. Across the board, these studies show that the emotional ston, 1992). Lacking the ability to forecast affective states, lay- impact of an event dampens with time as people habituate to their people might underestimate the long-term effects of these condi- new circumstances (Brickman et al., 1978), alter their activities tions on subjective well-being. Bagenstos and Schlanger (2007) and adjust their aspirations (Easterlin, 2003; Menzel, Dolan, Rich- suspect that plaintiffs’ lawyers capitalize on this fact by highlight- ardson, & Olsen, 2002), or reduce their focus on the life-changing ing the great distance between a “normal” life and their clients’ event itself (Frederick & Loewenstein, 1999). As Sunstein (2008) “disabled” lives. noted, what once may have seemed a serious hedonic loss “often The present research uses vignette methodology to examine becomes part of life’s furniture” (p. S169). Other research shows estimations of hedonic loss. We ask whether laypeople misap- that after enduring inexplicably negative events, victims strive to praise hedonic loss in a manner consistent with Sunstein’s (2008) reappraise the situation to find meaning in their experiences (Park, assertions. The answer to this question has relevance to the size 2010) which leads them to realize some benefit from their distress and predictability of jury damage awards for hedonic loss. We also (Tennen & Affleck, 2002). An overarching model of affective examine how rehabilitation professionals who treat injury sufferers adaptation suggests that people show intense affective reactions to and are arguably better positioned to understand variability in unexplained events that they then attempt to explain or understand. hedonic adaptation, assess hedonic loss. If successful, they adapt to and attend less to these events (Wilson Before we describe our studies, we tackle two important ques- & Gilbert, 2008). tions: To what extent can injury victims adapt hedonically to Importantly though, studies showing broad levels of affective different types of injuries, and to what extent can laypeople and adaptation used cross-sectional data, and without information on professionals predict others’ emotional reactions, initially and over participants’ previous levels of well-being, their conclusions can time? To answer these questions, we review studies on affective be called into question. The more useful studies employ longitu- adaptation postinjury and illness, including theoretical explana- dinal data, tracking the reported life-satisfaction levels of individ- tions of how and why some people adapt emotionally to their uals before and after they became disabled. These studies, de- changed circumstances and others do not. We also describe the scribed next, show that for many people, subjective well-being research on affective forecasting that examines laypeople’s and improves with time after the onset of a disability, but does not experts’ abilities to forecast emotional reactions and adaptation to completely rebound. life-changing events. This will set the stage for our studies on how Oswald and Powdthavee (2008) analyzed responses to the Brit- laypeople (in Study 1) and both laypeople and rehabilitation pro- ish Household Panel Survey in which, since 1966, individuals fessionals (in Study 2) forecast hedonic loss. rated their psychological well-being and reported whether and to what extent they suffer from a disability. Among people who Can People Adapt Affectively to Illness and Injury? became disabled over the course of the study, ratings of happiness on a 7-point scale, where larger numbers indicate greater life Affective adaptation occurs when the emotional response to an satisfaction, were 4.8 for the two years preceding disability, 3.7 at injury or illness fades and a person gradually regains a preinjury or the onset of the disability, and 4.1 for the two years following This document is copyrighted by the American Psychological Association or one of its allied publishers. preillness level of contentment. An early example of hedonic onset. The researchers distinguished between people with moder- This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. adaptation came from research by Brickman, Coates, and Janoff- ate and severe disabilities and showed approximately 50% adap- Bulman (1978); one year after sustaining a serious injury, para- tation in the former and 30% adaptation in the latter. Findings from plegics, though not as happy as a control group, still rated their a nationally representative sample of Australian adolescents and happiness at above the midpoint of the scale and anticipated that young adults who became disabled over the course of a 7-year they would attain a level of happiness comparable with that of the study (Emerson, Kariuki, Honey, & Llewellyn, 2014) support the control group in the future. More recently, studies have shown that conclusion that many people adapt, hedonically, to disability, but despite variability in the extent and time course of adjustment some do not: Sixty-nine percent of participants reported high and (Stanton, Revenson, & Tennen, 2007), people can adapt hedoni- stable levels of subjective well-being after the onset of disability, cally to a variety of physical conditions including paraplegia and 22% reported reduced levels of well-being. Finally, analyzing (Schulz & Decker, 1985), quadriplegia (Wortman & Silver, 1987), the British data set with a different measure of disability, Lucas amputation (Horgan & MacLachlan, 2004), severe burns (Patter- (2007) found only partial adaptation in disabled individuals who son et al., 1993), heart disease (Wu, 2001), locked-in syndrome were followed for five to seven years postinjury. His data showed, (Bruno et al., 2011), and kidney disease (Riis et al., 2005). for example, that participants’ distress levels increased by 0.24 FORECASTING ABOUT HEDONIC ADAPTATION 3

points on a 4-point scale following onset of a disability, but underestimate the effects of persistent, enduring conditions on dropped to 0.15 points above baseline four years after onset. future enjoyment of life. The fact that the studies using longitudinal data showed incom- plete adaptation is worthy of further consideration. Bronsteen, Can People Predict Future Emotional States? Buccafusco, and Masur (2008) speculate that one reason that studies did not indicate higher levels of adaptation was because Affective forecasting is the ability to predict the emotional they did not distinguish between disabilities to which people can impact of future experiences. Data show that people are generally readily adapt, at least in the long run, and those to which they poor predictors of how they or others would feel after experiencing cannot. This distinction points to an important caveat in the data on a life-changing circumstance and suggest that laypeople will over- hedonic adaptation. Although people can adapt to certain life- estimate how much and for how long one’s emotional well-being changing physical impairments, their adaptation to other adverse will be affected by an accident or illness. Will those with profes- events, particularly psychological conditions and chronic pain— sional expertise do the same? both of which result in persistent reminders but are largely invis- Although people can anticipate fairly well the valence of emo- ible to observers—is far less likely (Dolan, 2011; Swedloff & tions they are likely to experience in the future, they are generally Huang, 2010). poor predictors of the intensity and duration of those feelings Various studies document the negative effects of health condi- (Wilson & Gilbert, 2005). People are also poor predictors of the tions such as chronic pain and anxiety on subjective well-being. intensity and duration of others’ future emotional states and are Shields and Wheatley Price (2005) discovered persistently low likely to overestimate the duration of negative affect experienced levels of psychological well-being in migraine sufferers, and Gra- by others as compared to themselves (Igou, 2008). Healthy people ham, Higuera, and Lora (2011) found that even after controlling generally predict that disabled people will have diminished hap- for variations in optimism, individuals experiencing chronic pain piness for a longer period of time than they actually do (e.g., Ubel, and anxiety were significantly less happy than those suffering Loewenstein, & Jepson, 2005). severe physical impairments. Degenerative conditions such as One explanation of errors in prediction is the focusing illusion rheumatoid arthritis (e.g., Smith & Wallston, 1992) and multiple (Schkade & Kahneman, 1998). When asked to predict emotional reactions to a particular change in life circumstances, people focus sclerosis (e.g., Antonak & Livneh, 1995), both of which result in excessively on the narrow aspects of life that are affected by the depression and anxiety in many patients, are also resistant to event and not on the many ways that one’s life will not change: hedonic adaptation. “When people are asked to think about the effect paraplegia would A longitudinal study reached a similar conclusion. Binder and have on their lives, they tend to focus on the limitations it would Coad (2013) examined subjective well-being across more than create rather than, say, their unaltered ability to enjoy a glass of 100,000 observations of approximately 10,000 individuals in the wine” (Bronsteen et al., 2008, p. 1533). Further, when evaluating British Household Panel Survey between 1996 and 2006, assess- the happiness of a person who has become paralyzed, people have ing, among other things, patterns of adaptation for different health a tendency to focus on the experience of becoming paralyzed conditions. The survey tapped individuals’ assessments of their rather than on the state of being paralyzed. More generally, they health during the previous 12 months and the presence of specific tend to focus on the early stages of adapting to change—the time health conditions and impairments. Analyses showed clear varia- when hedonic reactions may be most intense—and tend not to tion in adaptation by the type of impairment, with anxiety, depres- realize that after a period of time, adaptation can occur. sion, and other mental illnesses leading to greater reductions in Closely related to focalism is the phenomenon of “immune subjective well-being than stroke, and stomach, chest, and heart neglect,” the failure to anticipate the ability of one’s psychological problems. immune system to counteract the negative effects of adverse Pondering the failure to adapt to persistent and enduring ail- experiences (Gilbert, Pinel, Wilson, Blumberg, & Wheatley, ments, Binder and Coad (2013) suspect that the uncertainty asso- 1998). Through a series of cognitive processes, people can trans- ciated with some impairments, including the inability to anticipate form their reactions to adverse events, becoming less susceptible to the next headache or anxiety attack, may hinder adaptation. Sun- negative emotions and allowing more positive emotions to prevail. stein (2008) speculates that apprehension about whether a condi- Forecasters tend to be unaware of such tendencies. This document is copyrighted by the American Psychological Association or one of its allied publishers. tion has stabilized and when further deterioration will occur—as is Another reason that people mispredict future emotional states is This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. likely in degenerative illnesses—may explain failure to adapt to that they lack familiarity with the emotional experience in ques- certain conditions. tion. As Blumenthal (2004) notes, lottery winners hit the jackpot Data showing that people can adapt hedonically to some con- only once, so they, like others who experience once-in-a-lifetime ditions but not to others should temper the assertion that laypeople sorts of events, have no repository of past knowledge and reactions routinely overestimate hedonic loss. Rather, they suggest that to fall back on. Forecasts of their future emotional states occur because hedonic adaptation is domain-specific, laypeople may largely in a void, without useful information on which to rely. actually underestimate the hedonic effects of enduring ailments There are reasons to suspect that people with relevant expertise like pain and depression because they are common, easy to imag- (in our research, rehabilitation professionals) might be immune ine, likely to be experienced by many people albeit in mild form, from these biases. First and most simply, they have undoubtedly and often hidden from view (Sunstein, 2008). Presumably, profes- seen patients rebound emotionally from serious injuries and ill- sionals with experience assessing and treating individuals postin- nesses to regain a sense of pleasure and happiness within their jury would be aware that adaptation varies by injury type, and lives. This should help them avoid the focalism problem. In neither overestimate the impact of serious physical injuries nor addition, when people in a laboratory setting think about how the 4 GREENE, STURM, AND EVELO

