Dr. Trent N. Cash | Dr. Rotem Paz | Dr. Anvita Gopal | Dr. Reza Hadi Mogavi | Dr. Krystle Shore
Dr. Trent N. Cash, Lupina Foundation Postdoctoral Research Fellow, 2025-27
Supervised by: Professor Sam Johnson, Department of Psychology
Using LLMs to Improve Patients’ Knowledge of Their Medical Preferences
Every year, millions of Canadians make complex medical decisions that require them to balance the pros and cons of multiple courses of action. For example, patients may be asked to choose between a stronger medication with harsher side effects and a weaker medication with more tolerable side effects. Similarly, patients may have to choose whether to wait for an MRI that is covered by their insurance or pay out of pocket for an ultrasound that is available sooner. Dr. Trent Cash’s work explores decision makers’ awareness and understanding of their own decision-making processes when faced with complex choices like these. Specifically, Trent studies decision makers’ metacognitive knowledge of why they make the decisions that they do.
In his Lupina project, he will investigate how patients facing complex medical decisions develop an understanding of their own preferences and priorities, and how the accuracy of this metacognitive knowledge influences their satisfaction with the medical care that they receive. This research is critical because decision makers who have less accurate metacognitive knowledge tends to make worse decisions. In the medical context, inaccurate metacognitive knowledge could result in patients making life-altering decisions without fully understanding the factors that influence their choices, leading to dissatisfaction and poor health outcomes. He will also design and test a new intervention that leverages AI-powered LLM chatbots – like ChatGPT or Gemini – to increase the accuracy of participants’ metacognitive knowledge and improve their healthcare outcomes. This intervention will focus on using Reflective-LLMs that talk patients through their options and help them understand their own motivations, priorities, and needs. Given the growing popularity and power of LLM chatbots, this kind of intervention could be highly scalable and provide a valuable tool for physicians and patients alike.
Trent would like to thank the Lupina Foundation for their support, and is excited for the opportunity to contribute to the foundation’s mission of better understanding the intersection of health, society and technology. He believes that this interdisciplinary perspective is essential to developing healthcare systems that are effective, equitable, and innovative.
Dr. Rotem Paz's work, conducted under the supervision of Professor David Moscovitch and in collaboration with Dr. Brian Levine at the Rotman Research Institute at Baycrest, focuses on the contribution of autobiographical memories to self-schemas and mental health. As a clinical psychologist and neuropsychologist (licensed in Israel) with training in neuroscience, she is deeply interested in how early experiences and autobiographical memories shape the brain, biological processes, personality, self-schemas (i.e., our core beliefs about ourselves) and our subjective experience. Her previous work has focused on investigating neurodegenerative diseases affecting autobiographical memory, as well as developing interventions for mental health disorders.
Autobiographical memories and the self are intertwined, as is tragically evident in Alzheimer’s disease, in which the fading of specific personal memories results in the loss of self-identity. Since autobiographical memories serve important functions like guiding future behaviour, supporting social bonds, and maintaining a coherent sense of self, it is essential to better understand the process of how memories are formed and reconstructed. Dr. Paz's research program seeks to elucidate how individual differences in cognitive profiles influence the encoding, retrieval and recollection of autobiographical memories, and how they contribute to the development and maintenance of self-schemas and real-world behavioural patterns. She further investigates how such differences affect whether individuals become vulnerable to, or can overcome, various mental health challenges, with the ultimate goal of developing new forms of therapy interventions. Her specific focus is on using a person's personal memories to help them modify unhelpful beliefs they hold about themselves.
Dr. Anvita Gopal, Lupina Foundation Postdoctoral Research Fellow, 2023-25
Supervised by: Professor James Dankert, Department of Psychology
Exploring the relation between boredom, social media use, and mental well-being
Dr. Anvita Gopal’s work explores the interplay between boredom proneness, social media usage, social connectedness, and mental well-being. She integrates psychology, social and cognitive sciences to examine how boredom proneness affects our social connections both online and offline and how this in turn may be exacerbated by external factors such as socioeconomic status (SES). The project aims to elucidate how boredom proneness affects social connectedness, both online and in the real world and how this impacts mental well-being.
