Decision making and cognitive psychology

How do we make decisions about treatment? What errors are we likely to make and can we counter those errors?

These are really important questions to ask ourselves as clinicians if we want to avoid leaping into decisions that won’t stand up to scrutiny. Unfortunately it does mean we need to learn a bit about our human fallibility – oh and something about cognitive psychology. And the latter means reading some fairly intense material! Thankfully the paper I’m discussing to day helps to unpack some of the cognitive psychology literature into a form that I can make sense of…

This is a paper by Abraham Schwab, who is based in the Philosophy Department of Brooklyn College. That in itself is interesting – philosophy being about reasoning…
Anyway, he has summarised some of the material that has an influence on how we make decisions in complex situations – and there is no doubt that sifting through the information we collect during an assessment is a complex situation, confounded by the fact that these are real people with problems that will affect their real lives. And emotions surely influence our decisions – think about the effectiveness of advertising if you don’t believe me! (more…)

Count your blessings and focus on the positive

I just had to record this reflection on my last session with a wonderful client who has been struggling with chronic pain, anxiety and not feeling at all confident that she can take action.
I’ve been following a different tack with her from usual, and instead of working hard on modifying thoughts and beliefs, I’ve been using a ‘meta-cognitive’ approach where we’ve been ‘noticing’ her thoughts and feelings – and taking actions in line with her valued goals anyway.

Alongside this awareness of thoughts and emotions without acting on them (or avoiding them), we’ve been working on using mindfulness and full appreciation of the NOW, and identifying the positive in each day.

What I’ve noticed is how much lighter and easier the sessions have been – how much we laugh and how much more positive the talk is. She’s also doing much more and ‘analysing’ much less. In doing more she’s gaining joy and happiness from living in alignment with what’s really important to her (even if I don’t always agree with what she thinks is important!). What I mean by this last comment is that she believes it’s important to help people feel happy by doing things for them, which sometimes contradicts some of her other values which are about enjoying peace, having time out to think, and being independent.

Some useful tools have been the ‘importance’ and ‘confidence’ rulers from the Motivational Interviewing approach, the ‘wise self’ or ‘mini me’ looking from above at thoughts, feelings/sensations and actions, mindfulness meditations, and goal setting and problem solving. The work is much more about taking action, becoming aware of values and actions that are in line with values, noticing the good in a day and planning to make it happen, and allowing thoughts and feelings to simply float by.

The thought struck me that people who we think are brave because they climb really big mountains only become brave by climbing really big mountains. Bravery isn’t about the emotion attached to it, it’s about doing despite the emotion (in fact, bravery is almost entirely about feeling afraid, but doing it anyway!). To become confident and increase self esteem, we need to do things that we are not confident about, so that by achieving we increase our self esteem.