Choosing what we like vs liking what we choose: How choice-induced preference change might actually be instrumental to decision-making

For more than 60 years, it has been known that people report higher (lower) subjective values for items after having selected (rejected) them during a choice task. This phenomenon is coined "choice-induced preference change" or CIPC, and its established interpretation is that of "cognitive dissonance" theory. In brief, if people feel uneasy about their choice, they later convince themselves, albeit not always consciously, that the chosen (rejected) item was actually better (worse) than they had originally estimated. While this might make sense from an intuitive psychological standpoint, it is challenging from a theoretical evolutionary perspective. This is because such a cognitive mechanism might yield irrational biases, whose adaptive fitness would be unclear. In this work, we consider an alternative possibility, namely that CIPC is -at least partially- due to the refinement of option value representations that occurs while people are pondering about choice options. For example, contemplating competing possibilities during a choice may highlight aspects of the alternative options that were not considered before. In the context of difficult decisions, this would enable people to reassess option values until they reach a satisfactory level of confidence. This makes CIPC the epiphenomenal outcome of a cognitive process that is instrumental to the decision. Critically, our hypothesis implies novel predictions about how observed CIPC should relate to two specific meta-cognitive processes, namely: choice confidence and subjective certainty regarding pre-choice value judgments. We test these predictions in a behavioral experiment where participants rate the subjective value of food items both before and after choosing between equally valued items; we augment this traditional design with both reports of choice confidence and subjective certainty about value judgments. The results confirm our predictions and provide evidence that many quantitative features of CIPC (in particular: its relationship with metacognitive judgments) may be explained without ever invoking post-choice cognitive dissonance reduction explanation. We then discuss the relevance of our work in the context of the existing debate regarding the putative cognitive mechanisms underlying CIPC.

How do critical care staff respond to organisational challenge? A qualitative exploration into personality types and cognitive processing in critical care

Critical care staff are frequently required to respond to stressful scenarios. The way staff counter organisational challenge may be influenced by their underlying personality type, preferred style of cognitive processing and previous clinical experience. Our objective was to explore the personality types of a sample of critical care workers, and the potential relationship of this with cognitive processing. This was achieved through a qualitative interview study in which participants were presented with difficult but realistic scenarios pertaining to staffing. Data on individual’s personality were captured using the ‘16 Personality Factor’ assessment, a tool that produces scores for 16 different elements of an individual’s personality. The existence of perfectionist and pragmatic cognitive processing styles were identified as one theme emerging from a prior analysis of these interview transcripts. We aimed to validate this, explore our ability to categorise individuals into groups based upon their cognitive processing. We identified that some individuals strongly tended to either a perfectionist or pragmatic style of cognitive processing for the majority of their decisions; however most adapted their style of processing according to the nature of the decision. Overall participants generally demonstrated average scores for all 16 personality factors tested. However, we observed that some factors tended to higher scores than others, indicating a pattern within the personalities of our sample cohort. Whilst a small sample size, our data suggests that individuals working within the same critical care environment may have clear differences in their approach to problem solving as a consequence of both their personality type and preferred style of cognitive processing. Thus there may be individuals within this environment who would benefit from increased support to minimise their risk of cognitive dissonance and stress in times of challenge.

Cognitive dissonance: how self-protective distortions can undermine clinical judgement

CONTEXT

When errors occur in clinical settings, it is important that they are recognised without defensiveness so that prompt corrective action can be taken and learning can occur. Cognitive dissonance - the uncomfortable tension we experience when we hold two or more inconsistent beliefs - can hinder our ability to respond optimally to error.

OBJECTIVES

The aim of this paper is to describe the effects of cognitive dissonance, a construct developed and tested in social psychology. We discuss the circumstances under which dissonance is most likely to occur, provide examples of how it may influence clinical practice, discuss potential remedies and suggest future research to test these remedies in the clinical context.

METHODS

We apply research on cognitive dissonance from social psychology to clinical settings. We examine the factors that make dissonance most likely to occur. We illustrate the power of cognitive dissonance through two medical examples: one from history and one that is ongoing. Finally, we explore moderators at various stages of the dissonance process to identify potential remedies.