experience of paraplegia changes over time or how to enhance ical injury than to a comparably severe but illusory physical injury. emotional reactions to a disability, their paraplegia-related quality But various errors in affective forecasting impair laypeople’s abil- of life ratings increase (Ubel et al., 2005). Finally, reminding ity to forecast hedonic losses, which leads to the following hy- people that negative injury experiences will fade from one’s potheses: thoughts makes affective forecasts more accurate (Wilson, Wheat- ley, Meyers, Gilbert, & Axsom, 2000). Clinicians often provide 1. Participants will rate loss of enjoyment of life as greater patients with these kinds of reframes, so they should be less following a physical injury than a comparably severe susceptible to immune neglect. psychological injury So what can we expect about laypeople’s and professionals’ ability to forecast hedonic losses and adaptation? Both groups 2. Participants will rate loss of future opportunities as probably know that the impact of injuries and illnesses diminishes greater following a physical injury than a comparably over time. But the concept of long-term hedonic adaptation, espe- severe psychological injury cially to serious conditions, may be counterintuitive to laypeople 3. Participants will estimate a longer timeframe to return to though understood by professionals. Affective forecasting errors normal functioning following a physical injury than a may further diminish laypeople’s ability to gauge future emotional comparably severe psychological injury well-being in others, but may have less deleterious effects on professionals. Thus, we suspect that when estimating long-term Although we expected higher ratings of hedonic loss in the hedonic loss, laypeople and professionals will respond differently moderate than the mild loss scenario, given the novelty of this to distinct kinds of injuries. subject area it was unclear whether that effect would hold for both physical and psychological injuries. Thus, we had no specific The Current Studies hypotheses regarding interactions. In Study 1, we examined laypeople’s awareness of hedonic adaptation by assessing what they believe about the impact of Method physical and psychological injuries on a victim’s well-being. In Study 2, we assessed judgments of lost enjoyment of life as a result Participants. One hundred thirty-three individuals partici- of paralysis (an illusory loss) and back pain (an enduring loss) by pated, including 68 community members and 65 students at a laypeople and rehabilitation professionals. Our primary focus is on midsized university. Participants ranged in age from 18 to 81 and how these groups judge others’ well-being and adaptation postin- all were fluent in English, consistent with the requirements for jury jury. Because we lack objective measures of adequate compensa- service in many jurisdictions. Community members were con- tion, we only tangentially address the size and accuracy of hedonic tacted at a farmers’ market or while waiting near a bus stop and damage awards. were asked to volunteer. They were not compensated monetarily. Students received extra course credit for participating. Design and procedure. Participants were randomly assigned Study 1 to one condition of a 2 (Primary Injury Type: physical, psycho- In this study, we ask how laypeople think about hedonic adap- logical) ϫ 2 (Extent of Long-term Hedonic Loss as rated by tation in response to physical and psychological impairments of mental health professionals: mild, moderate) between-subjects de- approximately equivalent severity. We examine how they rate sign. After providing informed consent, they read a vignette that hedonic loss subsequent to a visible physical injury and a compa- described an individual who had been injured in the past and rably severe but largely invisible psychological injury. Obviously, whose condition had now stabilized. Then they answered several it is difficult to find physical and psychological injuries of com- questions about the impact of the injury on the victim and about parable severity, given the subjective nature of this perception recovery time, after which they were thanked and debriefed. (Vallano, 2013) and the fact that physical injuries can have psy- Materials. chological sequelae and vice versa. Thus, we used scenarios de- Vignettes. Two vignettes (one involving primarily physical veloped by Andrews (1993) and employed by Andrews, Meyer, injuries and the other, primarily psychological injuries) depicted This document is copyrighted by the American Psychological Association or one of its allied publishers. and Berlá (1996) to ascertain mental health professionals’ ratings injuries that mental health clinicians in Andrews et al.’s (1996) This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. of the lost enjoyment of life experienced by people suffering from study rated as causing mild long-term loss. The physical injury various injuries. We selected scenarios that depicted two types of scenario depicted a woman who was attacked by and fell off a primarily physical injuries and two types of primarily psycholog- horse, suffered a bulging disk and shoulder infection, and required ical injuries, with one of each type involving an injury that mental several surgeries. The psychological injury scenario depicted a health professionals rated as causing moderate long-term hedonic woman who became terrified of sudden loud noises and highly loss and the other as causing mild long-term hedonic loss. anxious about incurring an injury after being struck in the face by If laypeople are aware that hedonic adaptation is domain- a projectile from a machine she operated in a factory. specific, they would forecast fewer losses and limitations in re- Two vignettes depicted injuries that clinicians rated as causing sponse to physical injuries to which people can more readily adapt moderate long-term loss. The physical injury scenario depicted a than to psychological injuries to which people can less readily woman who was involved in a car accident in which she sustained adapt. In other words, accurate understanding of hedonic adapta- a head injury as well as broken ribs, clavicle, and scapula, and was tion should lead to assessments of greater loss of well-being, hospitalized for two months. The psychological injury scenario enjoyment, and opportunity subsequent to an enduring psycholog- depicted a woman who became depressed and suicidal after sus- FORECASTING ABOUT HEDONIC ADAPTATION 5