The work is ongoing with data collection anticipated to be complete by Fall, 2024. Preliminary analyses suggest that undergraduate students spend substantial time on social media and that boredom is a prominent driver of that usage. For those who use social media to form social connections, boredom proneness tends to be low. Data also show that when social media use is driven by boredom, feelings of life satisfaction are diminished.
The data gained from this project informs our understanding of the role played by boredom in how youth interact with social media and how that in turn affects their mental well-being. Ultimately, by understanding boredom’s impact on mental health, interventions could be tailored to mitigate its negative effects.
This work identifies boredom as a potential risk factor for mental well-being particularly as it relates to smartphone and social media use. As such, we could develop targeted interventions where appropriate that would aim to improve public health outcomes associated with mental health disorders. The public will benefit from this knowledge by adopting strategies to manage both boredom and smartphone/social media use adaptively, ultimately to foster stronger social connections.
Reflecting on what drew her to apply for the Lupina postdoc, Dr. Gopal says, “The emphasis on social determinants of health was a key draw for applying to the Lupina fellowship. What attracted me to the Lupina scholarship was the opportunity to contribute to a research program that bridges academic insights with practical applications in public health and policy.”
"The importance of user experience, or UX, has never been greater than in today's tech-driven world. However, a one-size-fits-all design approach just doesn't work, especially in crucial areas like health. For example, exergames—these are video games that also serve as a form of exercise—are often created without considering the opinions of vulnerable groups, such as older adults.
Dr. Reza Hadi Mogavi's research aims to change this by involving various groups of older adults from different geographical regions in the design process. He wants to ensure their voices are heard and that UX is improved. When UX is enhanced, it can attract and retain users in these systems for longer periods.
Emphasizing human-centered design, his research has revealed some new insights. The preliminary study with more than 60 older adults showed that most of them view exergames with positive curiosity. However, some socio-cultural factors can hinder this interest. In this research, it was found that perceptions of aging, lifestyle, support networks, and the cultural relevance of game mechanics are all crucial factors affecting their engagement with exergames.
Dr. Mogavi's is hopeful that these findings contribute significantly to more inclusive design practices, stressing the need for socio-cultural sensitivity and attention to diverse groups in game or even technology design in general. In conclusion, he urges the HCI community to adopt more diverse design practices.
I want to sincerely thank the Lupina Foundation for providing me with this valuable opportunity to work on this research direction, which I am truly passionate about," he says.
Dr. Krystle Shore’s research explores the adoption of innovative electronic health records software in Canadian long-term care (LTC). She is investigating how this software, which uses artificial intelligence and global health indicators to generate patient assessments and care plans, is marketed as a solution to ongoing deficiencies in Canada’s LTC system and whether the technology responds to practical LTC staff needs.
Existing EHR research tends to frame the software as a promising means for improving LTC organizational efficiency. However, research focusing on the promises of innovative healthcare administration technologies tends to ignore important contextual factors that shape how technology is used and experienced. Her work compares how EHR software is marketed with how it is used and perceived of by LTC staff to identify the dominant interests reflected in the technology. Through this work, she will evaluate the broader social context in which innovative, data-driven technologies flourish as a solution to public health challenges.
If identified LTC deficiencies are left unaddressed, they will compound over time as Canada’s population ages. Digital healthcare technologies like integrated EHR software carry a potential to improve LTC though research is needed to substantiate whether this potential translates into practice. Her work aims to address this gap by providing insight into the capacity of ‘smart’ health records technology to assist staff in the delivery of person-centered care to Canada’s aging population.
Dr. Shore's findings can inform internal LTC policy by distinguishing the caregiving tasks that are supported by integrated EHR technology from those that are not. Her findings can also assist industry with the (re)design of healthcare administration technologies so that they better serve the practical needs of frontline care workers. Additionally, she hopes her findings will be of interest to the broader public, as everyone has a vested interest in improving the future of Canadian LTC.
She was drawn to the Lupina Foundation Postdoctoral Fellowship as it supports research at the intersection of health, society, and technology. Importantly, the fellowship champions research connecting healthcare technologies to the perspectives and needs of the people and populations that use them to address pressing healthcare issues in society.