RESULTS

We show that there is great opportunity for cognitive dissonance to distort judgements, delay optimal responses and hinder learning in clinical settings. We present a model of the phases of cognitive dissonance, and suggestions for preventing dissonance, reducing the distortions that can arise from dissonance and inhibiting dissonance-induced escalation of commitment.

CONCLUSIONS

Cognitive dissonance has been studied for decades in social psychology but has not had much influence on medical education research. We argue that the construct of cognitive dissonance is very relevant to the clinical context and to medical education. Dissonance has the potential to interfere with learning, to hinder the process of coping effectively with error, and to make the accepting of change difficult. Fortunately, there is the potential to reduce the negative impact of cognitive dissonance in clinical practice.

Perceived barriers to quitting cigarettes among hospitalized smokers with substance use disorders: A mixed methods study

AIMS

Smoking cessation may promote long-term recovery in patients with substance use disorders (SUD). Yet smoking rates remain alarmingly high in this population. Using a sequential explanatory mixed methods approach, we examined smoking rates among hospitalized patients with SUD at a large safety-net hospital, and then characterized factors associated with smoking behaviors both quantitatively and qualitatively.

METHOD

We abstracted data from all hospital admissions (7/2016-6/2017) and determined demographics, substance use type, and other characteristics associated with cigarette use among those with SUD. We then conducted semi-structured qualitative interviews with 20 hospitalized SUD smokers. We analyzed transcripts to characterize factors that affect patients' smoking habits, focusing on the constructs of the Health Belief Model.

RESULTS

The prevalence of cigarette smoking among hospitalized smokers with SUD was three times higher than those without SUD. Qualitative analyses showed that patients perceived that smoking cigarettes was a less serious concern than other substances. Some patients feared that quitting cigarettes could negatively impact their recovery and perceived that clinicians do not prioritize treating tobacco dependence. Almost all patients with heroin use disorder described how cigarette use potentiated their heroin high. Many SUD patients are turning to vaping and e-cigarettes to quit smoking.

CONCLUSION

Hospitalized patients with SUD have disproportionately high smoking rates and perceive multiple barriers to quitting cigarettes. When designing and implementing smoking cessation interventions for hospitalized patients with SUD, policymakers should understand and take into account how patients with SUD perceive smoking-related health risks and how that influences their decision to quit smoking.

The impact of hypocrisy on opinion formation: A dynamic model

Humans have a demonstrated tendency to copy or imitate the behavior and attitude of others and actively influence each other’s opinions. In plenty of empirical contexts, publicly revealed opinions are not necessarily in line with internal opinions, causing complex social influence dynamics. We study to what extent hypocrisy is sustained during opinion formation and how hidden opinions change the convergence to consensus in a group. We build and analyze a modified version of the voter model with hypocrisy in a complete graph with a neutral competition between two alternatives. We compare the process from various initial conditions, varying the proportions between the two opinions in the external (revealed) and internal (hidden) layer. According to our results, hypocrisy always prolongs the time needed for reaching a consensus. In a complete graph, this time span increases linearly with group size. We find that the group-level opinion emerges in two steps: (1) a fast and directional process, during which the number of the two kinds of hypocrites equalizes; and (2) a slower, random drift of opinions. During stage (2), the ratio of opinions in the external layer is approximately equal to the ratio in the internal layer; that is, the hidden opinions do not differ significantly from the revealed ones at the group level. We furthermore find that the initial abundances of opinions, but not the initial prevalence of hypocrisy, predicts the mean consensus time and determines the opinions’ probabilities of winning. These insights highlight the unimportance of hypocrisy in consensus formation under neutral conditions. Our results have important societal implications in relation to hidden voter preferences in polls and improve our understanding of opinion formation in a more realistic setting than that of conventional voter models.

