Momentary lapse of control: A cognitive continuum approach to understanding and mitigating perseveration in human error
Introduction
Operators of critical systems (e.g. an airplane, unmanned vehicle, nuclear power plant) are subjected to numerous factors known to impair human cognitive performance (e.g., overload, fatigue, emotional stressors), as well as having to contend with external distractions and interruptions that can further reduce situation awareness (e.g., Hodgetts et al., 2014, 2005). Such complex activities require adaptive behavior to deal with dynamic and uncertain situations, yet safety analysis highlights that even the most experienced human operators can persist in inappropriate courses of action when overwhelmed by unexpected events. In most of these highly degraded but often recoverable situations, operators are unable to comprehend the situation and persist in erroneous behaviors despite the occurrence of multiple visual/auditory cues that should instigate a change in strategy. This kind of behavior in which operators make decisions without reevaluating whether or not they are correct – even in the face of information that directly contradicts their decision – has been coined perseveration (Hall et al., 1982). Such a lack of mental flexibility is seen with dysexecutive patients in the clinical domain, but in the current paper we seek to provide a holistic account for perseveration to help advance our understanding of human performance failures in the real world. We identify how neural correlates of perseverative behavior can be compromised by either situational variables or brain damage particularly to the dorslolateral prefrontal cortex (DLPFC), and propose a cognitive continuum whereby perseveration can result from a brain lesion or from a temporary loss of control as a function of environmental stressors in safety-critical operations. The current article is not intended as an exhaustive review of the perseveration literature; rather, we provide examples from clinical and cognitive psychology to illustrate the proposed cognitive continuum and refer the reader elsewhere for more comprehensive reviews of perseverative behaviours (e.g., Clancy et al., 2016; Hauser, 1999; Hotz and Helm-Estabrooks, 1995), as well as complementary approaches, for example, from social psychology (Fox and Hoffman, 2002) and ergonomics (De Keyser and Woods, 1990).
In the neuropsychological domain, the concept of perseveration is the continuation or repetition of an action or a strategy after the cessation of the original stimulus or goal, and to an extent that the activity is no longer optimal or relevant to the task at hand (Sandson and Albert, 1984). More precisely, these authors defined three categories of perseveration: recurrent, continuous, and, of most relevance to the current human factors focus, stuck-in-set perseveration. It is defined as “the inappropriate maintenance of a current category or framework”, and is considered a process deficit in executive functioning. This inability to shift between representations and strategy, observed in patients (Waegeman et al., 2014), is commonly assessed with the Wisconsin Card Sorting Test (WCST; Berg, 1948) whereby cards must be sorted according to implicit rules that change across time. This ability to adapt strategy in line with changing circumstances is important in everyday situations, and particularly for the operators of dynamic and complex critical systems. For example, piloting an airplane involves adaptation to continually evolving scenarios, and mental flexibility as measured by one of the performance metrics on the WCST has proven successful in predicting pilot perseveration in a subsequent flight simulation (Causse et al., 2011a, 2011b). A correlation was found between the total number of errors (including perseverative errors) and a pilot's erroneous decision to continue to land in bad weather. This suggests that impaired performance on the WCST can be indicative of non-adaptive perseveration in pilots as well as in the aforementioned patient population, supporting the idea of common neural correlates underlying different manifestations of perseverative behavior.
Research from areas of cognitive psychology (Lee, 2014), cognitive neuroscience (Dreisbach et al., 2004) and social psychology (Atkinson and Cartwright, 1964; Masicampo and Baumeister, 2011) have identified certain pre-conditions that can lead healthy people to rigidly pursue their initial goal even if it would seem maladaptive. One main explanation for this phenomenon is that any interference with the on-going activity (Dehais et al., 2012a, 2012b) can induce a feeling of loss that leads to increased physiological arousal and prefrontal activity (Yechiam, and Hochman, 2013), which serves to focus attention on task achievement. This focus promotes a fixation on the initial goal to the exclusion of other viable alternatives. Several factors are thought to increase the likelihood of this type of human error, including high task demand (Durantin, Gagnon, Tremblay et al., 2014; Dehais et al., 2012a, 2012b), time-on-task (Van der Linden et al., 2003; Cho et al., 2000; Orzeł-Gryglewska Jolanta, 2010; Rouch et al., 2005), and stress and emotions (Shanteau, and Dino, 1993; Cowen, 1952). These pre-conditions are endemic in the work environments of critical systems that are analogous with multitasking, time pressure, emotional stress, and in some cases, under stimulation (e.g., supervisory monitoring/vigilance, such as air traffic control), making these tasks particularly susceptible to perseverative error. A greater understanding of the neural basis of perseveration could inform strategies or support systems that could help to mitigate this class of human error.