Past Lupina Foundation Postdoctoral Research Fellows
Dr. Derek Albert, Lupina Foundation Postdoctoral Research Fellow, 2022-23
Stereotype Threat: A Potential Contributor to Distraction and Workplace Accidents
Dr. Derek Albert is a cognitive scientist whose program of research under the Lupina Foundation Postdoctoral Research Fellowship examines how mind wandering (i.e., spontaneous, off-task thoughts) resulting from the fear of being penalized, negatively evaluated, or stereotyped may increase the risk of workplace accidents among migrant workers and other at-risk groups.
Dr. Albert explains: “Each year in Canada, more than 200,000 workers are injured in workplace accidents. Migrant workers are disproportionately represented in workplace injuries, and fatalities. Recent evidence suggests that stereotype threat contributes to disparities in workplace accidents. Stereotype threat describes the fear of behaving in ways that confirm a negative stereotype. Understanding the mechanisms by which stereotype threat contributes to workplace accidents may inform the development of interventions targeting this risk factor.”
His research program is comprised of two studies: Study 1 examines whether stereotype threat contributes to workplace accidents by increasing mind wandering in migrant workers; and Study 2 tests whether practices of re-framing or re-appraising mind wandering as normal versus problematic can reduce the effects of stereotype threat. “The results from these studies may inform the development of interventions that target mind wandering as a risk factor for workplace accidents,” says Dr. Albert.
This research program leverages a collaboration between Dr. Daniel Smilek’s Vision and Attention Lab in the Psychology department at UWaterloo and Exo Insights, a Waterloo-based company specializing in the development of virtual-reality applications for training in high-risk workplaces.
“The long-term goal of this collaboration is to create a virtual-reality platform capable of safely studying risk factors, mechanisms, and impacts of mind wandering in the workplace, and supporting the development and administration of evidence-based interventions for mitigating the impact of mind wandering in the workplace,” says Dr. Albert.
Dr. Eugene Kukshinov, Lupina Foundation Postdoctoral Research Fellow, 2022-23
“Well Represented”: The Positive Effect of Avatar Customization (via Presence) On Mental Well-Being in Social VR
With a PhD in media and communication, Dr. Eugene Kukshinov’s research interests include psychology, cognition, presence, immersion, user experience (UX) and virtual reality (VR). His program of research under the Lupina Foundation Postdoctoral Research Fellowship analyzes people’s attitude towards and behavior in social virtual environments during various activities (from educational to entertaining) to evaluate the experiences of being represented and the state of presence in those environments, and their effects on users’ mental well-being.
“Digital environments are mediated spaces that often exclude marginalized groups from being represented in them and often misrepresent these groups,’ says Dr. Kukshinov. “Negative social/cultural effects of mis- and underrepresentation in the digital environments (such as video games or Second Life) are well known among cultural/critical scholars, but embodying an avatar can also impose strong psychological effects on users, and yet, very little is known about the positive effects of avatar customization, specifically on users’ mental well-being and health.”
With the goal to enhancing self-expression, improve mental health and make safer virtual environments, Dr. Kukshinov’s interdisciplinary project is focused on two major objectives: 1) To identify major intersections of social and physical experiences necessary to define and measure (co)presence in Social VR; 2) To explore the intensity and nature of the experiences of being represented in Social VR by people of different identities and positions in power structure.
Dr. Kukshinov is working with Dr. Lennart Nacke (Communication Arts and the Stratford School of Interaction Design and Business) and his HCI Games Group at Waterloo’s Games Institute. Dr. Nacke runs ongoing projects, including the Social VR/Metaverse project, that intersect Dr. Kukshinov’s area of research.
This project will develop methodological and theoretical frameworks based on empirical research of extended and virtual environments. “To better connect with the non-academic communities, I plan to use HCI Games group’s ties with the industrial sector to initiate joint public events with XR/VR organizations and associations, which will hopefully attract attention of the video games and Metaverse producers on issues of media representation and diversity,” says Dr. Kukshinov.