taining injuries to her knee that aggravated a preexisting back hypothesis, F(1, 128) ϭ 2.52, p ϭ .12, d ϭ 0.33, 95% CI [Ϫ.02, problem and led to abuse of pain medications and alcohol. 0.68]. The interaction was not statistically significant, F(1, 128) ϭ In Andrews et al.’s (1996) study, the vignettes described women 1.24, p ϭ .27, ␩2 ϭ .01. aged 34 (physical injury-mild loss) and 33 (psychological injury- Hypothesis 2 predicted that lacking an understanding of hedonic mild loss), and men aged 38 (psychological injury-moderate loss) adaptation, participants would give higher ratings of loss of future and 71 (physical injury-moderate loss), but to control for the opportunities following physical injuries than psychological inju- effects of age and gender, we depicted each injury-sufferer as a ries of comparable severity. This hypothesis was supported. Par- 44-year-old woman who had reached maximum medical recovery. ticipants gave significantly higher scores for lost opportunities We consider the implications of this choice in the Discussion. The following physical injuries (M ϭ 5.51, SD ϭ 1.31) than psycho- vignettes were between 110 and 133 words. logical injuries (M ϭ 4.03, SD ϭ 1.58), F(1, 129) ϭ 35.28, p Ͻ Questionnaire. We asked four questions about the impact of .001, d ϭ 1.02, 95% CI [0.65, 1.38]. They rated loss of future the injury: to what extent it impaired the victim’s physical well- opportunities as greater after moderate loss injuries (M ϭ 5.45, being, to what extent it impaired her emotional well-being, to what SD ϭ 1.22) than mild loss injuries (M ϭ 4.14, SD ϭ 1.72), F(1, extent it limited her future enjoyment of life, and to what extent it 129) ϭ 27.21, p Ͻ .001, d ϭ 0.88, 95% CI [0.52, 1.24]. The limited her future opportunities. Responses were recorded on a interaction was not statistically significant, F(1, 129) ϭ 3.86, p ϭ 7-point Likert scale from 1 (not at all)to7(extremely). We also .05, ␩2 ϭ .03. asked “in how many months or years will she return to her original Responses to the question about the time necessary to return to level of happiness?” Using a fill-in-the-blank format, respondents original levels of well-being showed only an effect of Primary could answer with a number of months, years, a combination Injury Type. We recoded the data to form a 4-point scale (1 ϭ thereof, or could answer “never.” 0–12 months;2ϭ 13–24 months;3ϭ more than 24 months;4ϭ never). Consistent with Hypothesis 3, mean estimates were signif- ϭ ϭ Results icantly greater for the physical injury (M 2.70, SD 1.29) than for the psychological injury (M ϭ 2.14, SD ϭ 1.08), F(1, 128) ϭ After determining that responses to questions about limitations 6.59, p ϭ .01, d ϭ 0.46, 95% CI [0.12, 0.81]. There was no in future enjoyment of life and future opportunities—the variables statistically significant main effect of Extent of Long-Term Hedo- of prime interest—did not differ significantly between the com- nic Loss, F(1, 128) ϭ 0.42, p ϭ .52, d ϭϪ0.16, 95% CI [Ϫ.51, munity and student samples (ps Ͼ .53, two-tailed), we combined 0.18], or an interaction, F(1, 128) ϭ 0.12, p ϭ .73, ␩2 Ͻ .01. the samples in all subsequent analyses. We used a series of 2 ϫ (Primary Injury Type: physical, psychological) 2 (Extent of Discussion Long-Term Hedonic Loss: mild, moderate) factorial ANOVAs to analyze the data. Missing data were deleted pairwise. Effect sizes Results of this study seem to support the contention that lay- are Cohen’s D (d) and eta squared (␩2); all eta squares are partial. people lack an awareness of hedonic adaptation to physical and The questions concerning impairment to physical and emotional psychological injuries. Respondents’ ratings of limitations to fu- well-being served as manipulation checks. The manipulations were ture enjoyment of life subsequent to a physical injury and to a successful; ratings of physical impairment were significantly comparably severe psychological injury did not differ, and their higher in the physical injury scenarios (M ϭ 5.75, SD ϭ 1.12) than ratings of limitations to future opportunity were actually greater in in the psychological injury scenarios (M ϭ 5.08, SD ϭ 1.19), F(1, response to a physical injury than to a psychological injury. This 129) ϭ 10.42, p ϭ .002, d ϭ 0.59, 95% CI [0.24, 0.94], and in was true despite data (e.g., Binder & Coad, 2013) showing better response to injuries that clinicians rated as leading to moderate hedonic adaptation to physical injuries (because losses are often hedonic loss (M ϭ 5.73, SD ϭ 1.02) than to injuries rated as illusory) than to psychological injuries (because losses are often involving mild loss (M ϭ 5.12, SD ϭ 1.29), F(1, 129) ϭ 8.61, p ϭ enduring). Participants were also more likely to assume that a .004, d ϭ 0.53, 95% CI [0.18, 0.87]. Conversely, ratings of person with a physical injury would be unable to return to a emotional impairment were higher in the psychological injury preinjury level of happiness than one with a comparably severe scenarios (M ϭ 5.78, SD ϭ 0.92) than in the physical injury psychological injury. scenarios (M ϭ 5.45, SD ϭ 1.17), F(1, 129) ϭ 4.35, p ϭ .04, d ϭ An alternative explanation tempers this conclusion, however. This document is copyrighted by the American Psychological Association or one of its allied publishers. 0.31, 95% CI [Ϫ0.03, 0.66], and in response to moderate loss Regardless of their beliefs about hedonic adaptation, people may This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. injuries (M ϭ 5.82, SD ϭ 0.94) than to mild loss injuries (M ϭ simply devalue psychological injuries and underestimate their im- 5.39, SD ϭ 1.15), F(1, 129) ϭ 6.51, p ϭ .01, d ϭ 0.41, 95% CI pact on subjective well-being and functioning over time. Indeed, [0.06, 0.75]. judges and jurors alike question the legitimacy of psychological Hypothesis 1 predicted that because participants lack accurate injuries because of erroneous beliefs about their causes and con- understanding of hedonic adaptation, they would rate the loss of sequences (Vallano, 2013). enjoyment of life following a physical injury as greater than the We must also acknowledge concerns about our methodology. loss of enjoyment of life following a comparably severe psycho- Andrews et al.’s (1996) case descriptions did not include situations logical injury. Although lost enjoyment of life ratings were sig- that fit with our manipulations and that held all other variables nificantly higher for moderate loss injuries (M ϭ 5.37, SD ϭ 1.29) constant. Thus, to control for age and gender effects, we altered the than for mild loss injuries (M ϭ 3.86, SD ϭ 1.41), F(1, 128) ϭ age and (in two scenarios) the gender of injury sufferers in our 40.21, p Ͻ .001, d ϭ 1.12, 95%, CI [0.75, 1.49], they did not differ vignettes. This meant that we were not completely faithful to as a function of injury type (physical injury M ϭ 4.87, SD ϭ 1.45; Andrews et al.’s case descriptions and their clinicians’ analyses but psychological injury M ϭ 4.37, SD ϭ 1.61), contrary to our we opted for this tradeoff to maintain internal validity. Another 6 GREENE, STURM, AND EVELO