Meta-analytic review of dissonance-based eating disorder prevention programs: Intervention, participant, and facilitator features that predict larger effects

Many trials have provided support for dissonance-based eating disorder prevention programs. This meta-analytic review characterized the average intervention effects and tested whether various intervention, participant, and facilitator features correlated with larger effects to guide implementation of optimally effective versions of this program. We identified 56 trials that evaluated 68 dissonance-based eating disorder prevention programs (7808 participants). Average intervention effect sizes (d) relative to minimal intervention control conditions and credible alternative interventions (respectively) were 0.57 and 0.31 for thin-ideal internalization, 0.42 and 0.18 for body dissatisfaction, 0.37 and 0.17 for dieting, 0.29 and 0.21 for negative affect, and 0.31 and 0.13 for eating disorder symptoms. As hypothesized, effects were larger for interventions with more dissonance-inducing activities, more group sessions, and larger group sizes, as well as when delivered in-person versus on-line, sessions were recorded, participation was voluntary, body dissatisfaction was required, participants were mid-adolescents or adults (versus older adolescence), there were more ethnic minority participants, groups were led by clinicians versus researchers and at least two facilitators, and when facilitators received more training and supervision. Unexpectedly from a dissonance-induction perspective, effects were larger when participants were compensated. Results offer directions for maximizing the benefits of implementation efforts with dissonance-based eating disorder prevention programs, and may hold lessons for preventing other public health problems with dissonance-based interventions.

Gambling-related cognitive distortions mediate the relationship between depression and disordered gambling severity

BACKGROUND AND OBJECTIVES

Symptoms of depression are highly prevalent among individuals with gambling disorder, and severity of depression is associated with severity of gambling problem. Yet, little is known about the psychological mechanisms by which symptoms of depression lead to greater gambling severity. In this study, we tested whether cognitive distortions represent one such mechanism, as cognitive distortions are key characteristics in both depression and gambling disorder and have been shown to be associated with gambling severity.

METHODS

A mediation model was tested among 345 treatment-seeking individuals with gambling disorder in Sao Paulo, Brazil. The diagnosis of gambling disorder was made using semi-structured clinical interviews and participants completed psychometrically sound self-report measures of depression symptoms (Beck Depression Inventory-I), gambling-related cognitive distortions (Gamblers' Beliefs Questionnaire), and gambling severity (Gambling Symptom Assessment Scale).

RESULTS

As hypothesized, increased symptoms of depression were significantly associated with both increased disordered gambling severity and increased gambling-related cognitive distortions. Further, gambling-related cognitive distortions predicted greater disordered gambling severity when controlling for depression symptomology. Results from the bootstrapping method indicated that the relationship between symptoms of depression and increased disordered gambling severity is mediated by gambling-related cognitive distortions.

CONCLUSIONS

Consistent with our predictions, gambling-related cognitive distortions mediated the relationship between depression symptoms and gambling severity among a sample of treatment-seeking disordered gamblers. These results suggest that cognitive distortions may be a key intervention target for the treatment of concurrent depression and gambling disorder.

Randomized trial of a dissonance-based group treatment for eating disorders versus a supportive mindfulness group treatment

OBJECTIVE

This report evaluates a dissonance-based group eating disorder treatment designed to be a cost-effective front-line transdiagnostic treatment that could be more widely implemented than extant treatments that are more intensive and expensive relative to a supportive mindfulness group treatment typical of that offered at colleges.

METHOD

Young women with eating disorders (N = 84) were randomized to 8-week dissonance-based Body Project treatment (BPT) or supportive mindfulness treatment, completing diagnostic interviews and questionnaires at pretest, posttest, and 6-month follow up.

RESULTS

Regarding primary outcomes, by 6-month follow up 77% of BPT participants no longer met diagnosis for an eating disorder versus 60% of supportive mindfulness participants (relative risk ratio = 2.22; 95% CI [1.01, 4.93]), though groups did not differ on eating disorder symptom change. Regarding secondary outcomes, BPT versus supportive mindfulness participants showed significantly lower dissonance about affirming the thin ideal at posttest and 6-month follow up (d = .38 and .32), body dissatisfaction at posttest and 6-month follow up (d = .62 and .62), negative affect at posttest and 6-month follow up (d = .49 and .48), and functional impairment (d = .36) at 6-month follow up; differences in thin-ideal internalization and abstinence from binge eating and compensatory behaviors were not significant.