Despite the development of technology to automate aspects of the work environment and circumvent the fallibility of human operators, human error – and in particular perseverative error – remains a key feature of many real world catastrophic events. The history of aviation is unfortunately rich with perseverative behaviors such as the 1978 United Air Lines Flight 173 incident in which the pilots faced a faulty landing gear indicator and decided to postpone the landing with a holding pattern. The pilots became so fixated on handling the landing gear issue that they forgot to check the fuel tank instrument and eventually crashed in the vicinity of Portland airport (National Transportation Safety Board (NTSB, 1979). In the medical domain, Bromiley (2008) described how his wife died following “routine” surgery: during anesthesia, the medical team faced a “can’t intubate, can’t ventilate” situation as they were trying to intubate the patient. While a solution to this situation exists (tracheotomy), the team ignored it and persisted in unsuccessful attempts at intubating for 35 min before abandoning the procedure, after which time the patient could not recover. These dramatic events are not specific to these fields, and such critical persistence in inappropriate behaviors has occurred in the nuclear power plant industry (e.g., Three Mile Island, Tchernobyl), the Aerospace domain (e.g., Challenger accident; Rogers, 1986) and has been observed with anesthesiologists (Fioratou et al., 2010; Gaba, 1989; Schwid and O’Donnell, 1992), drivers (Lee, 2014), traders (Haigh and List, 2005), navy operators (Collyer and Malecki, 1998; Rochlin, 1991), surveillance and monitoring operators (Hodgetts et al., 2017; Lanagan-Leitzel et al., 2015) and athletes in extreme sport (Krakauer, 1997). The ubiquity of these behaviors across varied domains raises the question of how highly trained personnel can become ‘trapped’ and fail to respond appropriately, despite being presented with cues that should prompt an alternative course of action.
The existence of perseverative behavior at the core of these real-world incidents supports the idea that environmental factors may cause an impairment of executive and attentional control within healthy operators, leading to deficits similar to those observed in patients with brain lesions. The boundary between normal and pathological cognitive performance can be crossed by a healthy individual, depending on his/her position along a cognitive continuum (see Petersen, 2004, for an illustration of the cognitive continuum in the clinical domain). We therefore suggest that advances in understanding and mitigating human error can be made by considering a cognitive continuum ranging from normal (high to normal intellectual performance) to pathological (very degraded intellectual performance), as a function of the level of mental workload, fatigue, or stress (Fig. 1).
In the sections below, we first review the constructs of perseveration and related executive impairments that can jeopardize the ability to adapt to external changes. In terms of the cognitive continuum hypothesis, we show that permanent or temporary deactivation of the DLPFC area can promote perseveration.
Secondly, we argue that perseveration can result from a lack of attentional control, thereby an erroneous course of action is continued due to an inability to notice relevant environmental changes that could indicate the need for an alternative approach. We review studies investigating temporal, parietal and frontal cortices involved in attentional networks within both healthy and patient populations, and note parallels between the two. In particular, we emphasize the key role of the DLPFC, at the interface between executive and attentional control, impairment of which can lead to biased attentional processing and neglect of information with the potential to instigate changes in behavior.
Thirdly, the cognitive continuum can provide a basis for further research and for the development of solutions specifically suited to degraded operational conditions. We therefore introduce a number of methods, such as training, neurostimulation and cognitive countermeasures for mitigating perseverative behavior.
Section snippets
Perseveration: making the parallel between a neurological deficit and a temporary loss of executive control
The construct of perseveration has been largely studied in the fields of neuropsychology, neurology, and psychiatry with patients exhibiting dysexecutive syndrome (e.g., following brain damage to the frontal lobes); however, as postulated, a similar syndrome also concerns human factors as it appears in healthy operators subjected to environmental stressors. In accordance with the continuum hypothesis, we propose that the manifestation of perseverative behavior in complex task operators is due
Perseveration as inattention to task-relevant changes
While we can make the case that perseverative behavior is an executive deficit – either due to frontal lesions or a temporary change in activity in the DLPFC due to environmental conditions – a complementary approach to conceptualize perseveration within healthy but stressed subjects is to consider the existence of attentional limitations. That is, individuals may fail to adapt to developing circumstances not because they lack the cognitive control or flexibility to assimilate and respond to
Mitigating human performance limitations
In accordance with the hypothesis of a putative cognitive continuum, we have highlighted some of the neural mechanisms underpinning perseveration at the executive and attentional levels and their deleterious consequences on human performance. Taking into account this clinical framework, an important next step is to implement cognitive countermeasures to mitigate the effect of these critical errors. We first describe potential solutions to improve the executive level impairment and then discuss
Conclusions
The current article combines human factors and neuroscience knowledge to present the idea of a cognitive continuum as a means to understanding and mitigating perseveration in complex and dynamic occupational settings. In particular, we raise the question as to why highly trained individuals continue to persist with non-adaptive and irrational courses of action, even when provided with information that should instigate a change in strategy. With neuroimaging techniques such as fNIRS, EEG, and
Acknowledgements
The research conducted by the authors and reported in this review is supported by the AXA Research Fund through the Neuroergonomics For Safety Chair to Frédéric Dehais, by the Natural Sciences and Engineering Research Council of Canada - Discovery grant awarded to Sébastien Tremblay - and by the foundation ISAE-SUPAERO. Thanks are due to Dr Francois Vachon, Emilie Jahanpour, and also to Mark Parent for their contribution to some of the empirical work reported in the paper.
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