limitation of our methodology is the stark distinction we made Method between physical and psychological injuries. This dichotomy ig- Participants. nores the obvious and multiple ways in which one affects the other, One hundred eighty laypeople participated in this study. As in Study 1, all were age 18 or older and able to for example, that a physical injury could result in chronic pain that speak, read, and write fluently in English. They ranged in age from leads to impairment of emotional well-being. Possibilities of this 18 to 87 (M ϭ 37.32); 59% were female. Ninety-three participants sort blur the distinction we made between primarily physical, and were recruited from a midsized university and received extra credit primarily psychological injuries. Accordingly, in Study 2 we elim- for participating. Eighty-seven participants were recruited from the inated the physical-psychological distinction and focused instead community and were given monetary incentives in the form of on how laypeople and professionals assess hedonic loss as a result scratch-off lottery tickets and gift cards in exchange for partici- of paraplegia which, according to Sunstein (2008), is an injury pating. Approximately half of the laypeople had at least some with illusory loss, and back pain, which Sunstein claims results in college or vocational training; one-quarter had only a high school enduring loss. degree. Data from 47 rehabilitation professionals were collected via an Study 2 electronic survey distributed to the listservs of the American Psychological Association’s Divisions 22 (Rehabilitation Psychol- In this study, laypeople and rehabilitation professionals read two ogy) and 38 (Health Psychology), requesting responses from mem- vignettes that provided considerably more detail about accident bers with professional expertise in injury rehabilitation. Respon- victims’ functioning over time; one described an individual who dents included 43 doctoral level psychologists and four individuals was paralyzed in a car accident and the other described an indi- who held a professional degree (e.g., MD, DO). The professionals’ vidual who experienced persistent back pain subsequent to a fall. experience in rehabilitation work ranged from 1 to 38 years (M ϭ We selected the former to represent an injury causing illusory loss 15.0 years, SD ϭ 10.1 years) with approximately 19% having less and the latter, to represent an injury causing enduring loss. After than four years of experience, 17% having four to nine years of reading each vignette, participants estimated the lost enjoyment of experience, and 64% having more than 9 years of experience in life experienced by each victim in the short- and in the long-term injury rehabilitation. Most (59.6%) had completed fewer than 24 and determined hedonic damage awards. One goal of the study was formal disability assessments whereas the rest had completed more to determine whether laypeople and rehabilitation professionals than 24 assessments. Notably, 17% had completed more than 100 have a nuanced understanding of hedonic adaptation, namely, that disability assessments. No incentive was provided to this group for it varies over time and as a function of the type of injury. Sup- participating. porting research leads to the following predictions: Design and procedure. Both laypeople and professionals participated in this 2 (Injury Type: paraplegia, back pain) ϫ 2 (Time 1. Laypeople will have a general sense that hedonic loss Frame: short-term, long-term) within-subjects design. After pro- decreases over time. Thus, their long-term hedonic loss viding informed consent, participants read vignettes that described ratings will be lower than their short-term loss ratings, individuals who sustained injuries resulting either in paraplegia or regardless of injury type (Hypothesis 1a). But they will chronic back pain. To control for order effects, we presented the lack awareness that the type of injury affects the extent of vignettes in counterbalanced order: 51% of laypeople read the adaptation. Hence, the difference between short-term and paraplegia scenario first, as did 45% of professionals. After read- long-term loss ratings will not depend on the type of ing a vignette, they answered several questions about the perceived injury (Hypothesis 1b). impact of that condition. The main dependent variables were ratings of hedonic loss experienced by the victims in the short-term 2. Rehabilitation professionals will also understand that he- and the long-term. In addition, participants answered questions donic loss decreases over time, so their long-term hedo- regarding their decisions about hedonic loss and laypeople as- nic loss ratings will also be lower than their short-term sessed hedonic damage awards. At the conclusion of the study, all loss ratings, regardless of injury type (Hypothesis 2a). participants were thanked and laypeople were debriefed. However, they will also understand that the extent of Materials. This document is copyrighted by the American Psychological Association or one of its allied publishers. long-term adaptation varies with injury type. Thus, there Vignettes. We used two vignettes created by Andrews et al. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. will be no difference between short-term and long-term (1996) to develop the Lost Pleasure of Life scale. The vignettes loss ratings for back pain but there will be a decrease included descriptions of victims’ functional capacities in the four from short-term to long-term loss ratings for paraplegia domains related to hedonic loss and adaption: (a) practical, that is, (Hypothesis 2b). That is, professionals will be aware that activities of daily living; (b) emotional/psychological; (c) social, hedonic loss in paraplegia is illusory, but that hedonic that is, interpersonal and leisure pursuits; and (d) occupational, that loss as a consequence of back pain is enduring. is, vocational activities and identity. Experts consider these areas as crucial to an individual’s overall enjoyment of life, and impair- 3. Laypeople’s hedonic damage awards will be greater in ments in any of these areas can influence a person’s sense of the case of paraplegia than back pain because jurors put well-being (Andrews, 1993; Berlá et al., 1999). significant weight on apparent injury severity when de- One vignette described a 23-year-old male who became para- termining damages for pain and suffering (Wissler, Ev- plegic as a result of an automobile accident. It included many ans, Hart, Morry, & Saks, 1997), and we expect the same details regarding the impact of the accident on his practical func- pattern for hedonic damages. tioning (e.g., no bowel or bladder control, confined to a wheel- FORECASTING ABOUT HEDONIC ADAPTATION 7

chair), psychological functioning (e.g., diminished self-image as dent variable—did not differ significantly across groups, all ps Ͼ an active male, sleep problems), social functioning (e.g., limited .16, two-tailed. The analyses are split into three sections. First, we social contact because of transportation and wheelchair access tested Hypotheses 1 and 2 using two separate ANOVAs: one for difficulties), and occupational functioning (e.g., suspended his laypeople and another for professionals. This was necessary be- career goal to become a research chemist). It included the fact that cause the nature of participant recruitment resulted in radically he has reached maximum medical recovery, and it was 301 words different population sizes in the lay and professional groups. Each long. The other vignette described a 24-year-old female who was ANOVA tested a 2 (Injury Type: paraplegia, back pain) ϫ 2 (Time injured when she fell from a carnival ride, underwent back surgery, Frame: short-term, long-term) within-subjects factorial model. and continues to experience back pain. Details included practical Next, we followed up on these ANOVAs with a series of four functioning (e.g., difficulty walking and standing or sitting for regressions (one for laypeople and another for professionals for more than 30 min), psychological functioning (e.g., nightmares, each injury type) to examine which participant-endorsed factors self-conscious about physical appearance), social functioning (e.g., predicted ratings of long-term hedonic loss. Finally, we tested pain with intercourse), and occupational functioning (e.g., ineligi- damage awards related to Hypothesis 3 with a repeated measures ble for anticipated military career). It also included the fact that she t test. Throughout, missing data were deleted pairwise, all eta has reached maximum medical recovery, and it was 274 words in squared effect sizes (␩2) are partial, and all coefficients of deter- length. mination (R2) are adjusted. Questionnaire. Ratings of the short- and long-term hedonic Hedonic loss assessments as a function of injury type. All losses were on a 6-point Likert scale, ranging from 1 (minimal)to univariate results are shown in Table 1. One objective of this study 6(catastrophic). We defined short-term and long-term in the same was to assess whether laypeople are aware that injury sufferers can way as Andrews et al. (1996). The former referred to the period adapt hedonically but that the extent of adaptation over time is between the injury and the time of maximum medical improve- influenced by the type of injury. There was a main effect of Injury ment, and the latter to the period between maximum medical Type: Laypeople rated paraplegia as resulting in greater hedonic improvement and death. Participants then rated the importance of loss (M ϭ 4.85, SD ϭ 0.99) than back pain (M ϭ 4.29, SD ϭ four factors to their decisions, using a 6-point Likert scale from 1 0.95). Hypothesis 1a led us to expect a main effect for the Time (not at all)to6(extremely): the extent to which the victim’s life Frame (short- vs. long-term). This hypothesis was supported. was changed by the injury, the extent of harm suffered by the Mean hedonic loss ratings were significantly lower in the long- victim, the status of the victim’s health prior to injury, and the term (M ϭ 4.45, SD ϭ 1.01) than the short-term (M ϭ 4.69, SD ϭ general human capacity to adapt to injuries. Finally, laypeople read 0.93), indicating that regardless of injury type, laypeople had a jury instructions on hedonic loss assessment that are typically rudimentary awareness that injury sufferers can adapt hedonically provided in personal injury cases and were asked to select a with time. Apparently they understood that any initial decline in damage award from an 11-point scale on which dollar amounts enjoyment of life eventually abates and that emotional well-being were approximately intervallic when converted to logarithmic val- generally improves. ues (1 ϭ nothing;2ϭ $1–$12,000;3ϭ $12,001–$25,000;4ϭ Importantly though, and consistent with Hypothesis 1b, their $25,001–$50,000;5ϭ $50,001–$100,000;6ϭ $100,001– $250,000;7ϭ $250,001–$500,000;8ϭ $500,001–$1 million;9ϭ understanding did not extend to the differential impact of injury $1 million–$2 million;10ϭ $2 million–$4 million;11ϭ more type, as the interaction between Time Frame and Injury Type was than $4 million; Stevens, 1958). not significant. The time frame effect was similar in the back pain condition and the paraplegia condition. These data are shown in Figure 1a. This finding suggests that laypeople lack nuanced Results understanding of the fact that people adapt differentially as a We combined the community and student layperson samples function of injury type, and in particular, that they have difficulty after determining that ratings of hedonic loss—the primary depen- adjusting to a state of chronic pain.