CONCLUSIONS

Whereas both treatments appeared effective, BPT produced larger effects and significantly greater remission of eating disorder diagnoses than a credible alternative treatment, which is very rare for trials that have compared active eating disorder treatments. Results suggest it would be useful to refine BPT and conduct target engagement research and efficacy trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Reducing Rape-Related Attitudes Utilizing a Cognitive Dissonance Paradigm

This study used a cognitive dissonance mechanism that required college students to write essays dispelling previously endorsed rape myth beliefs. Results indicate that participants in the cognitive dissonance condition reported less rape myth endorsement at a 2-week follow-up than the control group. Effect sizes were large. The cognitive dissonance condition also led to more sustained internal motivation to respond in a nonsexist manner and earlier identification of sexually coercive behavior. Counter-attitudinal advocacy appears to result in sustained decreases in endorsement of rape-supportive attitudes, which could lead to safer communities for women by altering beliefs predictive of sexual assault perpetration.

Dissonance reduction as emotion regulation: Attitude change is related to positive emotions in the induced compliance paradigm

The aim of this study was to clarify how positive and negative emotions are related to the common attitude-change effect in cognitive dissonance research. Drawing on appraisal theories of emotion, and emotion-regulation research, we predicted that negative emotions would be inversely related to attitude change, whereas positive emotions would be positively related to attitude change in the induced compliance paradigm. In two studies, participants (N = 44; N = 106) wrote a counter-attitudinal essay under the perception of high choice, and were later asked to state their emotions in relation to writing this essay, as well as to state their attitude. Results confirmed the predictions, even when controlling for baseline emotions. These findings untangled a previously unresolved issue in dissonance research, which in turn shows how important emotion theories are for the understanding of cognitive dissonance processes.

Observance to antiretroviral treatment in the rural region of the Democratic Republic of Congo: a cognitive dissonance

INTRODUCTION

This study aimed to understand the influence of local media, religion and cultural beliefs on the therapeutic compliance of patients living with HIV.

METHODS

This study was conducted in two rural hospitals in the Central Kongo province of the Democratic Republic of Congo. Semi-directional interviews were conducted with patients on antiretroviral therapy using a phenomenological qualitative method.

RESULTS

Our results indicated that patients living with HIV in the rural region of the Democratic Republic of Congo are in a constant state of tension between the messages for compliance to antiretroviral treatment advocated by caregivers, and those broadcasted by audiovisual media, religious leaders and local beliefs. This dissonance constitutes a real barrier to therapeutic compliance.

CONCLUSION

Collaborative strategies between healthcare providers, patients, as well as religious, media and traditional organizations are urgently needed.

Suggestion of self-(in)coherence modulates cognitive dissonance

While cognitive dissonance is an influential concept of social psychology, its relations with consciousness and episodic memory remain strongly debated. We recently used the free-choice paradigm (FCP) to demonstrate the crucial role of conscious memory of previous choices on choice-induced preference change (CIPC). After choosing between two similarly rated items, subjects reevaluated chosen items as more attractive, and rejected items as less attractive. However such a CIPC was present exclusively for items that were correctly remembered as chosen or rejected during the choice stage, both in healthy controls and in amnesic patients. In the present work, we show that CIPC can be modulated by suggestive quotes promoting self-coherence or self-incoherence. In addition to the crucial role of memory of previous choices, we discovered that memory of the suggestive quotes was correlated to the modulation of CIPC. Taken together these results suggest that CIPC reflects a dynamic homeostatic regulation of self-coherence.

Imagery rescripting and cognitive dissonance: A randomized controlled trial of two brief online interventions for women at risk of developing an eating disorder

OBJECTIVE

This pilot study compared two brief online interventions, imagery rescripting and cognitive dissonance, to an assessment-only control condition in a sample of body-dissatisfied young women at risk of developing an eating disorder. We examined the degree to which each intervention reduced disordered eating and modified risk and protective factors for eating disorders.

METHOD

Female university students (N = 107, 17-28 years of age) completed a screening questionnaire, followed by random allocation to one of the three conditions, followed by a baseline assessment, body dissatisfaction induction, and brief online intervention. Participants in the active conditions then completed online daily home practice and a postintervention questionnaire.

