Yesterday I discussed several systematic biases that are known to influence decision making. Today I want to look at two more – and briefly some thoughts about ‘debiasing’ (if that’s a word!).
Imagining the consequences of a decision is a really influential part of making that decision – cognitive psychologists call this ‘affective forecasting’. What this means is that people imagine how it will feel emotionally if they make a certain choice. While it seems that humans are pretty good at identifying whether they’ll feel good or bad about their choice, what they don’t do so well is estimate how long they’ll feel this way, or how intense that feeling will be. Wilson and Gilbert are researchers who look at this area of decision making, and call this effect ‘impact bias’, identifying seven influences on the accuracy of this bias…misconstrual, framing effects, recall/affective theories, correction for unique influences, expectation effects, actual unique influences, and underestimation of sense-making processes. (Wilson & Gilbert, 2003, cited in Schwab, 2008).
Sense-making processes are ‘the psychological means for making life-events less meaningful over time’. In other words, these are the ways we take the sting out of the end of a relationship, suspect an ulterior motive for an unexpected promotion and so on. Although we all experience changes in emotion, our emotions typically return to a ‘normal for me’ baseline. Wilson and Gilbert identified that people in the midst of making a decision under-estimate how much these ‘sense-making processes’ will affect how they will feel in the future. People focus on how they feel right now about that decision rather than thinking of it in context.
This affects both patients and health care providers. The patients we see make decisions about whether they will engage in treatment based on how they think they will feel about it in the future. In reality they only consider how they will feel about that single decision rather than thinking about the other events that could occur over that period of time, or considering how long or how intense that feeling will be. So, for example, a patient may decline getting into a hydrotherapy pool because of worries about body shape, forgetting that this emotion will probably be quite short-term, and may well be outweighed by other benefits that are experienced over a longer period.
This ‘impact bias’ directly affects treatment expectations, and treatment expectations have been identified as a very powerful indicator of whether treatments will have a good effect. Impact bias can be influenced – Schwab identifies that ‘contingent aspects of previous experience can have surprising effects on memory and future behaviour’. So as treatment providers, we can mitigate negative emotions that could stop someone from agreeing to participate in a therapy by ‘debriefing’ at the end of each session, because this opportunity to reduce the negative emotions directly influences what the person will recall about their treatment the next time they’re asked to consider it.
Framing is the term used to describe the context in which a decision is made. Framing decisions in terms of gains or losses, survival or mortality rates, effectiveness or failures makes a huge impact on which direction a decision-maker will choose.
Different people have different emotional tendencies – aversion to risk, or risk-seeking. What this means is if we are trying to encourage a certain decision, we need to be mindful of the person’s particular style of emotional disposition. For example, some people are very anxious about their health status, and as a result don’t really want to know that they are ‘at risk’. These people might be more motivated to engage in a therapy if they know that it will improve their health rather than ‘reduce the risk of future problems’. Others who are less anxious about their health and more comfortable with risk might be motivated more by having the risks of not engaging in a therapy being fully explained.
There is much more research needed into exactly how to frame choices to engage in therapy or not – there is no way to be ‘neutral’ because information about consequences of a choice must be presented in either a ‘gain’ or a ‘loss’ frame.
I’m running out of time today to look at clinician decision-making – and ‘unbiasing’ or ‘debiasing’! Back tomorrow with the next exciting instalment!
Wilson, T., Gilbert, D. (2003). Affective forecasting. Advances in Experimental Social Psychology, 35, 345-411.
A SCHWAB (2008). Putting cognitive psychology to work: Improving decision-making in the medical encounter Social Science & Medicine DOI: 10.1016/j.socscimed.2008.09.005