Table 1 Overview, Univariate Results, Study 2 This document is copyrighted by the American Psychological Association or one of its allied publishers.

This article is intended solely for the personal use of the individual userMain and is not to be disseminated broadly. effect/interaction tested df F Effect size CI p

Within-group (Laypeople) ءءInjury type 1, 173 17.04 1.19a .91, 1.31 Ͻ.001 ءءTime frame 1, 173 61.48 .63a .52, .74 Ͻ.001 Time Frame ϫ Injury Type 1, 173 .14 Ͻ.01b Ͻ.01, .03 .910 ءTime frame (back pain) 1, 174 61.48 .46a .35, .57 .003 ءءTime frame (paraplegia) 1, 174 12.02 .51a .40, .62 Ͻ.001 Within-group (professional) ءءInjury type 1, 45 11.99 1.03a .81, 1.25 Ͻ.001 ءءTime frame 1, 45 115.99 3.21a 2.90, 3.52 Ͻ.001 Time Frame ϫ Injury Type 1, 45 .16 Ͻ.01b Ͻ.01, .10 .690 ءءTime frame (back pain) 1, 45 64.69 2.40a 2.13, 2.67 Ͻ.001 ءءTime frame (paraplegia) 1, 46 61.01 2.30a 2.03, 2.57 Ͻ.001 a Cohen’s d effect size estimate. b Partial Eta Squared effect size estimate. .p Ͻ .001 ءء .p Ͻ .05 ء 8 GREENE, STURM, AND EVELO

Figure 1. (a) Laypeople’s mean hedonic loss ratings for back pain and paraplegia over time. Ratings were on a 6-point scale, 1 (minimal)to6(catastrophic). Error bars represent 95% confidence intervals for each mean. (b) Professionals’ mean hedonic loss ratings for back pain and paraplegia over time. Ratings were on a 6-point scale, 1 (minimal)to6(catastrophic). Error bars represent 95% confidence intervals for each mean.

This last point—that laypeople lack understanding of the differ- Factors that influenced hedonic loss ratings. We asked both ential impact of injury type on long-term hedonic loss—begs the laypeople and professionals about the importance of four factors in question of whether professionals possess such understanding. Our the assessment of long-term loss of enjoyment of life: (a) the data suggest that they do not. Surprisingly, a pattern similar to extent to which the victim’s life was changed by the injury, (b) the laypeople’s emerged for professionals. Like laypeople, profession- extent of harm experienced by the victim, (c) the status of the This document is copyrighted by the American Psychological Association or one of its allied publishers. als rated paraplegia as leading to greater hedonic loss (M ϭ 4.41, victim’s health prior to the injury, and (d) the general human This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. SD ϭ 0.81) than back pain (M ϭ 3.95, SD ϭ 0.96). Also, and in capacity to adapt to injuries. We conducted multiple regression support of Hypothesis 2a, mean hedonic loss ratings were signif- analyses (one for each injury type for each participant group) in an icantly lower in the long-term (M ϭ 3.70, SD ϭ 0.90) than the attempt to predict long-term loss assessment from these variables. short-term (M ϭ 4.66, SD ϭ 0.87). Like laypeople but in contrast After excluding four multivariate outliers for the case of paraplegia to Hypothesis 2b, the interaction between Time Frame and Injury and two for the case of back pain (outliers were present only in the Type was not significant. Again, the time frame effect was similar laypeople data), we entered all predictors simultaneously. Results in the back pain condition and the paraplegia condition. These data for laypeople respondents are shown in Table 2 and for profes- are shown in Figure 1b. This finding suggests that people with sionals in Table 3. experience in injury rehabilitation also lacked a nuanced under- The overall model for losses associated with paraplegia in the standing that injury sufferers adapt differentially based on injury laypeople group was statistically significant, adjusted R2 ϭ .27, condition. Apparently neither laypeople nor rehabilitation profes- F(4, 163) ϭ 16.58, p Ͻ .001, 95% CI [.16, .38]. Approximately sionals were aware that emotional well-being is more likely to 27% of the variance in ratings of long-term hedonic loss was improve over time for a paraplegic than for a chronic pain sufferer. accounted for by the regression. Three of the four individual FORECASTING ABOUT HEDONIC ADAPTATION 9

Table 2 Standard Multiple Regression Analyses Predicting Influences on Hedonic Assessments, Study 2 (Laypeople)

IV: Health DV: LT before IV: Life ⌬ IV: Capacity Effect IVs MSDLoss (r) injury (r) extent (r) to adapt (r) BSEb ␤ tpsr2

03. 007. 2.74 197. 086. 235. ء142. ءءParaplegia Harm suffered 5.04 .83 .42 .076 .390 Ϫ.066 .044 Ϫ.100 Ϫ1.49 .137 .01 094. ءHealth before injury 4.08 1.48 .07 — .147 12. 000. 5.32 388. 121. 643. ءLife ⌬ extent 5.63 .60 .55 — .188 Capacity to adapt 4.42 1.11 .24 — .124 .060 .139 2.05 .042 .02 01. 004. 2.91 221. 079. 231. ءء257. ءء471. ء242. ءءBack pain Harm suffered 4.57 .94 .41 Ͻ.01 975. 32. 002. 043. 001. ء162. ءء328. — ءHealth before injury 3.91 1.58 .19 12. 000. 5.38 409. 096. 514. 084. — ءءLife ⌬ extent 5.14 .78 .51 Capacity to adapt 4.34 1.00 .08 — Ϫ.013 .066 Ϫ.013 Ϫ.19 .849 Ͻ.01 Note. sr2 indicates the squared part correlation. .p Յ .001 ءء .p Ͻ .05 ء

predictors were statistically significant: extent of life change, paraplegic and this predictor explained approximately 12% of the t(163) ϭ 5.32, p Ͻ .001; extent of harm suffered, t(163) ϭ 2.74, variance. p ϭ .007; and general human capacity to adapt, t(163) ϭ 2.05, p ϭ The overall regression in the professionals group for the losses .042. Higher ratings of the influence of these items were separately associated with chronic pain included the same four predictors and related to long-term hedonic loss ratings as a result of paraplegia. was also found to be statistically significant, adjusted R2 ϭ .13, Of the significant predictors, extent of life change explained the F(4, 41) ϭ 2.68, p ϭ .045, 95% CI [Ϫ.03, .29]. The set of greatest amount of variance and capacity to adapt explained the variables in the model accounted for 13% of the variance in least. long-term hedonic loss assessments but none of the four predictors The overall regression for the losses associated with chronic was statistically significant on its own. pain in the laypeople group included the same four predictors and Laypeople’s damage awards as a function of injury type. was found to be statistically significant, adjusted R2 ϭ .28, F(4, Hypothesis 3 predicted that laypeople would assign higher hedonic 167) ϭ 17.86, p Ͻ .001, 95% CI [-.02, .10]. The set of variables damage awards to the paraplegic than the chronic back pain sufferer. in the model accounted for 28% of the variance in long-term A repeated measures t test supported this prediction. The mean hedonic loss assessments and only two of the four predictors were hedonic damage awards were $750,000 to the paraplegic (on an statistically significant: the extent of harm suffered, t(167) ϭ 2.91, 11-point scale, M ϭ 7.50, SD ϭ 2.24) and $372,500 to the back pain p ϭ .004], and the extent of life change, t(167) ϭ 5.38, p Ͻ .001. sufferer (M ϭ 6.49, SD ϭ 2.14), t(172) ϭ 8.21, p Ͻ .001, d ϭ 0.47, They uniquely explained 1% and 12% of the variance in long-term 95% CI [0.25, 0.68]. Correlations between hedonic damage awards loss assessments, respectively. and long-term hedonic loss assessments were significant for both The overall model for losses associated with paraplegia in the types of injuries: r(174) ϭ .28, p Ͻ .001, 95% CI [.14, .42] (para- professionals group was statistically significant, adjusted R2 ϭ .27, plegic); r(175) ϭ .23, p ϭ .003, 95% CI [.08, .37] (back pain F(4, 39) ϭ 4.87, p ϭ .003, 95% CI [.07, .46]. Approximately 27% sufferer). of the variance in ratings of long-term loss assessment was accounted for by the regression. One of the four individual predictors Discussion was statistically significant: the extent of life change, t(39) ϭ 2.63, p ϭ .012. Higher ratings of the influence of this predictor were Both laypeople and professionals rated long-term hedonic loss uniquely related to ratings of long-term hedonic loss for the as less than short-term loss, indicating an awareness that with time,