RESULTS

Findings provide qualified support for the imagery rescripting intervention, with participants reporting higher body image acceptance (Cohen's d = 0.49) than the cognitive dissonance condition, and higher self-compassion (d = 0.59) and lower levels of disordered eating (d = 0.59) than the control condition, at postintervention. There was no significant impact of cognitive dissonance on any factors. Change in body image acceptance and self-compassion mediated the relationship between allocated condition and change in disordered eating at postintervention.

DISCUSSION

These findings provide preliminary support for the use of online-adapted imagery-based techniques (e.g., imagery rescripting) to reduce risk for the development of an eating disorder by strengthening protective factors (i.e., body image acceptance and self-compassion) and reducing disordered eating. Further exploration of the use of imagery strategies in the prevention of disordered eating is required, including prospective tests of the mechanisms of action.

[Dissonance in addictology - The missed encounter between Laszlo Levendel and Thomas Szasz]

The starting point for this paper is a consideration of Jozsef Gerevich's seminal study of binarisms and dissonance in the field of drug treatment policies. Gerevich suggests the possibility of a synthesis of conflicting and divergent approaches. The present study focuses on some historical aspects of this polarisation or dichotomy, as it was exemplified in the contrasting life-works of two scholars of addictionology: Laszlo Levendel and Thomas Szasz. Levendel was one of the most important founding fathers of Hungarian drug treatment system, whilst the Hungarian descended Szasz is perhaps the most famous critic and opponent of addictionology. Born at the same time and growing up in the same city, they shared a generational experience of exclusion. Both initially focused on other medical specialties before developing their careers in the field of addiction. Their approach and methods were contradictory and became polarised. On the one hand Levendel practised an eclectic and inclusive "bricolage" approach to alcohol treatment policy, whilst on the other Szasz was committed to a critical and polemical perspective of "destructive creation". After the democratic transformation of Hungary, the two were about to meet, but Levendel's sudden death prevented this from happening. The lesson we should perhaps take from this fact is that "opportunity is fleeting" and should be taken whenever it occurs.

Justification and Indifference: Diverse Permissive Attitudes Toward Witnessed Violence Against the Elderly and Disabled

The violence against the elderly and disabled is widespread. This means that many people who witness acts of violence against elders and the disabled do not react. Instead, they are rather inclined to develop permissive attitudes. The presented article distinguishes two permissive attitudes toward witnessed violence against the elderly and disabled: justification and indifference. The rationale for such differentiation is justified with reference to differences concerning (a) the strength of their relationship, (b) their frequency distribution in the population, and (c) the disparate influence of the underlying predictors. A survey study carried out on a nationwide representative sample of 1,000 adult Poles was the empirical basis for answering research questions. The study showed that domestic violence against elders and the disabled is a noticeable phenomenon in the population of Poland. Around 50% of respondents claimed that they came in touch with physical, economic, or psychological violence against the elderly. More than 30% reported the same in the case of disabled persons. Based on this study, it was found that justification of and indifference to violence were actually unrelated phenomena. Moreover, justification was much less widespread in the population than indifference. It seems easier to accept excuses for passivity in the face of violence than to find justifications for violence. Both permissive attitudes turned out to have a disparate pattern of predictors: Justification turned out to be mainly a function of environmental exposure to violence, whereas indifference was mainly a matter of worldview based on materialism and the imperative of self-interest.

Mechanisms of action during a dissonance-based intervention through 14-month follow-up: The roles of body shame and body surveillance

Objectification theory posits that internalization of societal perspectives about the female body leads to increased body surveillance, which can result in body-related shame and subsequent eating disorder (ED) behaviors. Preliminary research indicates that these associations may be complex in nature. This study examined temporal relations among body surveillance, body shame, and eating disorder symptoms in the context of a dissonance-based body image intervention and through 14-month follow-up. College women (N=285) completed assessments at baseline, post-intervention, and at 8-week, 8-month, and 14-month follow-up. Cross-lag panel analyses revealed that changes in body surveillance significantly mediated the association between body shame and ED symptoms over time. Alternatively, body shame did not change over time and was not a significant mediator of associations between body surveillance and ED symptoms longitudinally. Results indicate that the ameliorative effects of dissonance-based interventions may be due to reductions in body surveillance, rather than decreased body shame.