Dr. Effie Pereira, the inaugural Lupina Foundation Postdoctoral Research Fellow, 2021-22
Unpredictable minds and dysfunctional emotions: The link between predictability of unintentional mind wandering and affective dysfunction in everyday life
Most of us experience the world in two different states of mind. In one, we're attentive and focused on what we’re doing, and in the other we wander through our mental landscape. These states of mind wandering occur 30 to 50 per cent of our daily lives says Dr. Effie Pereira. While science has studied states of attention for over a century, mind wandering remains a lot less understood, she adds.
Pereira’s previous research was one of the first to identify that the predictability of mind wandering is a core factor that determines how this state of mind can affect a person for better or worse. As a cognitive scientist and postdoctoral member of Professor Daniel Smilek’s Vision and Attention Lab based in Psychology, Pereira is deepening her study on the link between mind wandering and affective dysfunction — or negative mental health outcomes.
Here, Pereira unpacks her research and the app she’s developing to collect real-world mind wandering data — and why Waterloo and the Lupina fellowship are a good fit for this work:
Could you tell us a bit about mind wandering?
Mind wandering can be considered a state of internal attention, when our thoughts are not tied to our external environment. One way it can occur is intentionally, when we purposely or willingly choose to shift our attention away from our immediate situation to our internal thoughts. But another way it occurs is unintentionally, where this shift happens unexpectedly or involuntarily, similar to the surprising feeling we might have when we’re talking to a friend and we realize we've just lost the last minute of our conversation.
And what is affective dysfunction?
Affective states are used to define a broad range of feelings, thoughts, moods, and emotions that characterize how we’re subjectively experiencing things on a moment-to-moment basis. These can encompass positive affects like happiness and pleasure and excitement, but it can also mean negative affects, such as nervousness, frustration, and fear. So affective dysfunction is a state that occurs when an individual finds themselves temporally stuck in a negative state for either a short period of time or a very long period.
Okay, great. Now please tell us about your Lupina research project.
Past research supports the idea that people who tend to mind wander more tend to experience increased states of affective dysfunction — such as decreased happiness. And recent work from my advisor Dan Smilek’s lab has also found that these negative affective states were specifically associated with unintentional states of mind wandering. So, there are these tight links between these two constructs. And that's where some of my work comes in.
In my PhD work I found that each of us has a very specific style of mind wandering that is either very predictable or unpredictable. And it's this predictable nature of mind wandering — when you have a very cyclical or recurring pattern where you can’t stop your mind from wandering — where we tend to find an association with negative outcomes. In my Lupina postdoc work, I’m exploring this link between the predictability of mind wandering and negative outcomes by focusing on the predictability of intentional versus unintentional mind wandering and how these relate to affective dysfunction.
How does the smartphone app figure into this research?
Within cognitive science, one of the things that we try to keep developing is new and novel ways to examine real world behaviour — because there's really only so much that we can do to simulate this within the laboratory. But there are also ways to bring the laboratory into the real world. And that's what my work at the University of Waterloo is focusing on.
The smartphone app I'm currently developing and programming will be used by study participants who would keep it turned on during everyday activities. The app will message them at random intervals and ask them to document aspects of their mind wandering throughout the day. The notion that everyone carries their smartphone with them allows us to capture this wide and diverse range of behaviours and activities that we wouldn't really be able to test otherwise. And the app users can actually check out what their patterns of attention and mind wandering look like throughout the day. While it’s not meant to be diagnostic, it is a way for individuals to feel more connected to the scientific process they’re participating in.
With its emphasis on the social determinants of health, what attracted you to apply for the Lupina postdoc?
Larger demographic, societal or environmental factors, such as experiences of racism or historical trauma, are all negative determinants of health. So there's a lot more work that needs to be done to determine not just the effect, but also the intersectionality of these determinants and how they contribute to different outcomes. And while I'm a cognitive scientist who is very much focused on brain mechanisms and behaviour, individuals are not independent from their environment, and I think it's vital to understand what these embedded spheres of influence mean, even within a cognitive science framework.
One of the big reasons for joining Waterloo as a postdoctoral researcher is my current advisor, Dan Smilek, who is widely regarded for his expertise in attention and mind wandering. I'm excited to be part of such a creative team within his lab and within the Psychology department as a whole, as part of the next generation of researchers that are unpacking the connection between cognitive states and health outcomes. Waterloo’s research excellence and track record are just very clear – and the perfect place for me to continue my postdoc.