This document is copyrighted by the American Psychological Association or one of its alliedTable publishers. 3

This article is intended solely for the personal use ofStandard the individual user and is not to be disseminated broadly. Multiple Regression Analyses Predicting Influences on Hedonic Assessments, Study 2 (Professionals)

IV: Health DV: LT before IV: Life ⌬ IV: Capacity Effect IVs MSDLoss (r) injury (r) extent (r) to adapt (r) BSEb ␤ tpsr2

02. 241. 1.19 205. 142. 169. ءϪ.323 ء405. ءء513. ءParaplegia Harm suffered 4.59 1.19 .411 Ϫ.053 .144 Ϫ.058 Ϫ.37 .713 Ͻ.01 000. ءHealth before injury 4.27 1.07 .170 — .324 Ϫ.045 .405 .154 .381 2.63 .012 .12 — ءLife ⌬ extent 5.11 .92 .456 Ϫ.291 .163 Ϫ.253 Ϫ1.79 .082 .05 — ءCapacity to adapt 4.50 .85 Ϫ.336 Ϫ.099 .120 .131 .138 .92 .364 .02 235. ء341. ءBack pain Harm suffered 4.37 .93 .263 Ϫ.060 .074 .115 .102 .65 .522 .01 ء396. — ءHealth before injury 4.30 1.11 .279 07. 061. 1.92 297. 159. 305. 110. — ءLife ⌬ extent 4.96 .79 .347 Capacity to adapt 4.35 .95 Ϫ.193 — Ϫ.176 .121 Ϫ.206 Ϫ1.45 .154 .04 Note. sr2 indicates the squared part correlation. .p Յ .001 ءء .p Ͻ .05 ء 10 GREENE, STURM, AND EVELO

emotional reactions to adverse health conditions subside. But in cases that varied in apparent severity at the time of the injury to evaluating the extent of long-term hedonic losses, neither lay- assess how respondents would forecast hedonic adaptation. We people nor, surprisingly, professionals, seemed aware that people also acknowledge that despite successful counterbalancing, are more likely to adapt hedonically to paraplegia than to chronic there were order effects on ratings of long-term hedonic loss: pain. This suggests that both groups may forecast a future for Both laypeople and professionals gave higher ratings to the people who have suffered serious physical injuries as considerably paraplegic when that case was presented second, and laypeople grimmer than it is likely to be. People adapt—at least partially—to gave lower ratings to the back pain sufferer when that case was these injuries, allowing them to experience levels of contentment presented second. It is possible that our results were influenced and satisfaction of which laypeople and rehabilitation profession- by these potential confounds. als are apparently unaware. The data also suggest that both groups underappreciate the long-term emotional consequences of less General Discussion visible injuries (e.g., chronic back pain) to which people cannot easily adapt and that both groups forecast a rosier future than is The picture that emerges from these studies is that people likely. apparently lack nuanced understanding of hedonic adaptation. In These findings are consistent with Sunstein’s (2008) contention Study 1, laypeople’s ratings of limitations to future enjoyment of that jurors are likely to overestimate how much hedonic harm is life subsequent to a physical injury and a psychological injury of imposed by a serious physical injury in which losses “turn out to equivalent severity were not different despite the fact that people be low or even illusory, at least in the long run” (p. S168). They show better hedonic adaptation to the former than the latter also support his suspicion that jurors are likely to underestimate (Binder & Coad, 2013). In addition, participants assumed that how much hedonic harm results from conditions like depression people who sustain a physical injury are less likely to return to and chronic pain that impose enduring losses. their original level of well-being than people who sustain a com- It surprised us that rehabilitation professionals were insensitive parably severe psychological injury. In Study 2, both laypeople to the fact that long-term adaptation varies by type of injury. and rehabilitation professionals were aware that enjoyment of life Perhaps the extent of their experiences played a role. Despite an increases with time postinjury. But neither group seemed knowl- average of 15 years in the field, the majority had conducted fewer edgeable of the domain-specificity of hedonic adaptation in the than 24 disability assessments, so may have been unfamiliar with long run, as both groups indicated that a severe physical injury the time course of adaptation to different conditions. Paraplegia, in would detract more from enjoying life than a persistent but largely particular, is a relatively rare event for which clinicians may have invisible injury, despite evidence to the contrary (Binder & Coad, scant knowledge on which to rely. (Obviously, laypeople would 2013). Had participants understood that humans adapt differen- also lack relevant insight.) Further, the majority of their patients tially to injuries and illness as a function of the type of ailment, that may be in the early stages of rehabilitation so clinicians would not awareness would have affected their ratings of hedonic loss in both be privy to information about long-term adaptation. Finally, like studies. It did not. most people, professionals may fail to learn from past forecasting A premise of our research is that people adapt less well, in terms errors (assuming they are aware of them) and to make adjustments of enjoying life, if they experience psychological and other im- in the future (Novemsky & Ratner, 2003). pairments involving persistent reminders of infirmity than if they Another finding from our data suggests that adaptation may sustain severe physical injuries. Can we be assured of that fact? simply not factor prominently in hedonic loss judgments. Recall Undoubtedly, serious physical injuries reduce people’s sense of that we asked participants to rate the importance of four items well-being, and longitudinal studies show lingering effects of to their judgments of long-term hedonic loss and conducted injuries and illness on happiness (e.g., Oswald & Powdthavee, regression analyses to examine the predictors of this decision. 2008). But we would argue, like Sunstein (2008), that persistent The capacity to adapt was related to long-term loss assessments and nagging injuries that cannot be ignored lead to even greater only for laypeople and only when judging the case of paraple- erosion of subjective well-being, and new longitudinal data gia. (Binder & Coad, 2013) support that conclusion. Whereas many Although examination of hedonic damage awards was not the paraplegics, for example, eventually reduce their focus on the main focus of this study, it is worth noting that the awards life-changing event and adjust to their altered circumstances, This document is copyrighted by the American Psychological Association or one of its allied publishers. produced here support an oft-made observation about damage chronic pain sufferers and those experiencing mental illness ap- This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. awards, namely vertical equity, which occurs when awards parently have difficulty doing so. When pain, anxiety, depression, correlate with apparent injury severity (Wissler et al., 1997). and other persistent conditions such as tinnitus and dizziness color Long-term hedonic losses were rated as higher for the paraple- a person’s waking hours, that individual may be able to think of gic than the chronic pain sufferer (though, as we noted, those little else. Obviously, well-being suffers. forecasts may be erroneous), and damages were larger for the Why do laypeople and professionals alike lack understanding former than the latter. of this phenomenon? One reason may be the counterintuitive We acknowledge some concerns about our vignettes. Con- nature of hedonic adaptation, namely that people can regain a ceivably, the fact that we did not control for gender or injury sense of happiness and satisfaction with life even after experi- severity could confound our results. In this study, we made the encing catastrophic injuries that result in amputations, paraly- choice to opt for realism over tight experimental control, so sis, and the like. Relatedly, in forecasting the future happiness used Andrews’ (1993) descriptions of actual accident victims of a person who has sustained these conditions, observers that included details about their functional limitations; some of probably attend to outward, visible signs of impairment and those details were gender-specific. And we intentionally chose have little access to that person’s thoughts or feelings, including FORECASTING ABOUT HEDONIC ADAPTATION 11