Clinician-led, peer-led, and internet-delivered dissonance-based eating disorder prevention programs: Acute effectiveness of these delivery modalities

OBJECTIVE

Because independent trials have provided evidence for the efficacy and effectiveness of the dissonance-based Body Project eating disorder prevention program, the present trial tested whether clinicians produce the largest intervention effects, or whether delivery can be task-shifted to less expensive undergraduate peer educators or to Internet delivery without effect size attenuation, focusing on acute effects.

METHOD

In this study, 680 young women (Mage = 22.2 years, SD = 7.1) recruited at colleges in 2 states were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project, or an educational video control condition.

RESULTS

Participants in all 3 variants of the Body Project intervention showed significantly greater reductions in eating disorder risk factors and symptoms than did educational video controls. Participants in clinician-led and peer-led Body Project groups showed significantly greater reductions in risk factors than did eBody Project participants, but effects for the 2 types of groups were similar. Eating disorder onset over 7-month follow-up was significantly lower for peer-led Body Project group participants versus eBody Project participants (2.2% vs. 8.4%) but did not differ significantly between other conditions.

CONCLUSIONS

The evidence that all 3 dissonance-based prevention programs outperformed an educational video condition, that both group-based interventions outperformed the Internet-based intervention in risk factor reductions, and that the peer-led groups showed lower eating disorder onset over follow-up than did the Internet-based intervention is novel. These acute-effects data suggest that both group-based interventions produce superior eating disorder prevention effects than does the Internet-based intervention and that delivery can be task-shifted to peer leaders. (PsycINFO Database Record

Incidental mood state before dissonance induction affects attitude change

The way that incidental affect impacts attitude change brought about by controlled processes has so far been examined when the incidental affective state is generated after dissonance state induction. We therefore investigated attitude change when the incidental mood occurs prior to dissonance state induction. We expected a negative mood to induce systematic processing, and a positive mood to induce heuristic processing. Given that both systematic processing and attitude change are cognitively costly, we expected participants who experienced the dissonance state in a negative mood to have insufficient resources to allocate to attitude change. In our experiment, after mood induction (negative, neutral or positive), participants were divided into low-dissonance and high-dissonance groups. They then wrote a counterattitudinal essay. Analysis of their attitudes towards the essay topic indicated that attitude change did not occur in the negative incidental mood condition. Moreover, written productivity–one indicator of cognitive resource allocation–varied according to the type of incidental mood, and only predicted attitude change in the high-dissonance group. Our results suggest that incidental mood before dissonance induction influences the style of information processing and, by so doing, affects the extent of attitude change.

Doomsday in the Workplace?

If the right leader is not hired, the company is doomed to crumble from the top down, taking good employees with it.

PURLs: "Cold turkey" works best for smoking cessation

Counsel patients who want to quit smoking that doing so abruptly leads to higher cessation rates than does quitting gradually.

Cognitive dissonance resolution depends on episodic memory

The notion that past choices affect preferences is one of the most influential concepts of social psychology since its first report in the 50 s, and its theorization within the cognitive dissonance framework. In the free-choice paradigm (FCP) after choosing between two similarly rated items, subjects reevaluate chosen items as more attractive and rejected items as less attractive. However the relations prevailing between episodic memory and choice-induced preference change (CIPC) remain highly debated: is this phenomenon dependent or independent from memory of past choices? We solve this theoretical debate by demonstrating that CIPC occurs exclusively for items which were correctly remembered as chosen or rejected during the choice stage. We used a combination of fMRI and intra-cranial electrophysiological recordings to reveal a modulation of left hippocampus activity, a hub of episodic memory retrieval, immediately before the occurrence of CIPC during item reevaluation. Finally, we show that contrarily to a previous influential report flawed by a statistical artifact, this phenomenon is absent in amnesic patients for forgotten items. These results demonstrate the dependence of cognitive dissonance on conscious episodic memory. This link between current preferences and previous choices suggests a homeostatic function of this regulative process, aiming at preserving subjective coherence.