any adjusted aspirations and new pleasures. Finally, observers ple adapt to injuries of a particular sort and that observers tend may simply fail to consider the human capacity to adapt to to assume, incorrectly, that the emotional effects of those inju- injuries. Indeed, our regression analyses showed that consider- ries will linger. Alternatively, a mental health professional ation of one’s capacity to adapt was, at best, only a very weak could conduct a forensic evaluation of a particular plaintiff, predictor of hedonic loss assessments. providing a more specific assessment of his or her subjective well-being that will help jurors to forecast that person’s future Limitations happiness. The landmark case of Sherrod v. Berry (1985) paved the way in allowing expert testimony in cases involving hedonic In addition to the caveats mentioned previously, we must damage awards. acknowledge other limitations of our studies. We asked partic- Two directions for future research arise from our studies. One ipants to determine the future happiness of particular individ- involves longitudinal analysis of how victims of particular uals whose adjustment will surely depend on a large number of accidents and injuries fare hedonically as time passes, including factors, including the type and timing of injury or illness, how well they can forecast their own happiness. Measuring preinjury levels of subjective physical and emotional well- various components of subjective well-being across time and in being, and other situational and dispositional factors. Obvi- individuals with different types of injuries would provide a ously, vignettes cannot provide the richness of detail that is more accurate understanding of the ways that people adapt conveyed through interactions and observations, so partici- affectively to injuries and to the changed circumstances these pants’ access to information that may be vital to their judgments injuries impose. Doing a study of this nature would require was limited. following victims from their initial hospitalization, through In addition, it is worth asking whether participants were focus- rehabilitation, and at various points after they have stabilized. ing exclusively on hedonic losses when answering our questions, At each of these points they would report their level of subjec- rather than considering other components of noneconomic dam- tive well-being and estimate how they expect to feel in the ages such as disability, disfigurement, pain, and suffering. We future, and these forecasts would be compared with actual data have no direct means of addressing this issue, though previous collected at later points in the study. studies suggest that without explicit instruction, respondents might A second line of research could focus on mock jurors’ and merge the components in their minds (Gregory & Winter, 2011; juries’ decisions regarding lost enjoyment of life in simulated Poser et al., 2003). Whether and how the apparent lack of atten- trials using details from the cases of these real accident victims. tiveness to hedonic adaptation might affect awards for pain, suf- In essence, jurors could hear evidence about an accident and the fering, and disability is unknown, though clearly stated jury in- plaintiff’s recovery and make decisions regarding the plaintiff’s structions could inform jurors that lost enjoyment of life is wholly hedonic loss since the accident and into the future. Their distinguishable from those other noneconomic losses. judgments could then be compared with the actual losses reported by the real victims. This sort of research is undoubtedly Implications and Future Directions complex and time-consuming, but it could provide more defin- itive conclusions about the ability of laypeople to accurately Understanding what people presume about a victim’s ability forecast others’ hedonic losses and, if that ability is shown to be to return to preinjury levels of happiness and satisfaction has wanting, test various legal remedies to correct errors in fore- significant practical importance for trial-related judgments. Not casting. infrequently, jurors forecast how plaintiffs will fare in the future and then determine what amount of money will compen- References sate them for any diminishment in their level of enjoyment of life, among other things. These judgments are rife with uncer- Andrews, P. (1993). Study and refinement of the lost pleasure of life scale tainty, and an understanding of how such decisions are typically (Unpublished doctoral dissertation). University of Louisville, KY. made is only a first step in making awards more equitable and Andrews, P., Meyer, R., & Berla, E. (1996). Development of the Lost Pleasure of Life Scale. Law and Human Behavior, 20, 99–111. http:// predictable. Other steps can and perhaps should be taken. dx.doi.org/10.1007/BF01499134 If research continues to support the apparent misestimating of This document is copyrighted by the American Psychological Association or one of its allied publishers. Antonak, R. F., & Livneh, H. (1995). Psychosocial adaptation to disability hedonic loss, then jurors could benefit from instructions that point-

This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. and its investigation among persons with multiple sclerosis. Social edly inform them of this tendency and explain how they can avoid Science & Medicine, 40, 1099–1108. http://dx.doi.org/10.1016/0277- making this common judgment error. Courts are increasingly will- 9536(94)00167-R ing to incorporate findings from psychological research studies Bagenstos, S., & Schlanger, M. (2007). Hedonic damages, hedonic adap- into standardized jury instructions (see, e.g., Weiser, 2012), with tation, and disability. Vanderbilt Law Review, 60, 745–797. the goal to assist jurors in determining verdicts and damage awards Berlá, E. P., Andrews, P., & Berlá, K. A. (1999). Loss of pleasure of life: that are informed by scientific data rather than misconceptions. Conceptual, vocational, and forensic perspectives. Journal of Career Instructions summarizing what is known about hedonic adaptation Assessment, 7, 299–321. http://dx.doi.org/10.1177/10690727 9900700307 and affective forecasting errors could be helpful. Binder, M., & Coad, A. (2013). “I’m afraid I have bad news for you. . .” Another remedy involves the admission of expert testimony Estimating the impact of different health impairments on subjective in cases involving assessments of hedonic losses. This testi- well-being. Social Science & Medicine, 87, 155–167. http://dx.doi.org/ mony could take the form of social framework testimony (Mo- 10.1016/j.socscimed.2013.03.025 nahan & Walker, 1988) in which an expert with knowledge of Blumenthal, J. (2004). Law and emotions: The problems of affective relevant research would help jurors understand how most peo- forecasting. Indiana Law Journal, 80, 1–95. 12 GREENE, STURM, AND EVELO

Boan v. Blackwell, 541 S. E. 2d 242 (S. C. 2001). Journal of Public Economics, 92, 1061–1077. http://dx.doi.org/10.1016/ Brickman, P., Coates, D., & Janoff-Bulman, R. (1978). Lottery winners j.jpubeco.2008.01.002 and accident victims: Is happiness relative? Journal of Personality and Park, C. L. (2010). Making sense of the meaning literature: An integrative Social Psychology, 36, 917–927. http://dx.doi.org/10.1037/0022-3514 review of meaning making and its effects on adjustment to stressful life .36.8.917 events. Psychological Bulletin, 136, 257–301. http://dx.doi.org/10.1037/ Bronsteen, J., Buccafusco, C., & Masur, J. (2008). Hedonic adaptation and a0018301 the settlement of civil lawsuits. Columbia Law Review, 108, 1516–1549. Patterson, D. R., Everett, J. J., Bombardier, C. H., Questad, K. A., Lee, Retrieved from http://www.jstor.org/stable/40041791 V. K., & Marvin, J. A. (1993). Psychological effects of severe burn Bruno, M. A., Bernheim, J. L., Ledoux, D., Pellas, F., Demertzi, A., & injuries. Psychological Bulletin, 113, 362–378. http://dx.doi.org/10 Laureys, S. (2011). A survey on self-assessed well-being in a cohort of .1037/0033-2909.113.2.362 chronic locked-in syndrome patients: Happy majority, miserable minor- Poser, S., Bornstein, B. H., & McGorty, E. K. (2003). Measuring damages ity. British Medical Journal Open, 1, e000039. http://dx.doi.org/10 for lost enjoyment of life: The view from the bench and the jury box. .1136/bmjopen-2010-000039 Law and Human Behavior, 27, 53–68. http://dx.doi.org/10.1023/A: Dolan, P. (2011). Using happiness to value health. London, UK: Office of 1021626928063 Health Economics. Riis, J., Loewenstein, G., Baron, J., Jepson, C., Fagerlin, A., & Ubel, Easterlin, R. A. (2003). Explaining happiness. PNAS Proceedings of the P. A. (2005). Ignorance of hedonic adaptation to hemodialysis: A National Academy of Sciences of the United States of America, 100, study using ecological momentary assessment. Journal of Experi- 11176–11183. http://dx.doi.org/10.1073/pnas.1633144100 mental Psychology: General, 134, 3–9. http://dx.doi.org/10.1037/ Emerson, E., Kariuki, M., Honey, A., & Llewellyn, G. (2014). Becoming 0096-3445.134.1.3 disabled: The association between disability onset in younger adults and Schkade, D., & Kahneman, D. (1998). Does living in California make subsequent changes in productive engagement, social support, financial people happy? A focusing illusion in judgments of life satisfaction. hardship and subjective wellbeing. Disability and Health Journal, 7, Psychological Science, 9, 340–346. http://dx.doi.org/10.1111/1467- 448–456. http://dx.doi.org/10.1016/j.dhjo.2014.03.004 9280.00066 Frederick, S., & Loewenstein, G. (1999). Hedonic adaptation. In D. Kah- Schulz, R., & Decker, S. (1985). Long-term adjustment to physical dis- neman, E. Diener, & N. Schwarz (Eds.), Well-being: The foundations of ability: The role of social support, perceived control, and self-blame. hedonic psychology (pp. 302–329). New York, NY: Russell Sage Foun- Journal of Personality and Social Psychology, 48, 1162–1172. http://dx dation. .doi.org/10.1037/0022-3514.48.5.1162 Gilbert, D. T., Pinel, E. C., Wilson, T. D., Blumberg, S. J., & Wheatley, Sherrod v. Berry, 629 F. Supp. 159 (163 N. D. Ill. 1985). T. P. (1998). Immune neglect: A source of durability bias in affective Shields, M., & Wheatley Price, S. (2005). Exploring the economic and forecasting. Journal of Personality and Social Psychology, 75, 617–638. social determinants of psychological well-being and perceived social http://dx.doi.org/10.1037/0022-3514.75.3.617 support in England. Journal of the Royal Statistical Society A, 168, Graham, C., Higuera, L., & Lora, E. (2011). Which health conditions cause 513–537. http://dx.doi.org/10.1111/j.1467-985X.2005.00361.x the most unhappiness? Health Economics, 20, 1431–1447. http://dx.doi Smith, C. A., & Wallston, K. A. (1992). Adaptation in patients with .org/10.1002/hec.1682 chronic rheumatoid arthritis: Application of a general model. Health Gregory, A., & Winter, R. (2011). More than the sum of its parts? Psychology, 11, 151–162. http://dx.doi.org/10.1037/0278-6133.11.3.151 Itemizing impairment in civil cases. Legal and Criminological Psychol- Stanton, A. L., Revenson, T. A., & Tennen, H. (2007). Health psychology: ogy, 16, 173–187. http://dx.doi.org/10.1348/135532510X496204 Psychological adjustment to chronic disease. Annual Review of Psychol- Horgan, O., & MacLachlan, M. (2004). Psychosocial adjustment to lower- ogy, 58, 565–592. http://dx.doi.org/10.1146/annurev.psych.58.110405 limb amputation: A review. Disability and Rehabilitation, 26, 837–850. http://dx.doi.org/10.1080/09638280410001708869 .085615 Igou, E. R. (2008). “How long will I suffer?” versus “How long will you Stevens, S. S. (1958). Problems and methods of psychophysics. Psycho- suffer?” A self-other effect in affective forecasting. Journal of Person- logical Bulletin, 55, 177–196. http://dx.doi.org/10.1037/h0044251 ality and Social Psychology, 95, 899–917. http://dx.doi.org/10.1037/ Sunstein, C. (2008). Illusory losses. The Journal of Legal Studies, 37, a0011619 S157–S194. http://dx.doi.org/10.1086/595675 Krause, J. S. (1992). Longitudinal changes in adjustment after spinal cord Swedloff, R., & Huang, P. (2010). Tort damages and the new science of injury: A 15-year study. Archives of Physical Medicine and Rehabilita- happiness. Indiana Law Journal, 85, 553–595. Retrieved from http://ilj. tion, 73, 564–568. http://www.archives-pmr.org law.indiana.edu Lucas, R. E. (2007). Long-term disability is associated with lasting changes Tennen, H., & Affleck, G. (2002). The challenge of capturing daily in subjective well-being: Evidence from two nationally representative processes at the interface of social and clinical psychology. Journal of This document is copyrighted by the American Psychological Association or one of its allied publishers. longitudinal studies. Journal of Personality and Social Psychology, 92, Social and Clinical Psychology, 21, 610–627. http://dx.doi.org/10.1521/ This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 717–730. http://dx.doi.org/10.1037/0022-3514.92.4.717 jscp.21.6.610.22796 Menzel, P., Dolan, P., Richardson, J., & Olsen, J. (2002). The role of Ubel, P. A., Loewenstein, G., & Jepson, C. (2005). Disability and adaptation to disability and disease in health state valuation: A sunshine: Can hedonic predictions be improved by drawing attention preliminary normative analysis. Social Science & Medicine, 55, to focusing illusions or emotional adaptation? Journal of Experimen- 2149–2158. tal Psychology: Applied, 11, 111–123. http://dx.doi.org/10.1037/ Monahan, J., & Walker, L. (1988). Social science research in law: A new 1076-898X.11.2.111 paradigm. American Psychologist, 43, 465–472. http://dx.doi.org/10 Vallano, J. (2013). Psychological injuries and legal decision making in .1037/0003-066X.43.6.465 civil cases: What we know and what we do not know. Psychological Novemsky, N., & Ratner, R. (2003). The time course and impact of Injury and Law, 6, 99–112. http://dx.doi.org/10.1007/s12207-013- consumers’ erroneous beliefs about hedonic contrast effects. Journal 9153-z of Consumer Research, 29, 507–516. http://dx.doi.org/10.1086/ Weiser, B. (2012). New Jersey court issues guidance for juries about 346246 reliability of eyewitnesses. New York Times. Retrieved from http://www Oswald, A., & Powdthavee, N. (2008). Does happiness adapt? A longitu- .nytimes.com/2012/07/20/nyregion/judges-must-warn-new-jersey- dinal study of disability with implications for economists and judges. jurors-about-eyewitnesses-reliability.html FORECASTING ABOUT HEDONIC ADAPTATION 13

Wilson, T., & Gilbert, D. (2005). Affective forecasting: Knowing what to Wortman, C., & Silver, R. (1987). Coping with irrevocable loss. In G. R. want. Current Directions in Psychological Science, 14, 131–134. http:// Van den Bos & B. K. Bryant (Eds.), Cataclysms, crises, and catastro- dx.doi.org/10.1111/j.0963-7214.2005.00355.x phes: Psychology in action (pp. 185–235). Washington, DC: American Wilson, T. D., & Gilbert, D. T. (2008). Explaining away: A model of Psychological Association. http://dx.doi.org/10.1037/11106-005 affective adaptation. Perspectives on Psychological Science, 3, 370– Wu, S. (2001). Adapting to heart conditions: A test of the hedonic tread- 386. http://dx.doi.org/10.1111/j.1745-6924.2008.00085.x mill. Journal of Health Economics, 20, 495–507. http://dx.doi.org/10 Wilson, T. D., Wheatley, T., Meyers, J. M., Gilbert, D. T., & Axsom, D. .1016/S0167-6296(01)00084-4 (2000). Focalism: A source of durability bias in affective forecasting. Journal of Personality and Social Psychology, 78, 821–836. http://dx .doi.org/10.1037/0022-3514.78.5.821 Wissler, R. L., Evans, D. L., Hart, A. J., Morry, M. M., & Saks, M. J. (1997). Explaining “pain and suffering” awards: The role of injury Received December 8, 2014 characteristics and fault attributions. Law and Human Behavior, 21, Revision received December 28, 2015 181–207. http://dx.doi.org/10.1023/A:1024878329333 Accepted January 1, 2016 Ⅲ This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.